Associations between body composition and cardiovascular disease risk in pre- and postmenopausal women.

BACKGROUND: Menopause transition is a critical phase of women's life since body composition and cardiovascular risk factors begin to change during this period. This study investigated the associations between body composition and cardiovascular disease risk (CVDR) in pre (PrMW) and postmenopausal women (PMW). METHODS: A community-based cross-sectional study involving 184 PrMW and 166 PMW, selected randomly from Bope-Poddala area in Galle, Sri Lanka was carried out. Total-body fat mass (TBFM, kg), total body skeletal muscle mass (TBSMM, kg), total body bone mineral density (TBBMD, g/cm2) and total body bone mineral content (TBBMC, g) were measured with total body DXA scanner and they were taken as indices of body composition. CVDR was evaluated using Framingham risk score (FRS%) and individual CVDR factors, such as systolic blood pressure (SBP, mmHg), diastolic blood pressure (DBP, mmHg), fasting blood sugar (FBS, mg/dl), total cholesterol, (TC, mg/dl), tryglycerides (TG, mg/dl), high-density lipoprotein (HDL, mg/dl) and low-density lipoprotein (LDL, mg/dl). Correlations between indices of body composition and CVDR factors were assessed with adjusted partial correlation (adjusted for socio-demographic and gynecologic status, age, daily calorie consumption and physical activity level). RESULTS: Mean(SD) age of PrMW and PMW were 42.4(6.0) and 55.8(3.8) years respectively. TBFM correlated with SBP and DBP (r range; 0.15 to 0.21) and TBSMM correlated with SBP, DBP and HDL (r range; - 0.24 to 0.17) only in PrMW (p < 0.05). TBBMD correlated only with FBS in PMW (r; - 0.21, p = 0.01). TBBMC did not show correlations with CVDR factors (p > 0.05). Body composition indices did not show correlations with total CVDR estimated by FRS and in both groups of women (p > 0.05). CONCLUSIONS: Both SBP and DBP are associated with FM and SMM in different ways among PrMW. This association, however, was not seen among PMW. FBS is associated with BMD only in PMW.

Age-related trends and reference intervals of cross-linked C-telopeptide of type I collagen and procollagen type I N-propeptide from a reference population of Sri Lankan adult women.

Refer ence values of bone turnover markers (BTMs) are determined by factors that are country-specific. In Sri Lanka, unavailability of BTM reference data has led to their non-use in management of osteoporosis. The results of this study can be used as reference data for women in Sri Lanka. INTRODUCTION: This study was performed to establish age-related reference intervals for bone resorption marker; cross-linked C-telopeptide of type I collagen (CTX) and bone formation marker; procollagen type I N-propeptide (PINP) in a group of Sri Lankan adult women. METHODS: Adult women (n = 347) aged 20-70 years were recruited using age-stratified random sampling technique and categorized into age groups by decades. Serum CTX and PINP concentration were measured using enzyme-linked immunosorbent assay (ELISA). The geometric mean (95% confidence interval) and 2.5th and 97.5th percentiles were calculated. ANOVA was used to compare the means between groups. RESULTS: Mean CTX levels were relatively low and remained unchanged between 20 and 49 years. After the age of 49 years, mean CTXconcentration elevated significantly until the age of 70 years (43%, p < 0.001). Mean PINP concentrations were not significantly different between age categories (p > 0.05). Reference intervals of CTX and PINP were based on 2.5th and 97.5th percentile values. Reference intervals of CTX for the age groups of 20-29, 30-39, 40-49, 50-59, and 60-70 years were 0.19-0.97 ng/mL, 0.18-0.95 ng/mL, 0.20-1.29 ng/mL, 0.17-2.20 ng/mL, and 0.17-2.85 ng/mL respectively. Reference intervals of PINP for the same age groups were 118-810 pg/mL, 119-772 pg/mL, 116-645 pg/mL, 108-684 pg/mL, and 108-715 pg/mL respectively. CONCLUSION: In Sri Lanka, bone turnover markers are not used in evaluating patients mainly due to lack of normative data. These values can be used as reference data for women in this age group.

Quality of Life and Functional Independence of Hip Fracture Patients: Data from a Single Center Follow-Up Study in Sri Lanka.

BACKGROUND: Data on the functional outcomes of hip fracture patients in Sri Lanka are limited. As this information is required for the design of long-term care plans, we assessed the physical activities (activities of daily living [ADL]) and quality of life (QoL) of hip fracture survivors in Sri Lanka. METHODS: A group of 180 consecutive patients with incident hip fractures admitted to a tertiary care center in Southern Sri Lanka were followed up for 12 months. The Sinhala versions of the Barthel Index, 36-Item Short-Form Survey, and Mini-Mental State Examination were used to assess ADL, QoL, and mental status, respectively. RESULTS: Of the 180 patients (149 women), 107 underwent surgery. An initial sharp decline and partial recovery of ADL and QoL were observed among patients with hip fractures. Furthermore, patients who underwent surgical treatment showed faster recovery of ADL and QoL than did patients who were managed conservatively. Similarly, patients who did not have complications during the hospital stay showed faster recovery of ADL and QoL than did patients with one or more complications. Conclusions: Hip fractures profoundly affected both ADL and QoL, and recovery remained incomplete at 12 months post fracture. Patients who underwent surgery had a faster recovery than did patients who did not undergo surgery; similarly, patients without complications also had a faster recovery than did those with complications.

