Browsing by Author "Katulanda, P."

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The characteristics of people with diabetes mellitus in Kalutara District
(Sri Lanka Medical Association, 2010) de Silva, A.P.; de Silva, S.H.P.; Rajapakse, L.C.; Jayasinghe, S.; Katulanda, P.; Wijeratne, C.N.; Wijeratne, S.
INTRODUCTION AND OBJECTIVES: Diabetes mellitus is on the rise. Although recent studies are available data on ethnic minorities and estate sector are scarce. Aim of this study was to describe selected socio demographic aspects of people with diabetes mellitus in Kalutara District. METHODS: A cross sectional descriptive study was done. One person randomly selected from 20 randomly selected households in each gramasevaka (GS) division. There were 65 random (GS) divisions from all divisional secretariat areas. The data were collected using a pre-tested standard questionnaire. Fasting blood sugar was done to detect diabetes mellitus. RESULTS: Among 1225 screened there were 205 (16.7%) diabetics. Approximately one third was newly detected. There were 107 (52.2%) females in the diabetic group. The highest proportion was observed in the 50-54 and 55-59 age groups (44, 21.5%) and the middle income group (93, 48.9%). Those who were educated from Grade 6 to 0/L contained most of the diabetic patients (75, 39.7%). The prevalence in the urban, rural and estate sectors were 25.5%, 15.5 and 9.2% respectively. The prevalence among Sinhalese, Tamils and Muslims were 19.0%, 9.0% and 22.4% respectively. A gradient can be observed when prevalence was graphed according to the unsatisfactory basic needs index of the GS divisions. The highest proportion (23%) was observed in the richest GS Division. CONCLUSION: The prevalence of diabetes mellitus is high in the Kautara District. A higher prevalence was observed in urban areas, among Muslims and in rich GS divisions.
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
Effects of a lifestyle intervention programme after 1 year of follow-up among South Asians at high risk of type 2 diabetes: a cluster randomised controlled trial
(BMJ Publishing Group Ltd, 2021) Muilwijk, M.; Loh, M.; Siddiqui, S.; Mahmood, S.; Palaniswamy, S.; Shahzad, K.; Athauda, L.K.; Jayawardena, R.; Batool, T.; Burney, S.; Glover, M.; Bamunuarachchi, V.; Panda, M.; Madawanarachchi, M.; Rai, B.; Sattar, I.; Silva, W.; Waghdhare, S.; Jarvelin, M.R.; Rannan-Eliya, R.P.; Wijemunige, N.; Gage, H.M.; Valabhji, J.; Frost, G.S.; Wickremasinghe, R.; Kasturiratne, A.; Khawaja, K.I.; Ahmad, S.; Valkengoed, I.G.V.; Katulanda, P.; Jha, S.; Kooner, J.S.; Chambers, J.C.
Introduction South Asians are at high risk of type 2 diabetes (T2D). We assessed whether intensive family-based lifestyle intervention leads to significant weight loss, improved glycaemia and blood pressure in adults at elevated risk for T2D.Methods This cluster randomised controlled trial (iHealth-T2D) was conducted at 120 locations across India, Pakistan, Sri Lanka and the UK. We included 3684 South Asian men and women, aged 40–70 years, without T2D but with raised haemoglobin A1c (HbA1c) and/or waist circumference. Participants were randomly allocated either to the family-based lifestyle intervention or control group by location clusters. Participants in the intervention received 9 visits and 13 telephone contacts by community health workers over 1-year period, and the control group received usual care. Reductions in weight (aim >7% reduction), waist circumference (aim ≥5 cm reduction), blood pressure and HbA1C at 12 months of follow-up were assessed. Our linear mixed-effects regression analysis was based on intention-to-treat principle and adjusted for age, sex and baseline values. Results There were 1846 participants in the control and 1838 in the intervention group. Between baseline and 12 months, mean weight of participants in the intervention group reduced by 1.8 kg compared with 0.4 kg in the control group (adjusted mean difference −1.10 kg (95% CI −1.70 to −1.06), p<0.001). The adjusted mean difference for waist circumference was −1.9 cm (95% CI −2.5; to 1.3), p<0.001). No overall difference was observed for blood pressure or HbA1c. People who attended multiple intervention sessions had a dose-dependent effect on waist circumference, blood pressure and HbA1c, but not on weight. Conclusion An intensive family-based lifestyle intervention adopting low-resource strategies led to effective reduction in weight and waist circumference at 12 months, which has potential long-term benefits for preventing T2D. A higher number of attended sessions increased the effect on waist circumference, blood pressure and HbA1c.
