Browsing by Author "Anjana, R.M."

Now showing 1 - 7 of 7

Data resource profile: understanding the patterns and determinants of health in South Asians-the South Asia Biobank
(Oxford University Press., 2021) Song, P.; Gupta, A.; Goon, I.Y.; Hasan, M.; Mahmood, S.; Pradeepa, R.; Siddiqui, S.; Frost, G.S.; Kusuma, D.; Miraldo, M.; Sassi, F.; Wareham, N.J.; Ahmed, S.; Anjana, R.M.; Brage, S.; Forouhi, N.G.; Jha, S.; Kasturiratne, A.; Katulanda, P.; Khawaja, K.I.; Loh, M.; Mridha, M.K.; Wickremasinghe, A.R.; Kooner, J.S.; Chambers, J.C.
No abstract available
Food environment and diabetes mellitus in South Asia: A geospatial analysis of health outcome data
(Public Library of Science,San Francisco, 2022) Kusuma, D.; Atanasova, P.; Pineda, E.; Anjana, R.M.; de Silva, L.; Hanif, A.A.; Hasan, M.; Hossain, M.M.; Indrawansa, S.; Jayamanne, D.; Jha, S.; Kasturiratne, A.; Katulanda, P.; Khawaja, K.I.; Kumarendran, B.; Mridha, M.K.; Rajakaruna, V.; Chambers, J.C.; Frost, G.; Sassi, F.; Miraldo, M.
Background: The global epidemic of type 2 diabetes mellitus (T2DM) renders its prevention a major public health priority. A key risk factor of diabetes is obesity and poor diets. Food environments have been found to influence people's diets and obesity, positing they may play a role in the prevalence of diabetes. Yet, there is scant evidence on the role they may play in the context of low- and middle-income countries (LMICs). We examined the associations of food environments on T2DM among adults and its heterogeneity by income and sex. Methods and findings: We linked individual health outcome data of 12,167 individuals from a network of health surveillance sites (the South Asia Biobank) to the density and proximity of food outlets geolocated around their homes from environment mapping survey data collected between 2018 and 2020 in Bangladesh and Sri Lanka. Density was defined as share of food outlets within 300 m from study participant's home, and proximity was defined as having at least 1 outlet within 100 m from home. The outcome variables include fasting blood glucose level, high blood glucose, and self-reported diagnosed diabetes. Control variables included demographics, socioeconomic status (SES), health status, healthcare utilization, and physical activities. Data were analyzed in ArcMap 10.3 and STATA 15.1. A higher share of fast-food restaurants (FFR) was associated with a 9.21 mg/dl blood glucose increase (95% CI: 0.17, 18.24; p < 0.05). Having at least 1 FFR in the proximity was associated with 2.14 mg/dl blood glucose increase (CI: 0.55, 3.72; p < 0.01). A 1% increase in the share of FFR near an individual's home was associated with 8% increase in the probability of being clinically diagnosed as a diabetic (average marginal effects (AMEs): 0.08; CI: 0.02, 0.14; p < 0.05). Having at least 1 FFR near home was associated with 16% (odds ratio [OR]: 1.16; CI: 1.01, 1.33; p < 0.05) and 19% (OR: 1.19; CI: 1.03, 1.38; p < 0.05) increases in the odds of higher blood glucose levels and diagnosed diabetes, respectively. The positive association between FFR density and blood glucose level was stronger among women than men, but the association between FFR proximity and blood glucose level was stronger among men as well as among those with higher incomes. One of the study's key limitations is that we measured exposure to food environments around residency geolocation; however, participants may source their meals elsewhere. Conclusions: Our results suggest that the exposure to fast-food outlets may have a detrimental impact on the risk of T2DM, especially among females and higher-income earners. Policies should target changes in the food environments to promote better diets and prevent T2DM.