Factors associated with measures of sarcopenia in pre and postmenopausal women.

BACKGROUND: Menopause associated low serum estradiol marks varieties of derangements in muscle mass and functions leading to sarcopenia. This cross-sectional study was carried out to examine the factors associated with measures of sarcopenia; skeletal muscle mass (SMM), muscle strength and physical performance (PP) in a group of premenopausal (PrMW) and postmenopausal women (PMW) selected from Sri Lanka. METHODS: Randomly selected 184 PrMW and 166 PMW from Galle district, Sri Lanka were studied. SMM was measured with duel energy X ray absorptiometry and relative appendicular SMM index (RSMI; kg/m2) was calculated. Other measurements made include handgrip strength (HGS; kg) and gait speed (GS; m/s), anthropometric indices, consumption of macro and micronutrients, and pattern of physical activities (PA). A serum sample was analyzed for fasting insulin, serum estradiol and vitamin D. Variables which significantly correlated with RSMI, HGS and GS of PrMW and PMW were separately entered into multiple linear regression models to extract the associated factors. RESULTS: Mean (SD) age of PrMW and PMW were 42.4 (6.0) and 55.8 (3.8) years respectively. In the regression analysis, RSMI in PrMW showed significant associations with body mass index (BMI), HGS, total-body-fat-mass (TBFM) and weight (adjusted R2 = 0.85) and in PMW with BMI, weight, TBFM, hip-circumference and fasting insulin (adjusted R2 = 0.80). BMI showed the strongest association with RSMI in both PrMW (r = 0.87, R2 = 0.76) and in PMW (r = 0.87, R2 = 0.76). HGS in PrMW showed significant associations with appendicular SMM (ASMM), total-body-bone-mineral-content, vigorous PA score, age and weight (adjusted R2 = 0.33) and in PMW with ASMM and height (adjusted R2 = 0.23). ASMM showed the strongest association with HGS in both PrMW (r = 0.44, R2 = 0.20) and PMW (r = 0.44, R2 = 0.20). GS in PrMW showed significant associations with height, BMI and energy consumption (adjusted R2 = 0.13) while in PMW, with carbohydrate consumption and total-body-bone-mineral-density (adjusted R2 = 0.09). While in PrMW, height showed the strongest association with GS (r = 0.28, R2 = 0.08) in PMW, it was carbohydrate consumption (r = 0.24, R2 = 0.06). CONCLUSIONS: Factors that are associated with different measures of sarcopenia are not uniform and vary widely from anthropometry to nutrient intake indicating that these measures are somewhat independent and are governed by different factors.

Current incidence and future projections of fragility hip fractures in Sri Lanka.

IN SRI LANKA, THE CRUDE AND STANDARDIZED HIP FRACTURE RATES IN 2018 WERE 88.3 AND 115.5 PER 100,000 PERSON-YEARS, RESPECTIVELY. IN 2018, 3824 HIP FRACTURES WOULD HAVE OCCURRED IN THE COUNTRY AND THIS IS LIKELY TO REACH 12,068 IN 2051: PURPOSE: This study was designed to calculate the current crude, standardized, and age- and sex-specific fragility hip fracture incidence in Sri Lanka and hip fracture projection for 2051. Currently such data are not available. METHODS: New fragility hip fractures (resulting from falls from standing height or less) that occurred in the Southern province of Sri Lanka from Sep 2017 to 2018 were collected prospectively by visiting and contacting all health care centers that provide care for fracture patients. Traumatic fractures, old fractures, and fractures among residents outside Southern province were excluded. We calculated current crude, standardized (US standardized population 2000), and age- and sex-specific fragility hip fracture incidence. The number of hip fractures that would occur in 2051 was estimated based on the population projections of the country. RESULTS: There were 554 patients admitted during 1-year period from September 2017 giving crude hip fracture incidence of 88 per 100,000 person-years (95% CI 85-90). The crude hip fracture rates among women and men were 132.2 and 35.3 per 100,000 person-years, respectively. The standardized hip fracture rate was 115.5 per 100,000 person-years. According to the data, 3824 (95% CI 3200-4583) hip fractures would have occurred island-wide during the study period. This number is likely to reach 12,068 (95% CI 10405-13,990) in 2051 when the age-specific population projections are taken into consideration. CONCLUSIONS: Although the observed hip fracture rate was low when compared with other countries, the number of hip fracture would increase from the current 10 per day to around 33 in 2051.