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.
Genome-wide trans-ancestry meta-analysis provides insight into the genetic architecture oftype 2 diabetes susceptibility
(Nature Publishing Company, 2014) Mahajan, A.; Go, M.J.; Zhang, W.; Below, J.E.; Gaulton, K.J.; Ferreira, T.; Horikoshi, M.; Johnson, A.D.; Ng, M.C.; Prokopenko, I.; Saleheen, D.; Wang, X.; Zeggini, E.; Abecasis, G.R.; Adair, L.S.; Almgren, P.; Atalay, M.; Aung, T.; Baldassarre, D.; Balkau, B.; Bao, Y.; Barnett, A.H.; Barroso, I.; Basit, A.; Been, L.F.; Beilby, J.; Bell, G.I.; Benediktsson, R.; Bergman, R.N.; Boehm, B.O.; Boerwinkle, E.; Bonnycastle, L.L.; Burtt, N.; Cai, Q.; Campbell, H.; Carey, J.; Cauchi, S.; Caulfield, M.; Chan, J.C.; Chang, L.C.; Chang, T.J.; Chang, Y.C.; Charpentier, G.; Chen, C.H.; Chen, H.; Chen, Y.T.; Chia, K.S.; Chidambaram, M.; Chines, P.S.; Cho, N.H.; Cho, Y.M.; Chuang, L.M.; Collins, F.S.; Cornelis, M.C.; Couper, D.J.; Crenshaw, A.T.; van Dam, R.M.; Danesh, J.; Das, D.; de Faire, U.; Dedoussis, G.; Deloukas, P.; Dimas, A.S.; Dina, C.; Doney, A.S.; Donnelly, P.J.; Dorkhan, M.; van Duijn, C.; Dupuis, J.; Edkins, S.; Elliott, P.; Emilsson, V.; Erbel, R.; Eriksson, J.G.; Escobedo, J.; Esko, T.; Eury, E.; Florez, J.C.; Fontanillas, P.; Forouhi, N.G.; Forsen, T.; Fox, C.; Fraser, R.M.; Frayling, T.M.; Froguel, P.; Frossard, P.; Gao, Y.; Gertow, K.; Gieger, C.; Gigante, B.; Grallert, H.; Grant, G.B.; Grrop, L.C.; Groves, C.J.; Grundberg, E.; Guiducci, C.; Hamsten, A.; Han, B.G.; Hara, K.; Hassanali, N.; Hattersley, A.T.; Hayward, C.; Hedman, A.K.; Herder, C.; Hofman, A.; Holmen, O.L.; Hovingh, K.; Hreidarsson, A.B.; Hu, C.; Hu, F.B.; Hui, J.; Humphries, S.E.; Hunt, S.E.; Hunter, D.J.; Hveem, K.; Hydrie, Z.I.; Ikegami, H.; Illig, T.; Ingelsson, E.; Islam, M.; Isomaa, B.; Jackson, A.U.; Jafar, T.; James, A.; Jia, W.; Jöckel, K.H.; Jonsson, A.; Jowett, J.B.; Kadowaki, T.; Kang, H.M.; Kanoni, S.; Kao, W.H.; Kathiresan, S.; Kato, N.; Katulanda, P.; Keinanen-Kiukaanniemi, K.M.; Kelly, A.M.; Khan, H.; Khaw, K.T.; Khor, C.C.; Kim, H.L.; Kim, S.; Kim, Y.J.; Kinnunen, L.; Klopp, N.; Kong, A.; Korpi-Hyövälti, E.; Kowlessur, S.; Kraft, P.; Kravic, J.; Kristensen, M.M.; Krithika, S.; Kumar, A.; Kumate, J.; Kuusisto, J.; Kwak, S.H.; Laakso, M.; Lagou, V.; Lakka, T.A.; Langenberg, C.; Langford, C.; Lawrence, R.; Leander, K.; Lee, J.M.; Lee, N.R.; Li, M.; Li, X.; Li, Y.; Liang, J.; Liju, S.; Lim, W.Y.; Lind, L.; Lindgren, C.M.; Lindholm, E.; Liu, C.T.; Liu, J.J.; Lobbens, S.; Long, J.; Loos, R.J.; Lu, W.; Luan, J.; Lyssenko, V.; Ma, R.C.; Maeda, S.; Mägi, R.; Männisto, S.; Matthews, D.R.; Meigs, J.B.; Melander, O.; Metspalu, A.; Meyer, J.; Mirza, G.; Mihailov, E.; Moebus, S.; Mohan, V.; Mohlke, K.L.; Morris, A.D.; Mühleisen, T.W.; Müller-Nurasyid, M.; Musk, B.; Nakamura, J.; Nakashima, E.; Navarro, P.; Ng, P.K.; Nica