Food environments and obesity: A geospatial analysis of the South Asia Biobank, income and sex inequalities
(Elsevier Ltd, 2022) Atanasova, P.; Kusuma, D.; Pineda, E.; Anjana, R.M.; de Silva, L.; Hanif, A.A.M.; Hasan, M.; Hossain, M.M.; Indrawansa, S.; Jayamanne, D.; Jha, S.; Kasturiratne, A.; Katulanda, P.; Khawaja, K.I.; Kumarendran, B.; Mrida, M.K.; Rajakaruna, V.; Chambers, J.C.; Frost, G.; Sassi, F.; Miraldo, M.
Introduction: In low-middle income countries (LMICs) the role of food environments on obesity has been understudied. We address this gap by 1) examining the effect of food environments on adults' body size (BMI, waist circumference) and obesity; 2) measuring the heterogeneity of such effects by income and sex.Methods: This cross-sectional study analysed South Asia Biobank surveillance and environment mapping data for 12,167 adults collected between 2018 and 2020 from 33 surveillance sites in Bangladesh and Sri Lanka. Individual-level data (demographic, socio-economic, and health characteristics) were combined with exposure to healthy and unhealthy food environments measured with geolocations of food outlets (obtained through ground-truth surveys) within 300 m buffer zones around participants' homes. Multivariate regression models were used to assess association of exposure to healthy and unhealthy food environments on waist circumference, BMI, and probability of obesity for the total sample and stratified by sex and income.Findings: The presence of a higher share of supermarkets in the neighbourhood was associated with a reduction in body size (BMI, β = - 3∙23; p < 0∙0001, and waist circumference, β = -5∙99; p = 0∙0212) and obesity (Average Marginal Effect (AME): -0∙18; p = 0∙0009). High share of fast-food restaurants in the neighbourhood was not significantly associated with body size, but it significantly increased the probability of obesity measured by BMI (AME: 0∙09; p = 0∙0234) and waist circumference (AME: 0∙21; p = 0∙0021). These effects were stronger among females and low-income individuals.Interpretation: The results suggest the availability of fast-food outlets influences obesity, especially among female and lower-income groups. The availability of supermarkets is associated with reduced body size and obesity, but their effects do not outweigh the role of fast-food outlets. Policies should target food environments to promote better diets and reduce obesity.
Low uptake of COVID-19 prevention behaviours and high socioeconomic impact of lockdown measures in South Asia: Evidence from a large-scale multi-country surveillance programme
(Elsevier Science, 2021) Kusuma, D.; Pradeepa, R.; Khawaja, K.I.; Hasan, M.; Siddiqui, S.; Mahmood, S.; Ali Shah, S.M.; de Silva, C.K.; de Silva, L.; Gamage, M.; Loomba, M.; Rajakaruna, V.P.; Hanif, A.A.; Kamalesh, R.B.; Kumarendran, B.; Loh, M.; Misra, A.; Tassawar, A.; Tyagi, A.; Waghdhare, S.; Burney, S.; Ahmad, S.; Mohan, V.; Sarker, M.; Goon, I.Y.; Kasturiratne, A.; Kooner, J.S.; Katulanda, P.; Jha, S.; Anjana, R.M.; Mridha, M.K.; Sassi, F.; Chambers, J.C.; NIHR Global Health Research Unit for diabetes and cardiovascular disease in South Asia.
