Medicine
Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12
This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
Browse
98 results
Search Results
Item 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.Item The impact of COVID-19 on health care accessibility and financial risk protection in Sri Lanka(Sri Lanka Medical Association, 2023) Nandasena, S.; Gamage, A.U.; Periyasamy, N.; Rismy, M.; Balachandran, K.; Kasturiratne, A.INTRODUCTION: The COVID-19 pandemic negatively impacted the global economy, disrupted essential health services, and distorted social determinants of health, reducing healthcare accessibility and increasing financial risk. AIM: we aimed to assess the impact of COVID-19 on healthcare accessibility and financial risk protection in Sri Lanka. METHODOLOGY: We conducted a cross-sectional study on a representative sample (multi-stage sampling process) of 3151 households in 105 clusters representing all the districts of Sri Lanka. The data collection was conducted using an interviewer-administered questionnaire in early November 2021. This was important to classify three periods of interest, namely: (1) the pre-lockdown period (2) the nationwide lockdown period, and (3) the new normal period. (After Oct 1 to early November 2021). RESULTS: Among 11,463 household occupants, 12.6% reported having chronic diseases, with 76.5% diagnosed prior to six months. The majority had heart disease, high blood pressure, or diabetes. Of them, 53.7% have been followed up during the lockdown, increasing to 80.8% in the new normal period. Provincial variations in expenses were observed, with the highest food expenses in the Western Province. Catastrophic health expenditures affected 9.5% and 3.4% of households at 10% and 25%, respectively. CONCLUSIONS: A considerable proportion of those having heart disease, high blood pressure, high blood sugar or diabetes mellitus were not followed up in the lockdown period and the first month of the new normal period. Antenatal care and family planning were the least affected. Participants had incurred high out-of-pocket expenditures for healthcare during the entire period.Item 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.Item Multi-ancestry genetic study of type 2 diabetes highlights the power of diverse populations for discovery and translation(Nature Publishing Company, New York, 2022) Mahajan, A.; Spracklen, C.N.; Zhang, W.; Ng, M.C.Y.; Petty, L.E.; Kitajima, H.; Yu, G.Z.; Rüeger, S.; Speidel, L.; Kim, Y.J.; Horikoshi, M.; Mercader, J.M .; Taliun, D.; Moon, S.; Kwak, S.H.; Robertson, N.R.; Rayner, N.W.; Loh, M.; Kim, B.; Chiou, J.; Miguel-Escalada, I.; Parolo, P.D.B.; Lin, K.; Bragg, F.; Preuss, M.H.; Takeuchi, F.; Nano, J.; Guo, X.; Lamri, A.; Nakatoch, M.; Scott, R.A.; Lee, J.J.; Huerta-Chagoya, A.; Graff, M.; Chai, J.F.; Parra, E. J.; Yao, J.; Bielak, L.F.; Tabara, Y.; Hai, Y.; Steinthorsdottir, V.; Cook, J.P.; Kals, M.; Grarup, N.; Schmidt, E.M.; Pan, I.; Sofer, T.; Wuttke, M.; Sarnowski, C.; Gieger, C.; Nousome, D.; Trompet, S.; Long, J.; Sun, M.; Tong, L.; Chen, W.M.; Ahmad, M.; Noordam, R.; Lim, V.J.Y.; Tam, C.H.T.; Joo, Y.Y.; Chen, C.H.; Raffield, L.M.; Lecoeur, C.; Prins, B.P.; Nicolas, A.; Yanek, L.R.; Chen, G.; Jensen, R.A.; Tajuddin, S.; Kabagambe, E.K.; An, P.; Xiang, A.H.; Choi, H.S.; Cade, B.E.; Tan, J.; Flanagan, J.; Abaitua, F.; Adair, L.S.; Adeyemo, A.; Aguilar-Salinas, C.A.; Akiyama, M.; Anand, S.S.; Bertoni, A.; Bian, Z.; Bork-Jensen, J.; Brandslund, I.; Brody, J.A.; Brummett, C.M.; Buchanan, T.A.; Canouil, M.; Chan, J.C.N.; Chang, L.C.; Chee, M.L.; Chen, J.; Chen, S.H.; Chen, Y.T.; Chen, Z.; Chuang, L.M.; Cushman, M.; Das, S.K.; de