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2.
Nat Genet ; 51(3): 452-469, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30778226

RESUMO

Body-fat distribution is a risk factor for adverse cardiovascular health consequences. We analyzed the association of body-fat distribution, assessed by waist-to-hip ratio adjusted for body mass index, with 228,985 predicted coding and splice site variants available on exome arrays in up to 344,369 individuals from five major ancestries (discovery) and 132,177 European-ancestry individuals (validation). We identified 15 common (minor allele frequency, MAF ≥5%) and nine low-frequency or rare (MAF <5%) coding novel variants. Pathway/gene set enrichment analyses identified lipid particle, adiponectin, abnormal white adipose tissue physiology and bone development and morphology as important contributors to fat distribution, while cross-trait associations highlight cardiometabolic traits. In functional follow-up analyses, specifically in Drosophila RNAi-knockdowns, we observed a significant increase in the total body triglyceride levels for two genes (DNAH10 and PLXND1). We implicate novel genes in fat distribution, stressing the importance of interrogating low-frequency and protein-coding variants.


Assuntos
Predisposição Genética para Doença/genética , Variação Genética/genética , Homeostase/genética , Lipídeos/genética , Proteínas/genética , Animais , Distribuição da Gordura Corporal/métodos , Índice de Massa Corporal , Estudos de Casos e Controles , Drosophila/genética , Exoma/genética , Feminino , Frequência do Gene/genética , Estudo de Associação Genômica Ampla/métodos , Humanos , Masculino , Fatores de Risco , Relação Cintura-Quadril/métodos
4.
Nat Genet ; 50(5): 766-767, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29549330

RESUMO

In the version of this article originally published, one of the two authors with the name Wei Zhao was omitted from the author list and the affiliations for both authors were assigned to the single Wei Zhao in the author list. In addition, the ORCID for Wei Zhao (Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA) was incorrectly assigned to author Wei Zhou. The errors have been corrected in the HTML and PDF versions of the article.

5.
Nat Genet ; 50(1): 26-41, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29273807

RESUMO

Genome-wide association studies (GWAS) have identified >250 loci for body mass index (BMI), implicating pathways related to neuronal biology. Most GWAS loci represent clusters of common, noncoding variants from which pinpointing causal genes remains challenging. Here we combined data from 718,734 individuals to discover rare and low-frequency (minor allele frequency (MAF) < 5%) coding variants associated with BMI. We identified 14 coding variants in 13 genes, of which 8 variants were in genes (ZBTB7B, ACHE, RAPGEF3, RAB21, ZFHX3, ENTPD6, ZFR2 and ZNF169) newly implicated in human obesity, 2 variants were in genes (MC4R and KSR2) previously observed to be mutated in extreme obesity and 2 variants were in GIPR. The effect sizes of rare variants are ~10 times larger than those of common variants, with the largest effect observed in carriers of an MC4R mutation introducing a stop codon (p.Tyr35Ter, MAF = 0.01%), who weighed ~7 kg more than non-carriers. Pathway analyses based on the variants associated with BMI confirm enrichment of neuronal genes and provide new evidence for adipocyte and energy expenditure biology, widening the potential of genetically supported therapeutic targets in obesity.

