Prediction Equation for Physical Activity Energy Expenditure in 11-13-Year-Old Sri Lankan Children.

This study aimed to develop a regression equation to predict physical activity energy expenditure (PAEE) using accelerometry. Children aged 11-13 years were recruited and randomly assigned to validation (n = 54) and cross-validation (n = 25) groups. The doubly labelled water (DLW) technique was used to assess energy expenditure and accelerometers were worn by participants across the same period. A preliminary equation was developed using stepwise multiple regression analysis with sex, height, weight, body mass index, fat-free mass, fat mass and counts per minute (CPM) as independent variables. Goodness-of-fit statistics were used to select the best prediction variables. The PRESS (predicted residual error sum of squares) statistical method was used to validate the final prediction equation. The preliminary equation was cross-validated on an independent group and no significant (p > 0.05) difference was observed in the PAEE estimated from the two methods. Independent variables of the final prediction equation (PAEE = [0.001CPM] - 0.112) accounted for 70.6% of the variance. The new equation developed to predict PAEE from accelerometry was found to be valid for use in Sri Lankan children.

Is abdominal adiposity in healthy Sri Lankan neonates different from the rest of the world?

BACKGROUND AND OBJECTIVES: Adiposity at birth is a predictor of childhood obesity. Abdominal circumference (AC) at birth has been shown to correlate well with visceral adipose tissue and abdominal subcutaneous adipose tissue. Adiposity differs according to ethnicity and geography. The aim of this study was to describe the anthropometry derived adiposity phenotype in neonates from Colombo, Sri Lanka and compare it with global data. METHODS AND STUDY DESIGN: Birth anthropometry was performed within 12-24 hours by the same investigator as part of a prospective cohort study on healthy term babies, at a tertiary care hospital in Colombo, Sri Lanka, 2015-2019. The anthropometry derived adiposity phenotype was indicated by skinfold thickness, AC and upper arm fat area (UFA) derived from the mid-upper arm circumference (MUAC). RESULTS: Sri Lankan neonates had a significantly lower weight with significantly higher AC (n=337, 2.9±0.4 kg, 30.6±2.3 cm) compared to Canadian (n=389, 3.5±0.02 kg, 29.9±2.1 cm; p<0.001) and Australian (n=1270, 3.4±0.4 kg, 28.5±1.9 cm; p<0.001) neonates. Anthropometry derived adiposity at birth showed a significant correlation with weight and BMI of both mother and father (p<0.05) as opposed to their income or education (p>0.05). CONCLUSIONS: Healthy neonates from Colombo, Sri Lanka demonstrated significantly higher AC despite significantly lower weight, indicating increased abdominal adiposity compared to neonates from high-income countries as well as Indian neonates with the thin-fat phenotype.

Development of a New Equation for the Prediction of Resting Metabolic Rate in Sri Lankan Adults.

Resting metabolic rate (RMR) is the key determinant of the energy requirement of an individual. Measurement of RMR by indirect calorimetry is not feasible in field settings and therefore equation-based calculations are used. Since a valid equation is not available for Sri Lankans, it is important to develop a new population-specific equation for field use. The study objective was to develop a new equation for the prediction of RMR in healthy Sri Lankans using a reference method, indirect calorimetry. RMR data were collected from fifty-seven (male 27) adults aged 19 to 60 years. They were randomly assigned to validation (n = 28) and cross-validation (n = 19) groups using the statistical package R (version 3.6.3). Height, weight, and RMR were measured. Multivariable fractional polynomials (MFP) were used to determine explanatory variables and their functional forms for the model. A variable shrinkage method was used to find the best fit predictor coefficients of the equation. The developed equation was cross-validated on an independent group. Weight and sex code (male = 1; female = 0) were identified as reliable independent variables. The new equation developed was RMR (kcal/day) = 284.5 + (13.2 x weight) + (133.0 x sex code). Independent variables of the prediction equation were able to predict 88.5% of the variance. Root mean square error (RMSE) of the prediction equation in validation and cross-validation was 88.11 kcal/day and 79.03 kcal/day, respectively. The equation developed in this study is suitable for predicting RMR in Sri Lankan adults.

Micronutrient status and associated factors of adiposity in primary school children with normal and high body fat in Colombo municipal area, Sri Lanka.