BACKGROUND: South Asia has become a major epicentre of the COVID-19 pandemic. Understanding South Asians' awareness, attitudes and experiences of early measures for the prevention of COVID-19 is key to improving the effectiveness and mitigating the social and economic impacts of pandemic responses at a critical time for the Region. METHODS: We assessed the knowledge, behaviours, health and socio-economic circumstances of 29,809 adult men and women, at 93 locations across four South Asian countries. Data were collected during the national lockdowns implemented from March to July 2020, and compared with data collected prior to the pandemic as part of an ongoing prospective surveillance initiative. RESULTS: Participants were 61% female, mean age 45.1 years. Almost half had one or more chronic disease, including diabetes (16%), hypertension (23%) or obesity (16%). Knowledge of the primary COVID-19 symptoms and transmission routes was high, but access to hygiene and personal protection resources was low (running water 63%, hand sanitisers 53%, paper tissues 48%). Key preventive measures were not widely adopted. Knowledge, access to, and uptake of COVID-19 prevention measures were low amongst people from disadvantaged socio-economic groups. Fifteen percent of people receiving treatment for chronic diseases reported loss of access to long-term medications; 40% reported symptoms suggestive of anxiety or depression. The prevalence of unemployment rose from 9.3% to 39.4% (P < 0.001), and household income fell by 52% (P < 0.001) during the lockdown. Younger people and those from less affluent socio-economic groups were most severely impacted. Sedentary time increased by 32% and inadequate fruit and vegetable intake increased by 10% (P < 0.001 for both), while tobacco and alcohol consumption dropped by 41% and 80%, respectively (P < 0.001), during the lockdown. CONCLUSIONS: Our results identified important knowledge, access and uptake barriers to the prevention of COVID-19 in South Asia, and demonstrated major adverse impacts of the pandemic on chronic disease treatment, mental health, health-related behaviours, employment and household finances. We found important sociodemographic differences for impact, suggesting a widening of existing inequalities. Our findings underscore the need for immediate large-scale action to close gaps in knowledge and access to essential resources for prevention, along with measures to safeguard economic production and mitigate socio-economic impacts on the young and the poor. KEYWORDS: COVID-19; Preventative measures; Socioeconomic impact; South Asia; Surveillance system.
OP59 Ultra-processed food consumption in South Asia: quantification of regional variation in intakes and the assessment of their sociodemographic correlates. Findings from the South Asia Biobank in four South Asian countrie
(BMJ, 2024) Bhagtani, D.; Adams, J.; Imamura, F.; Lahiri, A.; Irfan, K.; Jha, V.; Kasturiratne, A.; Katulanda, P.; Mridha, M.; Anjana, R.M.
BACKGROUND Escalation of ultra-processed foods (UPFs) sales has been recorded in low-to-middle-income countries, including in South Asia. However, individual consumption levels and sociodemographic characteristics influencing UPF consumption remain largely unknown in South Asia. We aimed to quantify UPF consumption and investigate its sociodemographic correlates in South Asia.METHODS We analysed data from 60,714 participants in the South Asia Biobank that recruited adults in Bangladesh, Pakistan, Sri Lanka, North India, and South India. Dietary assessment was conducted using interviewer-led 24h dietary recalls with a South Asia-specific digital tool. Foods were classified by the degree of industrial processing using the NOVA classification. Adjusted two-part multivariable regression models examined associations between sociodemographic factors and any UPF consumption and quantity of UPF consumption in consumers.RESULTS In Bangladesh, Sri Lanka and North India, approximately 75% of the participants reported consuming any UPFs in the previous 24h while in South India and Pakistan this was 40%. Median contribution of UPFs to total energy among UPF consumers ranged between 17% in Pakistan, 15% in North India, and 13% in Bangladesh, Sri Lanka, and South India. Biscuits were a common source of UPF across all regions. Other commonly consumed UPFs among consumers included sweetened beverages in Pakistan, packaged salty snacks in South India, and breakfast cereals in Bangladesh. Diverse associations between sociodemographic factors and any UPF consumption were seen across regions. Younger age was associated with any UPF consumption in Pakistan and Sri Lanka whereas in Bangladesh and North India, older age was. In all regions except Bangladesh, female sex was associated with any UPF consumption. Higher education was associated with UPF consumption in Bangladesh (odds ratio 2.01; 95% confidence interval 1.71 to 2.35), Pakistan (1.69; 1.55 to 1.85), and North India (1.40; 1.13 to 1.73). Paid employment was not associated with UPF consumption in any region. Among UPF consumers, in all regions, UPF consumption was lower in married or cohabitating than in single people. In Bangladesh and Sri Lanka UPF consumption was higher in rural residents, while in Pakistan, consumption was higher in urban participants.CONCLUSION Younger age, female sex, higher education, employment, and income exhibited associations with UPF, but this varied across South Asia. This heterogeneity should be considered when developing regionally specific interventions to support dietary public health. Our findings of regional consumption of specific UPFs, such as biscuits, breakfast cereals, sweetened beverages, and salty snacks, provide valuable insights for targeted interventions.