6.
Environ Health Perspect ; 125(5): 057007, 2017 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-28599268

RESUMO

BACKGROUND: Millions of coastal inhabitants in Southeast Asia have been experiencing increasing sodium concentrations in their drinking-water sources, likely partially due to climate change. High (dietary) sodium intake has convincingly been proven to increase risk of hypertension; it remains unknown, however, whether consumption of sodium in drinking water could have similar effects on health. OBJECTIVES: We present the results of a cohort study in which we assessed the effects of drinking-water sodium (DWS) on blood pressure (BP) in coastal populations in Bangladesh. METHODS: DWS, BP, and information on personal, lifestyle, and environmental factors were collected from 581 participants. We used generalized linear latent and mixed methods to model the effects of DWS on BP and assessed the associations between changes in DWS and BP when participants experienced changing sodium levels in water, switched from "conventional" ponds or tube wells to alternatives [managed aquifer recharge (MAR) and rainwater harvesting] that aimed to reduce sodium levels, or experienced a combination of these changes. RESULTS: DWS concentrations were highly associated with BP after adjustments for confounding factors. Furthermore, for each 100 mg/L reduction in sodium in drinking water, systolic/diastolic BP was lower on average by 0.95/0.57 mmHg, and odds of hypertension were lower by 14%. However, MAR did not consistently lower sodium levels. CONCLUSIONS: DWS is an important source of daily sodium intake in salinity-affected areas and is a risk factor for hypertension. Considering the likely increasing trend in coastal salinity, prompt action is required. Because MAR showed variable effects, alternative technologies for providing reliable, safe, low-sodium fresh water should be developed alongside improvements in MAR and evaluated in "real-life" salinity-affected settings. https://doi.org/10.1289/EHP659.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Água Potável/química , Hipertensão/epidemiologia , Salinidade , Sódio/análise , Abastecimento de Água , Adulto , Bangladesh/epidemiologia , Mudança Climática , Estudos de Coortes , Feminino , Água Subterrânea/química , Humanos , Pessoa de Meia-Idade
7.
Nature ; 542(7640): 186-190, 2017 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-28146470

RESUMO

Height is a highly heritable, classic polygenic trait with approximately 700 common associated variants identified through genome-wide association studies so far. Here, we report 83 height-associated coding variants with lower minor-allele frequencies (in the range of 0.1-4.8%) and effects of up to 2 centimetres per allele (such as those in IHH, STC2, AR and CRISPLD2), greater than ten times the average effect of common variants. In functional follow-up studies, rare height-increasing alleles of STC2 (giving an increase of 1-2 centimetres per allele) compromised proteolytic inhibition of PAPP-A and increased cleavage of IGFBP-4 in vitro, resulting in higher bioavailability of insulin-like growth factors. These 83 height-associated variants overlap genes that are mutated in monogenic growth disorders and highlight new biological candidates (such as ADAMTS3, IL11RA and NOX4) and pathways (such as proteoglycan and glycosaminoglycan synthesis) involved in growth. Our results demonstrate that sufficiently large sample sizes can uncover rare and low-frequency variants of moderate-to-large effect associated with polygenic human phenotypes, and that these variants implicate relevant genes and pathways.


Assuntos
Estatura/genética , Frequência do Gene/genética , Variação Genética/genética , Proteínas ADAMTS/genética , Adulto , Alelos , Moléculas de Adesão Celular/genética , Feminino , Genoma Humano/genética , Glicoproteínas/genética , Glicoproteínas/metabolismo , Glicosaminoglicanos/biossíntese , Proteínas Hedgehog/genética , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/genética , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Fatores Reguladores de Interferon/genética , Subunidade alfa de Receptor de Interleucina-11/genética , Masculino , Herança Multifatorial/genética , NADPH Oxidase 4 , NADPH Oxidases/genética , Fenótipo , Proteína Plasmática A Associada à Gravidez/metabolismo , Pró-Colágeno N-Endopeptidase/genética , Proteoglicanas/biossíntese , Proteólise , Receptores Androgênicos/genética , Somatomedinas/metabolismo
8.
Glob Heart ; 11(1): 27-36, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27102020