, A.C.; Nilsson, P.M.; Njolstad, I.; Nöthen, M.M.; Ohnaka, K.; Ong, T.H.; Owen, K.R.; Palmer, C.N.; Pankow, J.S.; Park, K.S.; Parkin, M.; Pechlivanis, S.; Pedersen, N.L.; Peltonen, L.; Perry, J.R.; Peters, A.; Pinidiyapathirage, J.M.; Platou, C.G.; Potter, S.; Price, J.F.; Qi, L.; Radha, V.; Rallidis, L.; Rasheed, A.; Rathman, W.; Rauramaa, R.; Raychaudhuri, S.; Rayner, N.W.; Rees, S.D.; Rehnberg, E.; Ripatti, S.; Robertson, N.; Roden, M.; Rossin, E.J.; Rudan, I.; Rybin, D.; Saaristo, T.E.; Salomaa, V.; Saltevo, J.; Samuel, M.; Sanghera, D.K.; Saramies, J.; Scott, J.; Scott, L.J.; Scott, R.A.; Segrè, A.V.; Sehmi, J.; Sennblad, B.; Shah, N.; Shah, S.; Shera, A.S.; Shu, X.O.; Shuldiner, A.R.; Sigurdsson, G.; Sijbrands, E.; Silveira, A.; Sim, X.; Sivapalaratnam, S.; Small, K.S.; So, W.Y.; Stancáková, A.; Stefansson, K.; Steinbach, G.; Steinthorsdottir, V.; Stirrups, K.; Strawbridge, R.J.; Stringham, H.M.; Sun, Q.; Suo, C.; Syvänen, A.C.; Takayanagi, R.; Takeuchi, F.; Tay, W.T.; Teslovich, T.M.; Thorand, B.; Thorleifsson, G.; Thorsteinsdottir, U.; Tikkanen, E.; Trakalo, J.; Tremoli, E.; Trip, M.D.; Tsai, F.J.; Tuomi, T.; Tuomilehto, J.; Uitterlinden, A.G.; Valladares-Salgado, A.; Vedantam, S.; Veglia, F.; Voight, B.F.; Wang, C.; Wareham, N.J.; Wennauer, R.; Wickremasinghe, A.R.; Wilsgaard, T.; Wilson, J.F.; Wiltshire, S.; Winckler, W.; Wong, T.Y.; Wood, A.R.; Wu, J.Y.; Wu, Y.; Yamamoto, K.; Yamauchi, T.; Yang, M.; Yengo, L.; Yokota, M.; Young, R.; Zabaneh, D.; Zhang, F.; Zhang, R.; Zheng., W.; Zimmet, P.Z.; Altshuler, D.; Bowden, D.W.; Cho, Y.S.; Cox, N.J.; Cruz, M.; Hanis, C.L.; Kooner, J.; Lee, J.Y.; Seielstad, M.; Teo, Y.Y.; Boehnke, M.; Parra, E.J.; Chambers, J.C.; Tai, E.S.; McCarthy, M.I.; Morris, A.P.
To further understanding of the genetic basis of type 2 diabetes (T2D) susceptibility, we aggregated published meta-analyses of genome-wide association studies (GWAS), including 26,488 cases and 83,964 controls of European, east Asian, south Asian and Mexican and Mexican American ancestry. We observed a significant excess in the directional consistency of T2D risk alleles across ancestry groups, even at SNPs demonstrating only weak evidence of association. By following up the strongest signals of association from the trans-ethnic meta-analysis in an additional 21,491 cases and 55,647 controls of European ancestry, we identified seven new T2D susceptibility loci. Furthermore, we observed considerable improvements in the fine-mapping resolution of common variant association signals at several T2D susceptibility loci. These observations highlight the benefits of trans-ethnic GWAS for the discovery and characterization of complex trait loci and emphasize an exciting opportunity to extend insight into the genetic architecture and pathogenesis of human diseases across populations of diverse ancestry.