Silva, H.J.; Dedoussis, G.; Dimitrov, L.; Doumatey, A.P.; Du, S.; Duan, Q.; Eckardt, K.U.; Emery, L.S.; Evans, D.S.; Evans, M.K.; Fischer, K.; Floyd, J.S.; Ford, I.; Fornage, M.; Franco, O.H.; Frayling, T.M.; Freedman, B.I.; Fuchsberger, C.; Genter, P.; Gerstein, H.C.; Giedraitis, V.; Villalpando, C.G.; Villalpando, M.E.G.; Goodarzi, M.O.; Larsen, P.G.; Gorkin, D.; Gross, M.; Guo, Y.; Hackinger, S.; Han, S.; Hattersley, A.T.; Herder, C.; Howard, A.G.; Hsueh, W.; Huang, M.; Huang, W.; Hung, Y.; Hwang, M.Y.; Hwu, C.; Ichihara, S.; Ikram, M.A.; Ingelsson, M.; Islam, M.T.; Isono, M.; Jang, H.M.; Jasmine, F.; Jiang, G.; Jonas, J.B.; Jørgensen, M.E.; Jørgensen, T.; Kamatani, Y.; Kandeel, F.R.; Kasturiratne, A.; Katsuya, T.; Kaur, V.; Kawaguchi, T.; Keaton, J.M.; Kho, A.N.; Khor, C.C.; Kibriya, M.G.; Kim, D.H.; Kohara, K.; Kriebel, J.; Kronenberg, F.; Kuusisto, J.; Läll, K.; Lange, L.A.; Lee, M.; Lee, N.R.; Leong, A.; Li, L.; Li, Y.; Li-Gao, R.; Ligthart, S.; Lindgren, C.M.; Linneberg, A.; Liu, C.; Liu, J.; Locke, A.E.; Louie, T.; Luan, J.; Luk, A.O.; Luo, X.; Lv, J.; Lyssenko, V.; Mamakou, V.; Mani, K.R.; Meitinger, T.; Metspalu, A.; Morris, A.D.; Nadkarni, G.N.; Nadler, J.L.; Nalls, M.A.; Nayak, U.; Nongmaithem, S.S.; Ntalla, I.; Okada, Y.; Orozco, L.; Patel, S.R.; Pereira, M.A.; Peters, A.; Pirie, F.J.; Porneala, B.; Prasad, G.; Preissl, S.; Rasmussen-Torvik, L.J.; Reiner, A.P.; Roden, M.; Rohde, R.; Roll, K.; Sabanayagam, C.; Sander, M.; Sandow, K.; Sattar, N.; Schönherr, S.; Schurmann, C.; Shahriar, M.; Shi, J.; Shin, D.M.; Shriner, D.; Smith, J.A.; So, W.Y.; Stančáková, A.; Stilp, A.M.; Strauch, K.; Suzuki, K.; Takahashi, A.; Taylor, K.D.; Thorand, B.; Thorleifsson, G.; Thorsteinsdottir, U.; Tomlinson, B.; Torres, J.M.; Tsai, F.; Tuomilehto, J.; Tusie-Luna, T.; Udler, M.S.; Salgado, A.V.; Dam, R.M.; Klinken, J.B.; Varma, R.; Vujkovic, M.; Wacher-Rodarte, N.; Wheeler, E.; Whitsel, E.A.; Wickremasinghe, A.R.; Dijk, K.W.; Witte, D.R.; Yajnik, C.S; Yamamoto, K.; Yamauchi, T.; Yengo, L.; Yoon, K.; Yu, C.; Yuan, J.M.; Yusuf, S.; Zhang, L.; Zheng, W.; FinnGen; eMERGE Consortium; Leslie J Raffel; Igase, M.; Ipp, E.; Redline, S.; Cho, Y.S.; Lind, L.; Province, M.A.; Hanis, C.L.; Peyser, P.A.; Ingelsson, E.; Zonderman, A.B.; Psaty, B.M.; Wang, Y.; Rotimi, C.N.; Becker, D.M.; Matsuda, F.; Liu, Y.; Zeggini, E.; Yokota, M.; Rich, S.S.; Kooperberg, C.; Pankow, J.S.; Engert, J.C.; Chen, Y.I.; Froguel, P.; Wilson, J.G.; Sheu, W.H.H.; Kardia, S.L.R.; Wu, J.Y.; Hayes, M.G.; Ma, R.C.W.; Wong, T.Y.; Groop, L.; Mook-Kanamori, D.O.; Chandak, G.R.; Collins, F.S.; Bharadwaj, D.; Paré, G.; Sale, M.M.; Ahsan, H.; Motala, A.A.; Shu, X.O.; Park, K.S.; Jukema, J.W.; Cruz, M.; Cowdin, R.M.; Grallert, H.; Cheng, C.Y.; Bottinger, E.P.; Dehghan, A.; Tai, E.S.; Dupuis, J.; Kato, N.; Laakso, M.; Köttgen, A.; Koh, W.P.; Palmer, C.N.A.; Liu, S.; Abecasis, G.; Kooner, J.S.; Loos, R.J.F.; North, K.E.; Haiman, C.A.; Florez, J.C.; Saleheen, D.; Hansen, T.; Pedersen, O.; Mägi, R.; Langenberg, C.; Wareham, N.J.; Maeda, S.; Kadowaki, T.; Lee, J.; Millwood, I.Y.; Walters, R.G.; Stefansson, K.; Myers, S.R.; Ferrer, J.; Gaulton, K.J.; Meigs, J.B.; Mohlke, K.L.; Gloyn, A.L.; Bowden, D.W.; Below, J.E.; Chambers, J.C.; Sim, X.; Boehnke, M.; Rotter, J.I.; McCarthy, M.I.; Morris, A.P.We