RESUMO

BACKGROUND: Currently available tools for assessing high cardiovascular risk (HCR) often require measurements not available in resource-limited settings in low- and middle-income countries (LMIC). There is a need to assess HCR using a pragmatic evidence-based approach. OBJECTIVES: This study sought to report the prevalence of HCR in 10 LMIC areas in Africa, Asia, and South America and to investigate the profiles and correlates of HCR. METHODS: Cross-sectional analysis using data from the National Heart, Lung, and Blood Institute-UnitedHealth Group Centers of Excellence. HCR was defined as history of heart disease/heart attack, history of stroke, older age (≥50 years for men and ≥60 for women) with history of diabetes, or older age with systolic blood pressure ≥160 mm Hg. Prevalence estimates were standardized to the World Health Organization's World Standard Population. RESULTS: A total of 37,067 subjects ages ≥35 years were included; 53.7% were women and mean age was 53.5 ± 12.1 years. The overall age-standardized prevalence of HCR was 15.4% (95% confidence interval: 15.0% to 15.7%), ranging from 8.3% (India, Bangalore) to 23.4% (Bangladesh). Among men, the prevalence was 1.7% for the younger age group (35 to 49 years) and 29.1% for the older group (≥50); among women, 3.8% for the younger group (35 to 59 years) and 40.7% for the older group (≥60). Among the older group, measured systolic blood pressure ≥160 mm Hg (with or without other conditions) was the most common criterion for having HCR, followed by diabetes. The proportion of having met more than 1 criterion was nearly 20%. Age, education, and body mass index were significantly associated with HCR. Cross-site differences existed and were attenuated after adjusting for age, sex, education, smoking, and body mass index. CONCLUSIONS: The prevalence of HCR in 10 LMIC areas was generally high. This study provides a starting point to define targeted populations that may benefit from interventions combining both primary and secondary prevention strategies.


Assuntos
Países em Desenvolvimento , Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Infarto do Miocárdio/epidemiologia , Fumar/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , África/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Ásia/epidemiologia , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Escolaridade , Feminino , Cardiopatias/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Risco , Fatores de Risco , Fatores Sexuais , América do Sul/epidemiologia , Organização Mundial da Saúde
9.
Science ; 351(6278): 1166-71, 2016 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-26965621

RESUMO

Scavenger receptor BI (SR-BI) is the major receptor for high-density lipoprotein (HDL) cholesterol (HDL-C). In humans, high amounts of HDL-C in plasma are associated with a lower risk of coronary heart disease (CHD). Mice that have depleted Scarb1 (SR-BI knockout mice) have markedly elevated HDL-C levels but, paradoxically, increased atherosclerosis. The impact of SR-BI on HDL metabolism and CHD risk in humans remains unclear. Through targeted sequencing of coding regions of lipid-modifying genes in 328 individuals with extremely high plasma HDL-C levels, we identified a homozygote for a loss-of-function variant, in which leucine replaces proline 376 (P376L), in SCARB1, the gene encoding SR-BI. The P376L variant impairs posttranslational processing of SR-BI and abrogates selective HDL cholesterol uptake in transfected cells, in hepatocyte-like cells derived from induced pluripotent stem cells from the homozygous subject, and in mice. Large population-based studies revealed that subjects who are heterozygous carriers of the P376L variant have significantly increased levels of plasma HDL-C. P376L carriers have a profound HDL-related phenotype and an increased risk of CHD (odds ratio = 1.79, which is statistically significant).


Assuntos
HDL-Colesterol/sangue , Doença das Coronárias/sangue , Doença das Coronárias/genética , Receptores Depuradores Classe B/genética , Idoso , Substituição de Aminoácidos , Animais , Análise Mutacional de DNA , Feminino , Variação Genética , Heterozigoto , Homozigoto , Humanos , Leucina/genética , Masculino , Camundongos , Pessoa de Meia-Idade , Prolina/genética , Processamento de Proteína Pós-Traducional , Risco , Receptores Depuradores Classe B/metabolismo
10.
BMC Obes ; 3: 19, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27004127