BACKGROUND: The prevalence of obesity and associated risk of chronic diseases are increasing among the paediatric population. The effectiveness of preventive measures and interventions are likely to improve when all factors which associate with obesity in a specific target group are considered. Currently such comprehensive data is unavailable for Sri Lankan children aged 8-9 years. METHODS: This paper pertains to the data collected from August-2015 to November-2016 for a case-control study which included cases (high body fat) (N = 160; males-81) and controls (normal body fat) (N = 164; males-80) recruited from primary schools in the Colombo Municipal area. Anthropometry and body composition (Bioelectrical impedance analysis-BIA) were measured. Diet, physical activity and socio-demographic data were collected using validated interviewer administered questionnaires. Serum concentrations of vitamins A, D [25(OH)D], E, folate (serum and red blood cell-RBC), zinc (Zn), selenium (Se), copper (Cu), iron (Fe), magnesium (Mg), calcium (Ca), chromium (Cr), manganese (Mn), cobalt (Co), ferritin, leptin and high sensitivity C-reactive protein (hs-CRP) were assessed using fasting blood samples. RESULTS: Cases were from higher socio-economic strata and spent significantly less time on physical activities, more time on sedentary behaviours and consumed higher energy compared to the controls. Cases from both genders had significantly lower levels of vitamin D [25 (OH)D], Fe and Mg (all p < 0.05) and higher levels of Cu and Ca (all p < 0.01) compared to controls. Higher levels of ferritin and Cr were seen among male (p < 0.001) and female (p > 0.05) cases compared to the controls. However, total serum folate levels were lower in male (p < 0.01) and female (p > 0.05) cases while the RBC folate levels were higher among male (p < 0.01) and female (p > 0.05) cases compared with controls. Vitamins A, E, Se, Mn and Co (p > 0.05) were not significantly different between groups. The inflammatory markers, both hs-CRP and leptin levels were higher among cases (p < 0.001) compared to the controls. CONCLUSIONS: This study highlights higher socio-economic status, lower physical activity, more sedentary behaviours, higher energy intake and inconsistent distribution of micronutrients among the children with high body fat when compared with the control group. Increased levels of inflammatory markers indicate the presence of the risk of chronic inflammation in children with high body fat.

Birth anthropometry from a tertiary care hospital in Sri Lanka: Differs from the WHO growth standards.

BACKGROUND AND OBJECTIVES: The nutritional status of infants is assessed using the WHO growth references, based on the Multicenter Growth Reference Study (MGRS) in many countries including Sri Lanka. Birth parameters define infant growth curves. The aim of this study was to compare the birth anthropometric data of a healthy population of babies born in Colombo, Sri Lanka with the WHO MGRS birth data and determine its suitability for assessment of growth in this population. METHODS AND STUDY DESIGN: Birth data were obtained as part of a study on longitudinal infant body composition from birth to 2 years from 2015-2019. Healthy babies, born to non-smoking mothers, >18 years old, with a singleton pregnancy at term, living in the study area and intending to breastfeed, were recruited. The Ethical Review Committee of the Faculty of Medicine, University of Colombo, approved the study. RESULTS: Compared to WHO data, the mean birth weight (2.9±0.4 kg), length (48.2±2.7 cm) and head circumference (33.6±1.2 cm) of our study population (n=337) was significantly lower with a left shift in the z score distribution. This was despite similar background characteristics except for significantly lower income (USD 200) and lower maternal (154.2±9.0 cm) and paternal height (165±11.6 cm) in our study population. A significant change in birth parameters was only seen with maternal height when disaggregated. CONCLUSIONS: WHO birth parameters were significantly higher and underestimated the growth of healthy babies in Sri Lanka.

Effect of coconut oil on cardio-metabolic risk: A systematic review and meta-analysis of interventional studies.