Policy implementation and recommended actions to create healthy food environments using the healthy food environment policy index (Food-EPI): a comparative analysis in South Asia
(Elsevier Ltd, 2024) Pineda, E.; Atanasova, P.; Wellappuli, N.T.; Kusuma, D.; Herath, H.; Segal, A.B.; Vandevijvere, S.; Anjana, R.M.; Shamim, A.A.; Afzal, S.; Akter, F.; Aziz, F.; Gupta, A.; Hanif, A.A.; Hasan, M.; Jayatissa, R.; Jha, S.; Jha, V.; Katulanda, P.; Khawaja, K.I.; Kumarendran, B.; Loomba, M.; Mahmood, S.; Mridha, M.K.; Pradeepa, R.; Aarthi, G.R.; Tyagi, A.; Kasturiratne, A.; Sassi, F.; Miraldo, M.
BACKGROUND The increasing prevalence of diet-related non-communicable diseases (NCDs) in South Asia is concerning, with type 2 diabetes projected to rise to 68%, compared to the global increase of 44%. Encouraging healthy diets requires stronger policies for healthier food environments.METHODS This study reviewed and assessed food environment policies in Bangladesh, India, Pakistan, and Sri Lanka from 2020 to 2022 using the Healthy Food Environment Policy Index (Food-EPI) and compared them with global best practices. Seven policy domains and six infrastructure support domains were considered, employing 47 good practice indicators to prevent NCDs. Stakeholders from government and non-governmental sectors in South Asia (n = 148) were invited to assess policy and infrastructure support implementation using the Delphi method.FINDINGS Implementation of food environment policies and infrastructure support in these countries was predominantly weak. Labelling, monitoring, and leadership policies received a moderate rating, with a focus on food safety, hygiene, and quality rather than obesity prevention. Key policy gaps prioritized for attention included front-of-pack labelling, healthy food subsidies, unhealthy food taxation, restrictions on unhealthy food promotion, and improvements in school nutrition standards to combat NCDs.INTERPRETATION Urgent action is required to expand food policies beyond hygiene and food security measures. Comprehensive strategies targeting NCD prevention are crucial to combat the escalating burden of NCDs in the region.
Smokeless and combustible tobacco use among 148,944 South Asian adults: a cross-sectional study of South Asia Biobank
(Springer, 2023) Xie, W.; Mridha, M.K.; Gupta, A.; Kusuma, D.; Butt, A.M.; Hasan, M.; Brage, S.; Loh, M.; Khawaja, K.I.; Pradeepa, R.; Jha, V.; Kasturiratne, A.; Katulanda, P.; Anjana, R.M.; Chambers, J.C.
INTRODUCTION Tobacco use, in both smoking and smokeless forms, is highly prevalent among South Asian adults. The aims of the study were twofold: (1) describe patterns of SLT and combustible tobacco product use in four South Asian countries stratified by country and sex, and (2) assess the relationships between SLT and smoking intensity, smoking quit attempts, and smoking cessation among South Asian men. METHODS Data were obtained from South Asia Biobank Study, collected between 2018 and 2022 from 148,944 men and women aged 18 years and above, living in Bangladesh, India, Pakistan, or Sri Lanka. Mixed effects multivariable logistic and linear regression were used to quantify the associations of SLT use with quit attempt, cessation, and intensity. RESULTS Among the four South Asian countries, Bangladesh has the highest rates of current smoking (39.9% for male, 0.4% for female) and current SLT use (24.7% for male and 23.4% for female). Among male adults, ever SLT use was associated with a higher odds of smoking cessation in Bangladesh (OR, 2.88; 95% CI, 2.65, 3.13), India (OR, 2.02; 95% CI, 1.63, 2.50), and Sri Lanka (OR, 1.36; 95% CI, 1.14, 1.62). Ever SLT use and current SLT use was associated with lower smoking intensity in all countries. CONCLUSIONS In this large population-based study of South Asian adults, rates of smoking and SLT use vary widely by country and gender. Men who use SLT products are more likely to abstain from smoking compared with those who do not.