RESUMO

BACKGROUND: Type 2 diabetes and pre-diabetes are an increasing pandemic globally and often remain undiagnosed long after onset in low-income settings. The objective of this study is to assess the determinants and prevalence of undiagnosed diabetes and pre-diabetes among adults in Bangladesh. METHODS: In an exploratory study, we performed oral glucose tolerance test on 1243 adults ≥20 years of age from urban Mirpur, Dhaka (n = 518) and rural Matlab, Chandpur (n = 725) who had never been diagnosed with diabetes or pre-diabetes. We collected data on socioeconomic, demographic, past medical history, physical activity, and measured weight, height, waist and hip circumferences, and blood pressure. Risk factors associated with undiagnosed diabetes and pre-diabetes were examined using a multiple logistic regression model. RESULTS: Overall prevalence of diabetes and pre-diabetes was 6.6 % (95 % CI 5.3, 8.1) and 16.6 % (14.5, 18.7) respectively, with both being significantly higher in urban than rural populations (diabetes 12.2 % vs 2.6 % respectively, p < 0.000; pre-diabetes 21.2 % vs 13.2 %, p < 0.001). After adjustment the variables, urban residence (OR 2.5 [95 % CI 1.02, 5.9]), age group 40-59 y (2.9 [1.7-5.2]), ≥60 y (8.1 [2.8-23.8]), overweight (2.2 [1.3-3.9]), abdominal obesity (3.3 [1.8-6.0]) and high WHR 5.6 (2.7-11.9) were all significant predictors of diabetes. Significant predictors of pre-diabetes included age group 40-59 (1.6 [1.1-2.2]), female sex (1.5 [1.0-2.2]), abdominal obesity (1.7 [1.2-2.4]) and high WHR (1.6 [1.2-2.3]). CONCLUSION: Both overweight and abdominal obesity contribute to the hidden public health threat of undiagnosed diabetes and pre-diabetes. Awareness raising and screening of high risk groups combined with a tailored approach are essential for halting the epidemic of diabetes and pre-diabetes in Bangladesh.

11.
Conf Proc IEEE Eng Med Biol Soc ; 2016: 5283-5285, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-28325020

RESUMO

Socioeconomic status (SES) is a risk factor for cardiovascular disease (CVD) and either low or high heart rate variability (HRV) at rest has been shown to predict cardiovascular morbidity and mortality. The study investigated the extent HRV features can predict SES. Four hundred and twenty eight people were randomly selected from the commercial districts (high SES) and slum areas (low SES) within Dhaka city. Demographic, clinical, and HRV features were recorded. Of the clinical variables age, waist circumference and diastolic blood pressure (p<;0.01) were significantly different. HRV feature extraction from heart rate recordings were analyzed using Kubios software. Age corrected results showed that high frequency power (Median (IQR): 112.1 (85.6) ms2 vs. 96.8 (97.6) ms2, p=0.02) and the correlation dimension (0.78 (0.82) vs. 0.51 (1.20), p<;0.0002) were significantly lower in the low SES group, whilst the high frequency peak was significantly higher (0.1500 (0.0004) Hz vs. 0.1503 (0.0066) Hz, p<;0.0001). Our results show that although the high SES group had a more sedentary behavior, the low SES group had a higher risk of cardiac arrhythmia even though they were generally younger with normal blood pressure and waist circumference.


Assuntos
Frequência Cardíaca/fisiologia , Adulto , Fatores Etários , Arritmias Cardíacas/epidemiologia , Bangladesh/epidemiologia , Pressão Sanguínea/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Áreas de Pobreza , Comportamento Sedentário , Classe Social , Circunferência da Cintura/fisiologia , Adulto Jovem
12.
COPD ; 12(6): 658-67, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26263031