Development and Cross-Validation of Anthropometric Predictive Equations to Estimate Total Body Fat Percentage in Adult Women in Sri Lanka.

Attempts have been made to estimate body fat using anthropometry, and most of them are country-specific. This study was designed to develop and cross-validate anthropometric predictive equations to estimate the total body fat percentage (TBFP) of Sri Lankan adult women. A cross-sectional study was conducted in Galle, Sri Lanka, with two groups: Group A (group for equation development) and Group B (cross-validation group) (n = 175 each) of randomly selected healthy adult women aged 30-60 years. TBFP (%) was quantified with total body DXA (TBFPDXA). Height (m), weight (kg), and skinfold thickness (SFT, mm) at six sites and circumferences (cm) at five sites were measured. In the first step, four anthropometric equations were developed based on the data obtained from multiple regression analyses (TBFPDXA = dependent variable and anthropometric measurements and age = independent variables) with Group A. They were developed on the basis of circumferences (TBFP1), SFTs (TBFP2), circumferences and SFTs (TBFP3), and highly significant circumferences and SFTs (r ≥ 0.6) (TBFP4). In the second step, the newly developed equations were cross-validated using Group B. Three equations (TBFP1, TBFP2, and TBFP4) showed the agreement with cross-validation criteria. There were no differences between TBFPDXA and TBFP estimated by these equations (p > 0.05). They showed higher measurement concordance with TBFPDXA; correlation between measured TBFP with DXA and estimated with TBFP1, TBFP2, and TBFP4, respectively, was 0.80 (R 2 = 0.65, SEE = 3.10), 0.83 (R 2 = 0.69, SEE = 2.93), and 0.84 (R 2 = 0.72, SEE = 2.78). Three anthropometric measurements based on predictive equations were developed and cross-validated to satisfactorily estimate the TBFP in adult women.

Effect of Health-Promoting Lifestyle Modification Education on Knowledge, Attitude, and Quality of Life of Postmenopausal Women.

Limited knowledge and negative attitudes about menopause among postmenopausal women (PMW) create a multitude of health-related issues leading to impaired quality of life (QOL) among them. This study evaluated the impact of a health-promoting lifestyle education intervention (HPLEI) on knowledge, attitude, and QOL in a group of PMW in Sri Lanka. A quasi-experimental study was conducted with 72 PMW, matched for sociodemographic status of the community from two geographically separated areas in Galle, and they were allocated to intervention (n = 37) and control (n = 35) groups. HPLEI is comprised of health education sessions focused on postmenopausal health management with lifestyle modifications provided only for the intervention group for 8 weeks and follow-up for 6 months. The control group was not given any planned education programme and was allowed to proceed with the usual lifestyle during this period. Knowledge, attitude, menopause-specific QOL (MENQOL), and overall QOL were evaluated in both groups with self-administered questionnaires at the baseline, after 8 weeks of education sessions and at the end of 6 months of follow-up. The mean (SD) ages of the intervention and control groups were 54.6 (4.5) and 56.5 (3.4) (p = 0.06) years, respectively. All evaluated variable scores were not different between the intervention and control groups (p > 0.05) at the baseline. In the intervention group, knowledge (mean ± SD; 21.70 ± 1.05) and attitude (mean ± SD; 44.02 ± 5.33) scores increased at the end (p < 0.001). In the control group, a marginal increase in all dimensions of knowledge scores (mean ± SD; 9.71 ± 2.21) and unchanged attitude scores (mean ± SD; 23.91 ± 7.56) were seen. All MENQOL scores decreased during the follow-up in the intervention group (mean ± SD; 138.51 ± 18.47) (p < 0.001) except the sexual domain (p = 0.32). MENQOL scores were increased in the control group (mean ± SD; 92.05 ± 28.87) (p < 0.001) with time. Overall QOL scores increased (mean ± SD; 74.85 ± 9.71) (p < 0.001) in the intervention group during the study period and in the control group overall QOL (mean ± SD; 51.03 ± 13.61) showed a reduction (p < 0.001) at the end. Health education focused on health-promoting lifestyle modifications was effective in improving knowledge, attitude, MENQOL, and overall QOL of PMW.

Factors associated with one-year mortality of patients admitted with fragility hip fracture: a follow-up study in Southern Sri Lanka.

