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.

Prevalence of vitamin A deficiency in South Asia: causes, outcomes, and possible remedies.

Vitamin A deficiency (VAD) has been recognized as a public-health issue in developing countries. Economic constraints, sociocultural limitations, insufficient dietary intake, and poor absorption leading to depleted vitamin A stores in the body have been regarded as potential determinants of the prevalence of VAD in South Asian developing countries. VAD is exacerbated by lack of education, poor sanitation, absence of new legislation and enforcement of existing food laws, and week monitoring and surveillance system. Several recent estimates confirmed higher morbidly and mortality rate among children and pregnant and non-pregnant women of childbearing age. Xerophthalmia is the leading cause of preventable childhood blindness with its earliest manifestations as night blindness and Bitot's spots, followed by blinding keratomalacia, all of which are the ocular manifestations of VAD. Children need additional vitamin A because they do not consume enough in their normal diet. There are three general ways for improving vitamin A status: supplementation, fortification, and dietary diversification. These approaches have not solved the problem in South Asian countries to the desired extent because of poor governmental support and supervision of vitamin A supplementation twice a year. An extensive review of the extant literature was carried out, and the data under various sections were identified by using a computerized bibliographic search via PubMed, Web of Science, and Google Scholar. All abstracts and full-text articles were examined, and the most relevant articles were selected for screening and inclusion in this review. Conclusively, high prevalence of VAD in South Asian developing countries leads to increased morbidity and mortality among infants, children, and pregnant women. Therefore, stem efforts are needed to address this issue of public-health significance at local and international level in lower- and middle-income countries of South Asia.

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.

Low folic acid status and its association with anaemia in urban adolescent girls and women of childbearing age in Sri Lanka.

Folic acid deficiency is implicated in the aetiology of nutritional anaemia and adverse pregnancy outcomes for the fetus. Data on folic acid status among adolescent girls and non-pregnant, non-lactating young women are limited. We assessed folic acid status in a random sample of 552 subjects (277 adolescent girls aged 15-18.9 years and 275 women aged 19-30 years) living in Colombo, Sri Lanka. The association of low folic acid status with anaemia was evaluated. Socio-economic, food intake and anthropometric data were obtained. Hb, serum folic acid, vitamin B12 and ferritin and plasma homocysteine concentrations were measured. Forty-three per cent of subjects studied had low serum folic acid concentrations (<3 ng/ml) and 47 % had low Fe stores (serum ferritin <20 microg/l). Overall prevalence of anaemia was 12.9 %, and 43.9 % of anaemic subjects had both low folic acid status and depleted Fe stores (serum ferritin <12 microg/l). Both low folate status and depleted Fe stores were significantly associated with anaemia (odds ratio = 2.32; 95 % CI 1.34, 4.01 and odds ratio = 5.98; 95 % CI 3.36, 10.63, respectively). Serum folic acid concentration was associated (r = 0.108, P = 0.015) with folate intake as indicated by a computed folate index. Folate index was associated inversely with household size and positively with economic status and education level. In this study population low folic acid status, besides depleted Fe stores, was associated with anaemia. The high prevalence of low folic acid status observed highlights the need for nutrition education to improve intakes of folate, Fe and other micronutrients among adolescent girls and young women.

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.

Iron supplementation improves iron status and reduces morbidity in children with or without upper respiratory tract infections: a randomized controlled study in Colombo, Sri Lanka.

BACKGROUND: Iron deficiency anemia and recurrent infections are common among children of low socioeconomic status. OBJECTIVE: The objective was to evaluate the effects of iron supplementation on iron status and morbidity in children with or without infection. DESIGN: Children aged 5-10 y were recruited for a randomized, controlled, double-blind study from outpatients attending the Children's Hospital, Colombo, Sri Lanka. Clinical, inflammatory, nutritional, and iron statuses were determined at baseline and after the intervention. Children with a history of recurrent upper respiratory tract infections (URTIs) and with laboratory and clinical evidence of a current URTI constituted the infection group (n = 179), and children without infection constituted the control group (n = 184). Subjects in both groups were supplemented with ferrous sulfate (60 mg Fe) or placebo once daily for 8 wk. Morbidity from URTIs, the number of gastrointestinal infections, and compliance were recorded every 2 wk. RESULTS: The overall prevalence of anemia was 52.6%. Iron supplementation significantly improved iron status by increasing hemoglobin (P < 0.001) and serum ferritin (P < 0.001) concentrations from baseline values in the children with or without infection. There was no significant improvement in iron status in the children who received placebo. In both the infection group and the control group, the mean number of URTI episodes and the total number of days sick with an URTI during the period of intervention were significantly lower (P < 0.005 and P < 0.001, respectively) in the children who received iron supplements than in those who received placebo. CONCLUSION: Iron supplementation significantly improves iron status and reduces morbidity from URTIs in children with or without infection.

Ferritin concentrations in dried serum spots from capillary and venous blood in children in Sri Lanka: a validation study.

BACKGROUND: Assessing iron status continues to be challenging in field situations. Spot methods developed for analyzing ferritin from serum or plasma samples that are spotted and dried on filter paper have been shown to provide reliable and accurate iron-status assessments. However, the spot methods are based on samples from venous serum or plasma and have not been evaluated in field settings. OBJECTIVE: We evaluated the validity of analyzing ferritin to assess iron status by using venous and capillary dried-serum-spot (DSS) samples by the spot method compared with using serum ferritin by the traditional method in a field setting. DESIGN: Venous and capillary blood was obtained from healthy schoolchildren (n = 100; +/- SD age: 8.9 +/- 0.3 y) in Colombo, Sri Lanka. To prepare DSS samples, we aliquoted precisely 20 microL serum per spot on filter paper, air-dried the spots, and placed them in airtight plastic bags until analysis by the spot ferritin method with the use of cellulase from Trichoderma reesei at 2 wk after collection. Venous serum (100 microL) was frozen until ferritin determination by traditional radioimmunoassay. RESULTS: Venous and capillary DSS ferritin values correlated strongly with traditional serum ferritin values (r = 0.88 and 0.86, respectively; P = 0.0001). The geometric means (+/- 1 SD) for venous and capillary DSS ferritin and traditional ferritin were 26.9 (15.3-47.4), 33.9 (20.9-54.8), and 33.1 (18.6-58.8) microg/L, respectively, and were not significantly different. Venous and capillary DSS methods on average (+/- SD) yielded ferritin values that were 5.8 +/- 10.1 microg/L lower and 0.1 +/- 9.4 microg/L higher, respectively, than serum ferritin values obtained with the traditional method. CONCLUSIONS: Capillary and venous DSS methods for analyzing ferritin provide accurate tools for assessing iron status. Furthermore, capillary DSS ferritin is a practical means of detecting iron deficiency in field settings.