The iHealth-T2D study, prevention of type 2 diabetes amongst South Asians with central obesity and prediabetes: study protocol for a randomised controlled trial
(BioMed Central, London, 2021) Kasturiratne, A.; Khawaja, K.I.; Ahmad, S.; Siddiqui, S.; Shahzad, K.; Athauda, L.K.; Jayawardena, R.; Mahmood, S.; Muilwijk, M.; Batool, T.; Burney, S.; Glover, M.; Palaniswamy, S.; Bamunuarachchi, V.; Panda, M.; Madawanarachchi, S.; Rai, B.; Sattar, I.; Silva, W.; Waghdhare, S.; Jarvelin, M.R.; Rannan-Eliya, R.P.; Gage, H.M.; van Valkengoed, I.G.M.; Valabhji, J.; Frost, G.S.; Loh, M.; Wickremasinghe, A.R.; Kooner, J.S.; Katulanda, P.; Jha, S.; Chambers, J.C.
Background: People from South Asia are at increased risk of type 2 diabetes (T2D). There is an urgent need to develop approaches for the prevention of T2D in South Asians that are cost-effective, generalisable and scalable across settings.Hypothesis: Compared to usual care, the risk of T2D can be reduced amongst South Asians with central obesity or raised HbA1c, through a 12-month lifestyle modification programme delivered by community health workers.Design: Cluster randomised clinical trial (1:1 allocation to intervention or usual care), carried out in India, Pakistan, Sri Lanka and the UK, with 30 sites per country (120 sites total). Target recruitment 3600 (30 participants per site) with annual follow-up for 3 years.Entry criteria: South Asian, men or women, age 40-70 years with (i) central obesity (waist circumference ≥ 100 cm in India and Pakistan; ≥90 cm in Sri Lanka) and/or (ii) prediabetes (HbA1c 6.0-6.4% inclusive).Exclusion criteria: known type 1 or 2 diabetes, normal or underweight (body mass index < 22 kg/m2); pregnant or planning pregnancy; unstable residence or planning to leave the area; and serious illness.Endpoints: The primary endpoint is new-onset T2D at 3 years, defined as (i) HbA1c ≥ 6.5% or (ii) physician diagnosis and on treatment for T2D. Secondary endpoints at 1 and 3 years are the following: (i) physical measures: waist circumference, weight and blood pressure; (ii) lifestyle measures: smoking status, alcohol intake, physical activity and dietary intake; (iii) biochemical measures: fasting glucose, insulin and lipids (total and HDL cholesterol, triglycerides); and (iv) treatment compliance. Intervention: Lifestyle intervention (60 sites) or usual care (60 sites). Lifestyle intervention was delivered by a trained community health worker over 12 months (5 one-one sessions, 4 group sessions, 13 telephone sessions) with the goal of the participants achieving a 7% reduction in body mass index and a 10-cm reduction in waist circumference through (i) improved diet and (ii) increased physical activity. Usual care comprised a single 30-min session of lifestyle modification advice from the community health worker. Results: We screened 33,212 people for inclusion into the study. We identified 10,930 people who met study entry criteria, amongst whom 3682 agreed to take part in the intervention. Study participants are 49.2% female and aged 52.8 (SD 8.2) years. Clinical characteristics are well balanced between intervention and usual care sites. More than 90% of follow-up visits are scheduled to be complete in December 2020. Based on the follow-up to end 2019, the observed incidence of T2D in the study population is in line with expectations (6.1% per annum). Conclusion: The iHealth-T2D study will advance understanding of strategies for the prevention of diabetes amongst South Asians, use approaches for screening and intervention that are adapted for low-resource settings. Our study will thus inform the implementation of strategies for improving the health and well-being of this major global ethnic group.