One hundred and eighty patients with incident fragility hip fracture admitted to a tertiary care center in Sri Lanka were followed up for 12 months. When compared with those survived, patients who died were older and had higher comorbidity and physical impairment, before fracture and at discharge from the hospital. INTRODUCTION: This study examined the factors that are associated with mortality within the first 12 months, of patients admitted with fragility hip fracture to a tertiary care center in Southern Sri Lanka. METHODS: One hundred and eighty consecutive patients admitted with new fragility hip fracture were followed up for 12 months post-fracture. Apart from age and gender, information related to physical dependency (prefracture and at discharge) and comorbidity were collected from all subjects. RESULTS: Of 180 patients (149women), 107 had surgery while the rest were managed conservatively. Mean (SD) age of study subjects was 76.5 (9.2 years). Thirty-three patients died within the first 12 months were older and had higher comorbidity and physical impairment before fracture and at discharge from the hospital, when compared with those survived. Relative risk (95% CI, p value) of death for being a male was 6.52 (3.18-11.5, < 0.001) and corresponding values for conservative management were 6.59 (2.86-15.2, < 0.001). In the ROC analysis, in which mortality/survival was taken as state variable, AUCs for age, Charlson index, age-adjusted Charlson index, and Barthel index before fracture and Barthel index at discharge were 0.77 (0.04), 0.79 (0.04), 0.70 (0.05), 0.67 (0.05), and 0.76 (0.04 ) (p < 0.01 for all). Age-adjusted odd ratios (95% CI) of ACCI, CCI, surgical management, and Barthel index before fracture and at discharge were 2.21 (1.37 to 3.57), 2.37 (1.46 to 3.83), 0.18 (0.06 to 0.53), 0.91 (0.85 to 0.97), and 0.93 (0.88 to 0.99), respectively (p < 0.05 for all). CONCLUSIONS: We conclude that advanced age, male gender, higher comorbidity, physical impairment before and after fracture, and conservative management lead to a higher risk of mortality in patients admitted with incident fragility hip fracture. This study can be used as a platform for future research in this area in Sri Lanka.

Applicability of health promoting lifestyle profile-II for postmenopausal women in Sri Lanka; a validation study.

BACKGROUND AND OBJECTIVE: Health Promoting Lifestyle Profile-II (HPLP-II), developed in the West, evaluates 52 health promoting behaviors (HPB) under six subscales. In this study we evaluated the applicability of HPLP-II to assess the HPB of postmenopausal women (PMW) conversant in the Sinhala language in Sri Lanka. METHODS: The Sinhala version of HPLP-II was adapted following standard methodology of cross cultural adaptation. It included forward and backward translations, review by an expert group, focus group discussion and pre-testing. It was self-administered among randomly selected healthy, Sinhalese, community-dwelling PMW (n = 245, aged 55.9 ± 3.4 years), along with the Short Form 36 (SF-36) survey. The Sinhala version of HPLP-II was re-administered among a subsample (n = 105) after two weeks of first administration. Psychometric properties - reliability and validity, were evaluated. RESULTS: In the Sinhala version of HPLP-II, both internal consistency (Cronbach's alpha = 0.98) and test-retest reliability (intra class correlation / ICC = 0.98, 95%CI = 0.97-0.99) were high. Structural validity assessment with Factor analysis using Principal Component Analysis extracted seven factors explaining 80.65% cumulative variance with few exceptions from the original version. Health responsibility (HR) and spiritual growth (SG) subscales of HPLP-II and physical and psychological health dimensions scores of SF-36 scores correlated significantly (r > 0.63, p < 0.001) ensuring strong concurrent validity. CONCLUSIONS: The Sinhala version of HPLP-II adapted by us is a tool with high reliability and validity.

Variation of urinary and serum bone turnover marker reference values among pre and postmenopausal women in Asia: a systematic review.

PURPOSE: Bone turnover markers (BTMs) are not widely used in clinical decision-making partly due to the wide variation of the reference values. This paper describes the geographical variation in BTMs reported from Asian countries. METHOD: A systematic search was conducted using the PubMed, EMBASE, and Ovid. We searched for BTMs or individual BTMs in Asia or different countries in the Asian region. Original research which published BTM values were included while reviews, comments, and meta-analyses were excluded. RESULTS: Of 650 articles, 23 fulfilled the selection criteria and were considered for this study. Among premenopausal women, mean intact OC ranged from 3.35 in Japan to 7.38 ng/mL (55%) in Thailand while it ranged between 3.35 and 5.8 ng/mL (42%) within Japan. Mean BALP varied from 15.9 in India to 41.2 U/L (61%) in Japan whereas in India, it ranged between 15.9 and 53.7 U/L (70%). Mean sP1NP ranged from 29.5 in Japan to 38.02 ng/mL in China (22%) whereas sCTX varied from 0.26 in Thailand to 0.099 ng/mL (62%) in Japan. Among postmenopausal women, mean total OC ranged from 10.02 in India to 29.8 ng/mL (66%) in Japan and intact OC ranged between 2.69 and 9.49 ng/mL (72%) within China. Mean BALP ranged from 20.9 in Japan to 60.28 U/L (65%) in China, and within China, it ranged from 28.2 to 60.28 U/L (53%). Mean sP1NP ranged from 40.11 in China to 56.4 ng/mL (29%) in Japan whereas it ranged within China from 40.11 to 53.76 ng/mL (25%). Mean sCTX varied from 0.25 to 0.433 ng/mL (42%) between the same countries respectively while within China, it varied from 0.25 to 0.395 ng/mL (37%). Urinary BTMs showed a lesser variation. CONCLUSION: A wide inter-country and intra-country variation of serum BTMs was observed among pre and postmenopausal women in Asia. Differences in selection criteria of subjects and those inherited to analytical methods may have contributed to these differences.