RESUMO

RATIONALE: There is a paucity of population-based data on COPD prevalence and its determinants in Bangladesh. OBJECTIVE: To measure COPD prevalence and socioeconomic and lifestyle determinants among ≥40 years Bangladeshi adults. METHODS: In a cross-sectional study, we measured lung function of 3744 randomly selected adults ≥40 years from rural and urban areas in Bangladesh, using a handheld spirometer. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria as post-bronchodilator ratio of Forced Expiratory Volume in 1st second (FEV1) to Forced Vital Capacity (FVC) < 0.7. In addition, COPD was also assessed by the lower limit of normal (LLN) threshold defined as lower fifth percentile for the predicted FEV1/FVC. RESULTS: The prevalence of COPD was 13.5% by GOLD criteria and 10.3% by LLN criteria. Prevalence of COPD was higher among rural than urban residents and in males than females. More than half of the COPD cases were stage II COPD by both criteria. Milder cases (Stages I and II) were over estimated by the GOLD fixed criteria, but more severe cases (Stages III and IV) were similarly classified. In multiple logistic regression analysis, older age, male sex, illiteracy, underweight, history of smoking (both current and former), history of asthma and solid fuel use were significant predictors of COPD. CONCLUSION: COPD is a highly prevalent and grossly underdiagnosed public health problem in Bangladeshi adults aged 40 years or older. Illiteracy, smoking and biomass fuel burning are modifiable determinants of COPD.


Assuntos
Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Idoso , Bangladesh/epidemiologia , Índice de Massa Corporal , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Fatores de Risco , Fumar , Fatores Socioeconômicos , Espirometria
13.
Eur J Epidemiol ; 30(7): 577-87, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25930055

RESUMO

During recent decades, Bangladesh has experienced a rapid epidemiological transition from communicable to non-communicable diseases. Coronary heart disease (CHD), with myocardial infarction (MI) as its main manifestation, is a major cause of death in the country. However, there is limited reliable evidence about its determinants in this population. The Bangladesh Risk of Acute Vascular Events (BRAVE) study is an epidemiological bioresource established to examine environmental, genetic, lifestyle and biochemical determinants of CHD among the Bangladeshi population. By early 2015, the ongoing BRAVE study had recruited over 5000 confirmed first-ever MI cases, and over 5000 controls "frequency-matched" by age and sex. For each participant, information has been recorded on demographic factors, lifestyle, socioeconomic, clinical, and anthropometric characteristics. A 12-lead electrocardiogram has been recorded. Biological samples have been collected and stored, including extracted DNA, plasma, serum and whole blood. Additionally, for the 3000 cases and 3000 controls initially recruited, genotyping has been done using the CardioMetabochip+ and the Exome+ arrays. The mean age (standard deviation) of MI cases is 53 (10) years, with 88 % of cases being male and 46 % aged 50 years or younger. The median interval between reported onset of symptoms and hospital admission is 5 h. Initial analyses indicate that Bangladeshis are genetically distinct from major non-South Asian ethnicities, as well as distinct from other South Asian ethnicities. The BRAVE study is well-placed to serve as a powerful resource to investigate current and future hypotheses relating to environmental, biochemical and genetic causes of CHD in an important but under-studied South Asian population.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Doença das Coronárias/genética , Adulto , Idoso , Bangladesh , Estudos de Casos e Controles , Doença da Artéria Coronariana/etnologia , Doença da Artéria Coronariana/genética , Doença das Coronárias/etnologia , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Risco , Fatores de Risco
14.
Diabetes Metab Syndr ; 9(1): 7-13, 2015 Jan-Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25450814

RESUMO

AIMS: To investigate the clinical features of patients with type 2 diabetes on oral medication and determine the complications and risk factors in these patients. METHODS: A cross-sectional was conducted among 515 patients with type 2 diabetes at the outpatient clinics of Bangladesh Institute of Health Science (BIHS) hospital from September to December 2013. We collected data on socio-economic characteristics, clinical status, risk factors, complications, anthropometric measurements and blood tests. Univariate and multivariate logistic regression was performed to identify risk factors associated with diabetes complications. RESULTS: The mean(±SD) age of the participants was 50.0(±10.1) years and 15.3% were less than 40 years. The mean HbA1c was 8.3(±2.1). Only 28.7% of the participants achieved targets for HbA1c. The overall prevalence of hypertension, obesity and dyslipidemia was 57.5%, 62.6% and 72.7%, respectively. Eye problems were the most common complication (68.9%) followed by chronic kidney diseases (21.3%) and cardiovascular diseases (11.8%). There were significant associations between the complications and age, duration of diabetes and duration of hypertension. In the multivariate analysis adjusting for other confounding variables, only systolic blood pressure was found to be significantly associated with complications [OR 0.809, 95% CI 0.666-0.981 (p-value 0.031)]. CONCLUSION: Results of the study confirm that even under best clinical settings a great majority Bangladeshi adults with type 2 diabetes have uncontrolled diabetes and a high prevalence of risk factors that might contribute to early development of complications. Early screening of high risk groups and proper management of diabetes is recommended to avoid early complications.