BACKGROUND AND AIMS: High total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) could be major risk factors for cardiovascular disease burden among high risk populations especially in South Asians. This systematic review and meta-analysis aimed to quantify the effects of coconut oil compared with other oils and fats on cardio-metabolic parameters. METHODS: PubMed, Scopus and Web of Science were systematically searched. The main outcomes included are lipid and glycemic parameters. Subgroup analyses were performed to evaluate individual comparisons of vegetable oils and animal fat with coconut oil. Data were pooled using random-effects meta-analysis. RESULTS: Coconut oil consumption significantly increased TC by 15.42 mg/dL (95% CI, 8.96-21.88, p < 0.001), LDL-C by 10.14 mg/dL (95% CI, 4.44-15.84, p < 0.001) and high density lipoprorein cholesterol (HDL-C) by 2.61 mg/dL (95% CI, 0.95-4.26, p = 0.002), and significantly decreased glycosylated hemoglobin (HbA1c) by 0.39 mg/dL (95% CI, -0.50 to -0.27, p < 0.001) but, it had no effects on triglycerides (TG), (4.25 mg/dL; 95% CI, -0.49-8.99, p = 0.08) when compared with the control group. Sub-group analysis demonstrated that coconut oil significantly increased TC and LDL-C over corn, palm, soybean and safflower oils and not over olive oil. Compared with butter, coconut oil showed a better pattern in cardio-metabolic markers by significantly increasing HDL-C (4.38 mg/dL, 95% CI, 0.40 to 8.36, p = 0.03) and decreasing LDL-C (-14.90 mg/dL, 95% CI, -23.02 to-6.77, p < 0.001). CONCLUSIONS: Our results suggest that coconut oil consumption results in significantly higher TC, LDL-C and HDL-C than other oils. Consumption of coconut oil can be one of the risk factors for CVDs in South Asians.

Reducing childhood malnutrition in Bangladesh: the importance of addressing socio-economic inequalities.

OBJECTIVE: To obtain projections of the prevalence of childhood malnutrition indicators up to 2030 and to analyse the changes of wealth-based inequality in malnutrition indicators and the degree of contribution of socio-economic determinants to the inequities in malnutrition indicators in Bangladesh. Additionally, to identify the risk factors of childhood malnutrition. DESIGN: Cross-sectional study. A Bayesian linear regression model was used to estimate trends and projections of malnutrition. For equity analysis, slope index, relative index and decomposition in concentration index were used. Multilevel logistic models were used to identify risk factors of malnutrition. SETTING: Household surveys in Bangladesh from 1996 to 2014. PARTICIPANTS: Children under the age of 5 years. RESULTS: A decreasing trend was observed for all malnutrition indices. In 1990, predicted prevalence of stunting, wasting and underweight was 55·0, 15·9 and 61·8 %, respectively. By 2030, prevalence is projected to reduce to 28·8 % for stunting, 12·3 % for wasting and 17·4 % for underweight. Prevalence of stunting, wasting and underweight were 34·3, 6·9 and 32·8 percentage points lower in the richest households than the poorest households. Contribution of the wealth index to child malnutrition increased over time and the largest contribution of pro-poor inequity was explained by wealth index. Being an underweight mother, parents with a lower level of education and poorer households were the key risk factors for stunting and underweight. CONCLUSIONS: Our findings show an evidence-based need for targeted interventions to improve education and household income-generating activities among poor households to reduce inequalities and reduce the burden of child malnutrition in Bangladesh.

A field tool for prediction of body fat in Sri Lankan women: skinfold thickness equation.

BACKGROUND: Valid skinfold thickness (SFT) equations for the prediction of body fat are currently unavailable for South Asian women and would be a potentially robust field tool. Our aim was to assess the validity of existing SFT equations against deuterium (2H2O) dilution and, if invalid, to develop and validate an SFT equation for % fat mass (%FM) in Sri Lankan women. METHODS: H2O dilution was used with Fourier transform infrared (FTIR) spectroscopy as the criterion method for the assessment of %FM in urban Sri Lankan women (30-45 years). This data was used to assess the validity of available SFT equations and to generate and validate a new SFT equation for the prediction of %FM against the criterion method. Women (n = 164) were divided into validation and cross-validation groups for the development and validation of the new equation. The level of agreement between the %FM calculated by the final derived prediction equation and the %FM obtained by 2H2O dilution was assessed using Pearson's correlation coefficient (R) and Bland Altman plots. Student's t test was used to assess over- or underestimation, and significance was set at p < 0.05. RESULTS: Existing equations significantly (p < 0.001) underestimated %FM compared with the 2H2O dilution method. The final equation obtained was %FM = 19.621 + (0.237*weight) + (0.259*triceps). When compared with 2H2O dilution, %FM by the equation was not significantly different. There was a significant (p < 0.001) correlation between %FM by the reference method and %FM by the equation. The limit of agreement by Bland Altman plot was narrow with a small mean positive bias. CONCLUSIONS: Existing SFT equations were not applicable to this population. The new equation derived was valid. We report a new SFT equation to predict %FM in women of South Asian ancestry suitable for field use.

Lifestyle patterns and dysglycaemic risk in urban Sri Lankan women.