Development & cross-validation of anthropometric predictive models to estimate the appendicular skeletal muscle mass in middle-aged women in Sri Lanka.

Background & objectives: Attempts have been made to estimate appendicular skeletal muscle mass (ASMM) using anthropometric indices and most of these are country specific. This study was designed to develop and cross-validate simple predictive models to estimate the ASMM based on anthropometry in a group of healthy middle-aged women in Sri Lanka. Methods: The study was conducted on a randomly selected group of community-dwelling women aged 30-60 years. ASMM (kg) quantified with dual-energy X-ray absorptiometry (DXA) (ASMMDXA) was used as the reference standard. Anthropometric measurements such as body weight (kg), height (m), limb circumferences (cm) and skinfold thickness (mm) which showed significant correlations with ASMMDXA, were used to develop the models. The models were developed using a group of 165 women (aged 30-60 yr) and were cross-validated using a separate sample of women (n=167) (mean age: 48.9±8.56 yr), selected randomly. Results: Nine anthropometry-based models were developed using weight, height, skinfold thicknesses, circumferences, body mass index, menopausal status (MS) and age as independent variables. Four models which were based on height, weight, triceps skinfold thickness (TSFT), age and MS met all the validation criteria with high correlations (ranged 0.89-0.92) and high predictive values explaining high variance (80-84%) with low standard error of estimate (1.10-1.24 kg). Interpretation & conclusions: The four models (ASMM 1-ASMM 4) developed based on height, weight, TSFT, age and MS showed a high accuracy in estimating the ASMM in middle-aged women.

Trabecular bone score and bone mineral density reference data for women aged 20-70 years and the effect of local reference data on the prevalence of postmenopausal osteoporosis: a cross-sectional study from Sri Lanka.

This paper describes age-specific BMD and TBS data of Sri Lankan women aged 20-70 years. No significant change of TBS and BMDs were seen between 20 and 50 years but a rapid decline was seen between 50 and 70 years. Prevalence of osteoporosis showed a marked difference when local reference data were used instead of manufacture provided data. INTRODUCTION: It is recommended that country-specific reference data are used when estimating diagnostic and therapeutic thresholds in osteoporosis. This study estimated normative BMD and TBS reference data for women aged 20-70 in Sri Lanka and the effect of local reference data on the diagnosis of osteoporosis among postmenopausal women. METHODOLOGY: A group of healthy community-dwelling women (n = 355) aged 20-70 was recruited from Galle district in the Southern province in Sri Lanka using stratified random sampling method. They underwent DXA adhering to the manufacturer's protocol and regional BMDs and TBS of the lumbar spine were measured. RESULTS: The highest mean BMD in the spine (0.928 g/cm2) was seen in 20-29 age group while there was a delay in achieving the peak BMD in the femoral neck (0.818 g/cm2) and total hip (0.962 g/cm2) regions(40-49 years). BMDs showed only a mild change between 20 and 49 years but a rapid decline was seen after 50 years (spine 0.013, femoral neck 0.012, and total hip 0.011 g/cm2 per year). The highest TBS was seen in 20-29 age group (1.371) and TBS trend with age was parallel to spine BMD. When the reference data provided by the manufacturer was used, 37% of postmenopausal women were found to have osteoporosis but this value changed to 17.6% when the local reference data were used. CONCLUSION: We found a significant difference in the prevalence of osteoporosis when the local reference values were used instead of data provided by the manufacturer. However, representative data from more centers and fracture data are required before a recommendation to use local instead of international reference data can be stated.

Prevalence and Severity of Menopausal Symptoms and the Quality of Life in Middle-aged Women: A Study from Sri Lanka.