assembled an ancestrally diverse collection of genome-wide association studies (GWAS) of type 2 diabetes (T2D) in 180,834 affected individuals and 1,159,055 controls (48.9% non-European descent) through the Diabetes Meta-Analysis of Trans-Ethnic association studies (DIAMANTE) Consortium. Multi-ancestry GWAS meta-analysis identified 237 loci attaining stringent genome-wide significance (P < 5 × 10-9), which were delineated to 338 distinct association signals. Fine-mapping of these signals was enhanced by the increased sample size and expanded population diversity of the multi-ancestry meta-analysis, which localized 54.4% of T2D associations to a single variant with >50% posterior probability. This improved fine-mapping enabled systematic assessment of candidate causal genes and molecular mechanisms through which T2D associations are mediated, laying the foundations for functional investigations. Multi-ancestry genetic risk scores enhanced transferability of T2D prediction across diverse populations. Our study provides a step toward more effective clinical translation of T2D GWAS to improve global health for all, irrespective of genetic background.Item Prevalence, predictors and outcome of chronic kidney disease in a cohort of aging urban, adult Sri Lankans(Sri Lanka Medical Association, 2021) de Silva, S.T.; Ediriweera, D.D.; Niriella, M.A.; Kasturiratne, A.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.Introduction and Objectives Chronic kidney disease (CKD) affects 700 million people worldwide. In 2017, deaths due to CKD accounted for 4.6% of mortality globally. Prevalence of CKD is increasing worldwide, with increasing diabetes and hypertension in aging populations. Our objective was to determine prevalence of CKD in an urban, adult cohort, since such data is scarce in Sri Lanka. Methods The study population was selected by stratified random sampling from Ragama MOH area initially in 2007 (aged 35-64 years) and re-assessed in 2014. On both occasions, participants were assessed by structured interview, anthropometric measurements and biochemical tests. CKD was assessed in 2014. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI formula. CKD was defined as eGFR<60ml/min/1.72m2, using KDIGO/KDOQI classification. The cohort was further followed up in 2017 when all-cause and cardiovascular (CV) mortality and CV morbidity were also assessed. Results Of 2985 individuals recruited in 2007, 2148(71.6%) attended follow-up in 2014. 2032/2148 (94.6%) had CKD data [57.0% women, mean age 52.3(SD 7.7) years]. Age adjusted prevalence of CKD was 3.03(1.98–4.11) per 100 population in 2014; 41/61(67.2%) were in CKD Stage-3A, 14/61(23%) in Stage-3B, 6/61(9.8%) in Stage-4 and none in end-stage. Independent predictors of CKD in 2014 were older age (p<0.001), male gender (P<0.05) and presence of diabetes (p<0.001) and hypertension (p<0,001) in 2007. CKD was not associated with all-cause mortality, CV mortality or morbidity (p>0.05) in 2017.Conclusion Diabetes and hypertension were associated with CKD. Most with CKD were in Stage 3, where early recognition and better control of