Assuntos
Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Dislipidemias/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , População Urbana/estatística & dados numéricos , Adulto , Bangladesh/epidemiologia , Biomarcadores/sangue , Estudos Transversais , Complicações do Diabetes/sangue , Complicações do Diabetes/fisiopatologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Nefropatias Diabéticas/epidemiologia , Retinopatia Diabética/epidemiologia , Dislipidemias/sangue , Feminino , Hemoglobina A Glicada/metabolismo , Hospitais Urbanos/estatística & dados numéricos , Humanos , Hipertensão/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Prevalência , Medição de Risco , Fatores de Risco , Fatores de Tempo
15.
Pediatrics ; 134(4): e1001-8, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25266433

RESUMO

OBJECTIVE: We aimed to determine the timing and size of the cognitive deficit associated with poverty in the first 5 years of life and to examine the role of parental characteristics, pre- and postnatal growth, and stimulation in the home in Bangladeshi children. We hypothesized that the effect of poverty on cognition begins in infancy and is mainly mediated by these factors. METHODS: We enrolled 2853 singletons, a subsample from a pregnancy supplementation trial in a poor rural area. We assessed mental development at 7, 18, and 64 months; anthropometry at birth, 12, 24, and 64 months; home stimulation at 18 and 64 months; and family's socioeconomic background. In multiple regression analyses, we examined the effect of poverty at birth on IQ at 64 months and the extent that other factors mediated the effect. RESULTS: A mean cognitive deficit of 0.2 (95% confidence interval -0.4 to -0.02) z scores between the first and fifth wealth quintiles was apparent at 7 months and increased to 1.2 (95% confidence interval -1.3 to -1.0) z scores of IQ by 64 months. Parental education, pre- and postnatal growth in length, and home stimulation mediated 86% of the effects of poverty on IQ and had independent effects. Growth in the first 2 years had larger effects than later growth. Home stimulation had effects throughout the period. CONCLUSIONS: Effects of poverty on children's cognition are mostly mediated through parental education, birth size, growth in the first 24 months, and home stimulation in the first 5 years.


Assuntos
Desenvolvimento Infantil , Transtornos Cognitivos/economia , Transtornos Cognitivos/epidemiologia , Pobreza/economia , Pobreza/tendências , Adulto , Antropometria/métodos , Bangladesh/epidemiologia , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Transtornos Cognitivos/psicologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Lactente , Estudos Longitudinais , Masculino , Pobreza/psicologia , Gravidez , Fatores Socioeconômicos , Adulto Jovem
16.
BMC Public Health ; 14: 547, 2014 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-24888580

RESUMO

BACKGROUND: Non-communicable diseases are a threat to human health and economic development of low-income countries. Hypertension (HT) and chronic obstructive pulmonary disease (COPD) are two major causes of deaths, worldwide. This study assesses the health status, health-care seeking, and health provider responses among patients with these conditions. METHODS: The study carried out population-based cross-sectional survey in a rural and an urban surveillance area in Bangladesh. It interviewed all patients identified with HT and COPD at home using a structured questionnaire on the health consequences, healthcare-seeking behaviours, and coping strategies. Qualitative techniques identified key factors relating to the behaviours of patients and providers. RESULTS: COPD and HT correlate with lower activities of daily living (ADL) scores. The odds ratio (OR) for ADL scores in the combied conditions are high (OR: 3.04, p < 0.05) as compared to hypertension. Financial crises occur significantly more frequently among COPD patients in the urban site as compared to those in rural ares (12.5% vs. 2.4%, p < 0.01). Self-treatment at the onset is common. Seeking care from trained providers is higher in urban settings and is higher for HT. Referral for both COPD and hypertension was inadequate until the disease severity increased. CONCLUSIONS: COPD and HT significantly are associated with lower ADL scores and financial problems. Public-sector primary healthcare facilities should be better organised to address both conditions with the aim to reduce household poverty.