Menopausal symptoms and quality of life (QOL) of pre- and postmenopausal women in Sri Lanka have not been studied adequately. This study aimed to evaluate the prevalence and severity of menopausal symptoms and the QOL of pre- and postmenopausal women in Galle District, Sri Lanka. A cross-sectional study was conducted with a randomly selected sample of premenopausal (n=184) and postmenopausal (n=166) community-dwelling healthy women aged 30-60 years. The mean (SD) ages of pre- and postmenopausal women, respectively, were 46.1(3.7) and 55.8(3.8) years. Menopausal symptoms were evaluated using the menopause rating scale under three subscales: psychological symptoms, somatovegetative symptoms, and urogenital symptoms. The QOL was evaluated using the short form 36 survey under eight domains. Further, sociodemographic status, gynaecologic factors, physical activity pattern (walking, moderate, and vigorous), body mass index, and waist to hip ratio were also evaluated. The prevalence and severity of all the menopausal symptoms were higher among postmenopausal women. In premenopausal women, the most frequently reported menopausal symptoms were mental exhaustion (49.5%), joint and muscular discomforts (48.5%), and irritability (41.3%). Physical and mental exhaustion (53%), irritability (48.2%), depressive mood (43.4%), and hot flushes (42.2%) were the most frequently reported menopausal symptoms in postmenopausal women. The QOL was significantly impaired among postmenopausal women [mean (SD); 57.47(18.83)] compared to premenopausal women [mean (SD); 66.82(17.93)] (p<0.001). Psychological symptoms score and somatovegetative symptoms score were associated with the QOL of premenopausal women (adjusted R2; 0.35). Somatovegetative symptoms score, psychological symptoms score, moderate and vigorous physical activity scores, and monthly income were associated with the QOL in postmenopausal women (adjusted R2; 0.38). The current study showed that the prevalence and severity of menopausal symptoms and impaired QOL were significantly higher among postmenopausal women, compared to premenopausal women. Menopausal symptoms mostly contributed to the poorer QOL in both pre- and postmenopausal women.

Impact of Health-Promoting Lifestyle Education Intervention on Health-Promoting Behaviors and Health Status of Postmenopausal Women: A Quasi-Experimental Study from Sri Lanka.

Health promotion through lifestyle education is an important measure to enhance health status of postmenopausal women (PMW). This study evaluated the effectiveness of health-promoting lifestyle education intervention (HPLEI) on adhering to health-promoting behaviors (HPB) and enhancing the health status in a group of Sri Lankan PMW. A quasi-experimental study was conducted with randomly selected, sociodemographic status matched, 72 PMW from two geographically separated areas in Galle District, Sri Lanka, allocated as experimental (n = 37, 54.6 ± 4.5 years) and control (n = 35, 56.5 ± 3.4 years) groups. Education intervention focused on postmenopausal health management including lifestyle modifications was performed only for the experimental group during 8 weeks, and a health education package was provided. The control group was not given any planned education programme. Both groups were followed up for a 6-month period. HPB and menopausal symptoms severity were evaluated by validated Health Promoting Lifestyle Profile-II and Menopause Rating Scale, respectively. Anthropometric adiposity indices (AAIs) including weight, body mass index (BMI), waist (WC) and hip (HC) circumferences, and waist to hip ratio (WHR); cardiovascular disease risk indicators (CVDRI) including systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood sugar (FBS), total cholesterol and triglycerides, muscle strength; hand grip strength (HGS) and physical performance (PP); gait speed (GS) were measured. All parameters were evaluated before the intervention (baseline) and after follow-up of 6 months. All evaluated parameters were not different between experimental and control groups (p > 0.05) at the baseline. In the follow-up evaluation, HPB (p < 0.001), menopausal symptom scores (p < 0.001), AAI (p < 0.001), CVDRI (SBP, DBP, and FBS) (p < 0.05) and HGS and GS (p < 0.001) were significantly improved in the experimental group but not in the control group. Health education intervention focused on health-promoting lifestyle modifications is effective in improving the adherence to HPB and enhances the health status in PMW. This provides positive impact in lifestyle medicine.

Cross cultural adaptation and analysis of psychometric properties of Sinhala version of Menopause Rating Scale.

BACKGROUND: Menopause Rating Scale (MRS) evaluates eleven menopausal symptoms and health related quality of life (HRQOL) of postmenopausal women under three subscales. In this study we attempted cross cultural adaptation and evaluation of psychometric properties of a Sinhala translation of MRS. METHODS: Sinhala version of MRS was adapted following standard methodology; forward and backward translations, review by an expert group, focus group discussion (FGD) and pre-testing. It was self-administered among randomly selected healthy, Sinhalese, community-dwelling 166 postmenopausal women (aged; median = 56.5, IQR, 53.0-59.0 years) along with the Short Form 36 (SF-36) survey questionnaire. MRS was re-administered among a subsample (n = 80) after two weeks of first administration. Psychometric properties; reliability and validity were evaluated. RESULTS: In Sinhala version of MRS, both internal consistency (Cronbach's alpha coefficient = 0.79) and test retest reliability (intra class correlation / ICC = 0.86, 95%CI = 0.82-0.91, p < 0.001 and Pearson correlation / r = 0.93) were high. Factor analysis (FA) with Principal Component Analysis (PCA) extracted three factors explaining 59.82% cumulative variance with few exceptions from the original version. In the item-subscale correlation analysis items showed stronger correlations within their own subscale score (r range between 0.56-0.84) than with other subscales scores and subscales' scores showed strong correlations with the overall MRS score (r range between 0.70-0.86) indicating strong convergent validity. Mean (SD) symptom severities of each item were significantly different between symptomatic and asymptomatic women (p < 0.05) emphasizing good discriminant validity. The overall MRS and SF-36 scores correlated significantly (Pearson correlation: - 0.52, p < 0.01 and Kendall's tau-b: - 0.39, p < 0.01) ensuring strong criterion validity. CONCLUSIONS: The Sinhala version of MRS we adapted is an informative tool with high reliability and validity and this tool can be used to evaluate the menopausal symptoms and HRQOL in postmenopausal women conversant in Sinhala.