The iHealth-T2D study: a cluster randomised trial for the prevention of type 2 diabetes amongst South Asians with central obesity and prediabetes-a statistical analysis plan
(BioMed Central, London, 2022) Muilwijk, M.; Loh, M.; Mahmood, S.; Palaniswamy, S.; Siddiqui, S.; Silva, W.; Frost, G.S.; Gage, H.M.; Jarvelin, M.R.; Rannan-Eliya, R.P.; Ahmad, S.; Jha, S.; Kasturiratne, A.; Katulanda, P.; Khawaja, K.I.; Kooner, J.S.; Wickremasinghe, A.R.; van Valkengoed, I.G.M.; Chambers, J.C.
Background: South Asians are at high risk of type 2 diabetes (T2D). Lifestyle modification is effective at preventing T2D amongst South Asians, but the approaches to screening and intervention are limited by high costs, poor scalability and thus low impact on T2D burden. An intensive family-based lifestyle modification programme for the prevention of T2D was developed. The aim of the iHealth-T2D trial is to compare the effectiveness of this programme with usual care. Methods: The iHealth-T2D trial is designed as a cluster randomised controlled trial (RCT) conducted at 120 sites across India, Pakistan, Sri Lanka and the UK. A total of 3682 South Asian men and women with age between 40 and 70 years without T2D but at elevated risk for T2D [defined by central obesity (waist circumference ≥ 95 cm in Sri Lanka or ≥ 100 cm in India, Pakistan and the UK) and/or prediabetes (HbA1c ≥ 6.0%)] were included in the trial. Here, we describe in detail the statistical analysis plan (SAP), which was finalised before outcomes were available to the investigators. The primary outcome will be evaluated after 3 years of follow-up after enrolment to the study and is defined as T2D incidence in the intervention arm compared to usual care. Secondary outcomes are evaluated both after 1 and 3 years of follow-up and include biochemical measurements, anthropometric measurements, behavioural components and treatment compliance. Discussion: The iHealth-T2D trial will provide evidence of whether an intensive family-based lifestyle modification programme for South Asians who are at high risk for T2D is effective in the prevention of T2D. The data from the trial will be analysed according to this pre-specified SAP. Ethics and dissemination: The trial was approved by the international review board of each participating study site. Study findings will be disseminated through peer-reviewed publications and in conference presentations.
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.
Reference equations for evaluation of spirometry function tests in South Asia, and amongst south asians living in other countries
(European Respiratory Society, 2022) Leong, W.Y.; Gupta, A.; Hasan, M.; Mahmood, S.; Siddiqui, S.; Ahmed, S.; Goon, I.Y.; Loh, M.; Mina, T.H.; Lam, B.; Yew, Y.W.; Ngeow, J.; Lee, J.; Lee, E.S.; Riboli, E.; Elliott, P.; Tan, G.P.; Chotirmall, S.H.; Wickremasinghe, A.R.; Kooner, J.S.; Khawaja, K.I.; Katulanda, P.; Mridha, M.K.; Jha, S.; Ranjit, M.A.; Pradeepa, G.; Kasturiratne, A.; Chambers, J.C.
Background: There is little data to accurate interpretation of spirometry data in South Asia, a major global region with high reported burden for chronic respiratory disease. Method: We measured lung function in 7,453 healthy men and women aged over 18 years, from Bangladesh, North India, South India, Pakistan and Sri Lanka, as part of the South Asia Biobank study. We first assessed the accuracy of existing equations for predicting normal forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC ratio. We then used our data to derive (N=5589) and internally validate (N=1864) new prediction equations amongst South Asians, with further external validation amongst 339 healthy South Asians living in Singapore. Results: GLI2012 and NHANESIII consistently overestimated expiratory volumes (best fit GLI-African American, mean [sd] z-score (n=7453): FEV1 -0.94 [1.05]; FVC -0.91 [1.10]). Age, height and weight were strong predictors of lung function in our participants (p<0.001), and sex specific reference equations using these three variables were highly accurate in both internal validation (z-scores: FEV1 0.03 [0.99]; FVC 0.04 [0.97]; FEV1/FVC -0.03 [0.99]) and external validation (z-scores: FEV1 0.31 [0.99]; FVC 0.24 [0.97]; FEV1/FVC 0.16 [0.91]). Further adjustment for study regions improves the model fit, with highest accuracy for estimation of region specific lung function in South Asia. Conclusion: We present improved equations for predicting lung function in South Asians. These offer the opportunity to enhance diagnosis and management of acute and chronic lung diseases in this major global population.
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.