Assuntos
Disparidades em Assistência à Saúde , Hipertensão/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Bangladesh/epidemiologia , Estudos Transversais , Feminino , Humanos , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Áreas de Pobreza , Doença Pulmonar Obstrutiva Crônica/terapia , População Rural , Inquéritos e Questionários
17.
Global Health ; 10: 9, 2014 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-24555767

RESUMO

BACKGROUND: The burden of chronic kidney disease (CKD) will rise in parallel with the growing prevalence of type two diabetes mellitus in South Asia but is understudied. Using a cross-sectional survey of adults living in a middle-income neighborhood of Dhaka, Bangladesh, we tested the hypothesis that the prevalence of CKD in this group would approach that of the U.S. and would be strongly associated with insulin resistance. METHODS: We enrolled 402 eligible adults (>30 years old) after performing a multi-stage random selection procedure. We administered a questionnaire, and collected fasting serum samples and urine samples. We used the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation to estimate glomerular filtration rate, and sex-specific cut offs for albuminuria: > 1.9 mg/mmol (17 mg/g) for men, and >2.8 mg/mmol (25 mg/g) for women. We assessed health-related quality of life using the Medical Outcomes Study Short Form-12 (SF-12). RESULTS: A total of 357 (89%) participants with serum samples comprised the analytic cohort. Mean age of was 49.5 (± 12.7) years. Chronic kidney disease was evident in 94 (26%). Of the participants with CKD, 58 (62%) had albuminuria only. A participant with insulin resistance had a 3.6-fold increase in odds of CKD (95% confidence interval 2.1 to 6.4). Participants with stage three or more advanced CKD reported a decrement in the Physical Health Composite score of the SF-12, compared with participants without CKD. CONCLUSION: We found an alarmingly high prevalence of CKD--particularly CKD associated with insulin resistance-in middle-income, urban Bangladeshis.


Assuntos
Insuficiência Renal Crônica/epidemiologia , Saúde da População Urbana/estatística & dados numéricos , Adulto , Bangladesh/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos
18.
BMC Public Health ; 14: 70, 2014 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-24450958

RESUMO

BACKGROUND: Obesity and overweight in children and adolescents is an emerging public health concern alongside under-nutrition in low and middle income countries. Our aim was to conduct a scoping review of literature to ascertain what is known about childhood and adolescent overweight and/or obesity in Bangladesh. METHOD: Using the scoping review based on York methodology, a comprehensive search of published academic articles, conference proceedings and grey literature was carried out through PubMed, BanglaJOL, Google and Google scholar limited to English-written papers. We summarized prevalence, risk factors and health outcomes of obesity/overweight in young children and adolescents aged between 0 to 19 years old in Bangladesh and highlighted use of different reference standards to measure childhood obesity. RESULTS: In total 21 studies met the inclusion criteria. Nearly all of the reviewed articles used data from cross sectional studies, while only two used case-control design. Overall thirteen studies (62%) were primary research and eight (38%) included secondary data. Studies indicated an increasing trend in childhood obesity over time. Prevalence ranged from less than 1% to 17.9% based on different reference standards, with higher percentage amongst urban children across different age groups and sexes. CONCLUSION: This review demonstrated paucity of comprehensive literature on childhood obesity in Bangladesh, which might be explored through population-based prospective studies based on strong methodology and uniform reference standards. Sustainable and scalable preventative measures targeting high risk groups are required to avoid further rise.