Specific dietary patterns are associated with the risk of chronic disease. An in-depth understanding more reflective of lifestyle would be possible when assessing the synergistic effects of both diet and physical activity in pattern analysis. In the present study, we examined the biochemical markers of dysglycaemia and cardiometabolic risk in relation to lifestyle patterns using principal component analysis (PCA). Urban women (n 2800) aged 30-45 years were screened for dysglycaemia using cluster sampling from the Colombo Municipal Council area. All the 272 dysglycaemic women detected through screening and 345 randomly selected normoglycaemic women were enrolled. The International Physical Activity Questionnaire and a quantitative FFQ were used to assess physical activity and diet, respectively. Anthropometric measurements, bioelectrical impedance analysis and biochemical estimations were carried out. Lifestyle patterns were identified based on dietary and physical activity data using exploratory factor analysis. PCA was used for the extraction of factors. A total of three lifestyle patterns were identified. Women who were predominantly physically inactive and consumed snacks and dairy products had the greatest cardiometabolic risk, with a higher likelihood of having unfavourable obesity indices (increased waist circumference, fat mass percentage and BMI and decreased fat-free mass percentage), glycaemic indices (increased glycosylated Hb (HbA1c) and fasting blood sugar concentrations) and lipid profile (increased total cholesterol/TAG and decreased HDL-cholesterol concentrations) and increased high-sensitivity C-reactive protein concentrations. For the first time, we report lifestyle patterns and demonstrate the synergistic effects of physical activity/inactivity and diet and their relative association with cardiometabolic risk in urban women. Lifestyle pattern analysis greatly increases our understanding of high-risk behaviours occurring within real-life complexities.

Body composition in urban South Asian women; development of a bioelectrical impedance analysis prediction equation.

BACKGROUND: Assessment of body composition plays a significant role in combating chronic disease among South Asians. Accurate assessment of body composition by bioelectrical impedance analysis (BIA) requires population-specific equations which are currently unavailable for urban South Asian women. AIM: To assess validity of direct BIA assessment and selected equations for prediction of total body water (TBW), against Deuterium ((2)H2O) dilution and develop and validate a population-specific TBW equation for urban South Asian women. SUBJECTS AND METHOD: Data of 80 urban Sri Lankan women (30-45 years) were used for this analysis. Body composition was assessed by (2)H2O dilution (reference) and BIA. Available BIA equations were assessed for validity. A new TBW equation was generated and validated. RESULTS: Direct BIA measurements and other equations did not meet validation criteria in predicting TBW. TBW by the new equation (TBW = 3.443 + 0.342 × (height(2)/impedance) + 0.176 × weight) correlated (p < 0.001) with TBW by reference method. TBW using the new equation was not significantly different (25.30 ± 2.4 kg) from the reference (25.32 ± 2.7 kg). CONCLUSION: Direct use of TBW by instrument and existing equations are less suitable for this population. The new TBW equation is suitable for body composition assessment in urban South Asian women.

Sedentary behaviour and physical activity in South Asian women: time to review current recommendations?

OBJECTIVE: Our aims were to describe activity and sedentary behaviours in urban Asian women, with dysglycaemia (diagnosed at recruitment), and without dysglycaemia and examine the relative contribution of these parameters to their glycaemic status. METHODS: 2800 urban women (30-45 years) were selected by random cluster sampling and screened for dysglycaemia for a final sample of 272 newly diagnosed, drug naive dysglycaemic and 345 normoglycaemic women. Physical activity and sedentary behaviours were assessed by the International Physical Activity Questionnaire (IPAQ). Demographic data, diet and anthropometry were recorded. Logistic regression analysis assessed contribution of all parameters to dysglycaemia and exposure attributable fractions were calculated. RESULTS: The mean energy expenditure on walking (2648.5±1023.7 MET-min/week) and on moderate and vigorous physical activity (4342.3±1768.1 MET-min/week) for normoglycemic women and dysglycaemic women (walking;1046.4±728.4 MET-min/week, moderate and vigorous physical activity; 1086.7±1184.4 MET-min/week) was above the recommended amount of physical activity per week. 94.3% of women spent >1000 MET-minutes/week on activity. Mean sitting and TV time for normoglycaemic and dysglycaemic women were 154.3±62.8, 38.4±31.9, 312.6±116.7 and 140.2±56.5 minutes per day respectively. Physical activity and sedentary behaviour contributed to dysglycaemia after adjustment for family history, diet, systolic blood pressure and Body Mass Index. Exposure attributable fractions for dysglycaemia were; lower physical activity: 78%, higher waist circumference: 94%, and TV viewing time: 85%. CONCLUSIONS: Urban South Asian women are at risk of dysglycaemia at lower levels of sedentary behaviour and greater physical activity than western populations, indicating the need for re-visiting current physical activity guidelines for South Asians.