Concordance between appendicular skeletal muscle mass measured with DXA and estimated with mathematical models in middle-aged women.

BACKGROUND: Appendicular skeletal muscle mass (ASMM) is a measure of body muscle content, and it correlates with nutrition and physical status. Estimation of ASMM using anthropometric models is a well-established strategy to overcome issues related to the restricted availability of sophisticated techniques in measuring ASMM. This study aimed to assess the validity of four selected anthropometric models in estimating ASMM in middle-aged women in Sri Lanka. METHODS: A group of women (n = 165) aged 30-60 years underwent a series of anthropometric measurements such as body weight, height, circumferences, and skin fold thickness at specific sites. The limb circumferences were corrected for subcutaneous adipose tissue thickness. Two models developed by Lee et al. (ASM 1, ASM2) and two models developed by Wen et al. (ASM3, ASM4) were validated using ASMM measured by dual energy x-ray absorptiometry (ASMMDXA) as the reference standard. RESULTS: Mean (SD) age of the study group was 49.0 (8.2) years. Mean (SD) ASMMDXA and ASMM estimated by the four models were ASMMDXA = 15.39 (2.75) kg, ASM1 = 18.36 (3.27) kg, ASM2 = 16.46 (3.01) kg, ASM3 = 15.44 (2.40) kg, and ASM4 = 14.44 (2.45) kg. Correlations of ASMMDXA with ASMM estimated by the models were as follows: ASM1, r = 0.68, R2 = 0.46, SEE = 2.02 kg; ASM2, r = 0.90, R2 = 0.81, SEE = 1.18 kg; ASM3, r = 0.90, R2 = 0.81, SEE = 1.17 kg; and ASM4, r = 0.91, R2 = 0.82, SEE = 1.14 kg. ASMM estimated by ASM3 was not significantly different (P > 0.05) from ASMMDXA with mean difference of - 0.05 (range, 0.12 to - 0.23). Bland and Altman plot revealed satisfactory measurement agreements between ASM3 and ASMMDXA. The ASMM estimated by the other three models was significantly different from the ASMMDXA (P < 0.05). CONCLUSION: The ASM3 model introduced by Wen et al. met all validation criteria and can be recommended for the estimation of ASMM in middle-aged women in Sri Lanka.

Socioeconomic status is a predictor of neurocognitive performance of early female adolescents.

OBJECTIVE: Previous studies have shown that high socioeconomic status (SES) is significantly associated with inhibitory control, working memory, verbal comprehension and IQ. However, in the Asian setting, with its prevailing poverty, information about the influence of SES on cognitive development of female adolescents is limited. This study was aimed to investigate the association between SES and neurocognitive performance of early female adolescents in Sri Lanka. METHODS: Female adolescents aged 11-14 years (n = 200) of low and middle SES were studied to assess neurocognitive function. After obtaining baseline data, eight subtests of the Wechsler Intelligence Scale for Children (WISC - IV), Test Of Nonverbal Intelligence (TONI-3) and two computer-based executive function tests (inhibition and visuo-spatial working memory) were administered to assess neurocognitive measures of the above adolescents. The results were compiled into a data base and analyzed using SPSS version 20 statistical software. RESULTS: Higher SES was associated with higher performance in all neurocognitive tests. Low SES adolescents obtained significantly poor test scores for executive function test (inhibitory control: p < 0.0001) and for WISC [verbal comprehension index (VCI): p < 0.0001), working memory index (WMI): p < 0.0001 and estimated full scale IQ (EFSIQ): p < 0.0001)] when compared with middle SES adolescents. Maternal education alone significantly predicts VCI and EFSIQ than the combined influence of parental education, occupation and income. Psychosocial adversities of adolescents were inversely correlated with VCI (r = -0.30; p < 0.001) and EFSIQ (r = -0.20; p < 0.001) of WISC and mathematics performance (r = -0.34; p < 0.001) at examination in school. CONCLUSION: Findings of the study revealed the importance of upliftment of SES of the society to improve the cognitive and academic outcomes of low SES individuals.