Assuntos
Sobrepeso/epidemiologia , Obesidade Pediátrica/epidemiologia , Adolescente , Bangladesh/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Prevalência
19.
Bull World Health Organ ; 91(10): 757-64, 2013 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-24115799

RESUMO

OBJECTIVE: To directly estimate how much smoking contributes to cause-specific mortality in Bangladesh. METHODS: A case-control study was conducted with surveillance data from Matlab, a rural subdistrict. Cases (n = 2213) and controls (n = 261) were men aged 25 to 69 years who had died between 2003 and 2010 from smoking-related and non-smoking-related causes, respectively. Cause-specific odds ratios (ORs) were calculated for "ever-smokers" versus "never-smokers", with adjustment for education, tobacco chewing status and age. Smoking-attributable deaths among cases, national attributable fractions and cumulative probability of surviving from 25 to 69 years of age among ever-smokers and never-smokers were also calculated. FINDINGS: The fraction of ever-smokers was about 84% among cases and 73% among controls (OR: 1.7; 99% confidence interval, CI: 1.1-2.5). ORs were highest for cancers and lower for respiratory, vascular and other diseases. A dose-response relationship was noted between age at smoking initiation and daily number of cigarettes or bidis smoked and the risk of death. Among 25-year-old Bangladeshi men, 32% of ever-smokers will die before reaching 70 years of age, compared with 19% of never-smokers. In 2010, about 25% of all deaths observed in Bangladeshi men aged 25 to 69 years (i.e. 42,000 deaths) were attributable to smoking. CONCLUSION: Smoking causes about 25% of all deaths in Bangladeshi men aged 25 to 69 years and an average loss of seven years of life per smoker. Without a substantial increase in smoking cessation rates, which are low among Bangladeshi men, smoking-attributable deaths in Bangladesh are likely to increase.


Assuntos
Fumar/mortalidade , Adulto , Idoso , Bangladesh/epidemiologia , Causas de Morte/tendências , Intervalos de Confiança , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Vigilância da População , Estudos Retrospectivos
20.
Int J Epidemiol ; 42(4): 1077-86, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24062297

RESUMO

BACKGROUND: Arsenic exposure via drinking water increases the risk of chronic respiratory disease in adults. However, information on pulmonary health effects in children after early life exposure is limited. METHODS: This population-based cohort study set in rural Matlab, Bangladesh, assessed lung function and respiratory symptoms of 650 children aged 7-17 years. Children with in utero and early life arsenic exposure were compared with children exposed to less than 10 µg/l in utero and throughout childhood. Because most children drank the same water as their mother had drunk during pregnancy, we could not assess only in utero or only childhood exposure. RESULTS: Children exposed in utero to more than 500 µg/l of arsenic were more than eight times more likely to report wheezing when not having a cold [odds ratio (OR) = 8.41, 95% confidence interval (CI): 1.66-42.6, P < 0.01] and more than three times more likely to report shortness of breath when walking on level ground (OR = 3.86, 95% CI: 1.09-13.7, P = 0.02) and when walking fast or climbing (OR = 3.19, 95% CI: 1.22-8.32, P < 0.01]. However, there was little evidence of reduced lung function in either exposure category. CONCLUSIONS: Children with high in utero and early life arsenic exposure had marked increases in several chronic respiratory symptoms, which could be due to in utero exposure or to early life exposure, or to both. Our findings suggest that arsenic in water has early pulmonary effects and that respiratory symptoms are a better marker of early life arsenic toxicity than changes in lung function measured by spirometry.


Assuntos
Arsênico/toxicidade , Água Potável/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Transtornos Respiratórios/induzido quimicamente , Poluentes Químicos da Água/toxicidade , Adolescente , Bangladesh/epidemiologia , Criança , Exposição Ambiental/efeitos adversos , Métodos Epidemiológicos , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Transtornos Respiratórios/epidemiologia , Transtornos Respiratórios/fisiopatologia , Capacidade Vital/fisiologia
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