Body fat assessment in Sri Lankan adolescent girls; development of a simple field tool.

BACKGROUND: Development of accurate, simple measures of body fat is essential in developing countries due to the rising prevalence of overweight and obesity. Application of skin-fold thickness (SFT) to body fat prediction equations is an inexpensive method suitable for field settings. AIM: To determine percentage fat mass (%FM) of Sri Lankan adolescent girls using Fourier Transform Infrared spectrometry (FTIR) as a reference method and develop a SFT-prediction equation to estimate %FM. METHODS: Weight, height and SFT were measured and %FM determined by FTIR in 131 adolescent, post-menarcheal girls (15-19 years). SFT-measurements were applied to available body composition equations for validation in the population. A new equation for %FM was derived and validated. RESULTS: Mean %FM (FTIR) was 19.13 ± 8.2.Selected body composition prediction equations over-estimated %FM. The multiple regression procedure yielded a final equation consisting of two anthropometric and one demographic variable, % FM = 9.701 - (0.460)* age+(0.640)*TricepsSFT+(0.583)*Supra-iliacSFT. CONCLUSIONS: Existing SFT prediction-equations are unsuitable for predicting %FM in this population. The new equation utilizing one peripheral and one truncal skin-fold, is appropriate for prediction of %FM in this population and may be applicable to other South Asian/Asian-Indian adolescents following validation.

Dietary supplement intake in national-level Sri Lankan athletes.

Intake of dietary supplements is widespread among athletes in developed countries. This study evaluated the use of dietary supplements in athletes from a developing country. Dietary supplementation practices of 113 national-level athletes age 15-35 yr in Sri Lanka were assessed. All athletes from track-and-field, badminton, football, swimming, cycling, and karate squads who consented to participate in the study were administered an anonymous questionnaire by an interviewer. Information on number of supplements taken, frequency of use, nature of product, rationale, sources of advice, and reasons for taking supplements was obtained. Most athletes (94%) consumed dietary supplements. On average, 3.7 products/day were consumed. Footballers had significantly lower intake of supplements than other athletes (footballers 71%, others 98%; p < .05). They also consumed fewer products per day (footballers 0.7, others 3.5; p < .05). Popular supplements included multivitamins, vitamin E, calcium, energy foods and drinks, and creatine. Multiple supplement use was common, with 29% athletes taking 4 products/day. The athletes sought advice on supplement use from sports doctors (45%), team coaches (40%), or friends (15%). Most took supplements to improve performance (79%), and 19% claimed to take supplements to improve their overall health status. Dietary supplement use is widespread among national-level Sri Lankan athletes. The ad hoc use of supplements indicates that educational intervention in the sporting community is essential.

Nutrition education improves serum retinol concentration among adolescent school girls.

Dietary diversification has been identified as a sustainable intervention method in developing countries where subclinical vitamin A deficiency exists. Nutrition education is central to all methods of nutrition intervention including dietary diversification. The paucity of available data currently limits the effective use of nutrition education in national programs in Sri Lanka. We assessed the effect of nutrition education on nutrition related knowledge, food consumption patterns and serum retinol concentrations among 229 adolescent school girls, aged between 15-19 years. Knowledge on nutrition, food consumption patterns and serum retinol concentration was assessed at baseline. Intervention included nutrition education as lecture discussions, interactive group discussions and four different methods of reinforcement. Knowledge, food consumption patterns and serum retinol concentrations were reassessed after a ten week period of intervention. Educational intervention resulted in a significant increase in knowledge (P < 0.001) and consumption of local vitamin A rich foods. The percentage of subjects with low serum retinol concentrations (<20 microg/dL) decreased from 17% to 4.8%. The effect of nutrition education on serum retinol concentration was highly significant (P<0.001) in subjects with baseline serum retinol concentrations below 20 microg/L. Nutrition education was effective in improving knowledge and food consumption patterns among these girls. Effectiveness was of biological significance, as a positive change in serum retinol concentration was observed in subjects with initially low concentrations, and not in subjects with initially normal serum concentrations.