Effect of precision on longitudinal follow-up of bone mineral density measurements in elderly women and men.

Precision error of dual-energy X-ray absorptiometry exceeds the expected annual rate of bone loss in the elderly. The capacity to detect changes in areal bone mineral density (aBMD; g/cm(2)) over a 5-yr period was assessed. Six hundred ninety-one women, 75.2 (0.1)yr, from the Malmö OPRA-study, were measured using Lunar DPX-L (GE Lunar, Madison, WI), and 211 men, 74.7 (3.2)yr, from the Malmö Mr Os-study, were measured using Lunar Prodigy (GE Lunar) with follow-up 5 yr later. Precision error was determined with 30 degrees of freedom. Least significant change (LSC, i.e., 2.77 × precision error) was calculated. Women's precision errors (g/cm(2)) for DPX-L were 0.028 (total hip [TH]) and 0.016 (lumbar spine [LS]), and for Prodigy, they were 0.009 (TH) and 0.039 (LS). In men, corresponding results for Prodigy were 0.014 and 0.031. In women, 41% and in men, 39% had aBMD changes exceeding the LSC at TH. Follow-up intervals (i.e., LSC/median rate of aBMD change) for both women and men were 8 yr (TH) and 13 yr (LS). Based on Prodigy precision data, follow-up intervals for women were 3 and 32 yr at TH and LS. In summary, several years were needed to detect change. Only when a high rate of bone loss is suspected, a short follow-up time is possible, in elderly persons.

Effects of multiparity and prolonged breast-feeding on maternal bone mineral density: a community-based cross-sectional study.

BACKGROUND: Studies conducted in Western countries have shown that bone loss associated with pregnancy and breast-feeding is recovered after weaning. However, it is not clear whether recovery takes place after repeated pregnancies followed by prolonged periods of breast-feeding; especially in developing countries where nutritional intake is comparatively low.This study was designed to examine the effects of multiparity and prolonged breast-feeding on maternal bone mineral density (BMD) in a community-based sample of 210 Sri Lankan women, aged between 46 and 98 years. METHODS: BMD of the lumbar spine (L2-L4) and femoral neck were measured by dual-energy X-ray absorptiometry. Reproductive history was recorded by using a questionnaire. Women were, first, divided into groups according to parity (nulliparous, 1-2, 3-4, and 5 or more children), and BMDs in different groups were compared, initially unadjusted and then adjusted for age. Same subjects were subdivided, again, according to the total duration of breast-feeding (0, 1-48, 49-96, and 97 months or more) and similar analysis was carried out. RESULTS: Women who had 5 or more children and women who had breast-fed for 97 months or more were older than the other women (p < 0.01) but no differences in height, weight or BMI were observed among the groups. Age adjusted BMD at lumbar spine and femoral neck BMDs of women grouped according to parity were not significantly different. Neither was there any difference between lumbar spine or femoral neck BMD in groups based on duration of breast-feeding. CONCLUSION: From this population-based study conducted in a developing country, we infer that history of multiparity or prolonged breast-feeding has no detrimental effects on maternal BMD in post-menopausal age.

Bone turnover markers are correlated with total skeletal uptake of 99mTc-methylene diphosphonate (99mTc-MDP).

BACKGROUND: Skeletal uptake of 99mTc labelled methylene diphosphonate (99mTc-MDP) is used for producing images of pathological bone uptake due to its incorporation to the sites of active bone turnover. This study was done to validate bone turnover markers using total skeletal uptake (TSU) of 99mTc-MDP. METHODS: 22 postmenopausal women (52-80 years) volunteered to participate. Scintigraphy was performed by injecting 520 MBq of 99mTc-MDP and taking whole body images after 3 minutes, and 5 hours. TSU was calculated from these two images by taking into account the urinary loss and soft tissue uptake. Bone turnover markers used were bone specific alkaline phosphatase (S-Bone ALP), three different assays for serum osteocalcin (OC), tartrate resistant acid phosphatase 5b (S-TRACP5b), serum C-terminal cross-linked telopeptides of type I collagen (S-CTX-I) and three assays for urinary osteocalcin (U-OC). RESULTS: The median TSU of 99mTc-MDP was 23% of the administered activity. All bone turnover markers were significantly correlated with TSU with r-values from 0.52 (p = 0.013) to 0.90 (p < 0.001). The two resorption markers had numerically higher correlations (S-TRACP5b r = 0.90, S-CTX-I r = 0.80) than the formation markers (S-Total OC r = 0.72, S-Bone ALP r = 0.66), but the difference was not statistically significant. TSU did not correlate with age, weight, body mass index or bone mineral density. CONCLUSION: In conclusion, bone turnover markers are strongly correlated with total skeletal uptake of 99mTc-MDP. There were no significant differences in correlations for bone formation and resorption markers. This should be due to the coupling between formation and resorption.