co-morbidities retard progression of CKD.Item The effect of a community-based health promotion intervention to improve utilization of healthy lifestyle centers in Sri Lanka(College of Community Physicians of Sri Lanka, 2021) Herath, H.M.T.P.; Perera, K.M.N.; Kasturiratne, A.Background: Healthy lifestyle centers (HLCs) report underutilization by the target population. There is a dearth of evidence on improving HLC utilization through the Health Promotion (HP) approach. This study aims to evaluate of the effectiveness of a HP intervention in improving the utilization of HLCs.Methods: A quasi-experimental study was conducted in six grama niladari divisions from the catchment area of two selected HLCs, one each in Gampaha (intervention) and Kalutara (comparison) districts. Community support groups (CSGs) were developed and empowered as the intervention. Contributory factors for the underutilization were addressed with the CSG.The pre and post intervention assessments were done in a random sample of 498 (aged 35-65 years) from each group. Primary outcome was improvement in the attendance of the HLC and secondary outcomes were changes in contributory factors. Data collected using an interviewer-administered questionnaire and secondary data from the HLCs were used. Results: Utilization of the HLC improved significantly among the sample from the intervention group (Post 35.3% [95% CI: 30.9 - 39.8]; Pre 5.85% [95% CI: 3.74 - 7.95], P < 0.001). The comparison group showed no significant change (Post 3.49% [95% CI: 1.80 -5.17] - Pre 3.25% [95% CI: 1.62 - 4.87], p = 1.00). There was a significant improvement in mean HLC attendance in the intervention group (Mean difference= 91.83, P < 0.05) compared to the comparison group (Mean difference = 2.66, P > 0.05). Conclusions: The utilization of the HLCs can be improved by a HP intervention through developing and empowering CSGs.Item Effect of a multicomponent intervention on antihypertensive medication intensification in rural South Asia: post-hoc analysis of a cluster RCT(Oxford University Press, 2021) Feng, L.; Jehan, I.; de Silva, A.; Naheed, A.; Khan, H.A.H.; Kasturiratne, A.; Clemens, J.D.; Lim, C.W.; Hughes, A.D.; Chaturvedi, N.; Jafar, T.H.; COBRA-BPS Study Group.BACKGROUND: Inadequate treatment of hypertension is a widespread problem, especially in South Asian countries where cardiovascular disease mortality rates are high. We aimed to explore the effect of a multicomponent intervention (MCI) on antihypertensive medication intensification among rural South Asians with hypertension. METHODS: A post-hoc analysis of a two-year cluster-randomized controlled trial including 2645 hypertensives aged≥ 40 years from 30 rural communities, 10 each, in Bangladesh, Pakistan, and Sri Lanka. Independent assessors collected information on participants' self-reports and physical inspection of medications. The main outcomes were the changes from baseline to 24 months in the following: 1) the therapeutic intensity score (TIS) for all (and class specific) antihypertensive medications; 2) the number of antihypertensive medications in all trial participants. RESULTS: At 24 months, the mean increase in the TIS score of all antihypertensive medications was 0.11 in the MCI group and 0.03 in the control group, with a between-group difference in the increase of 0.08 (95% CI (0.03, 0.12); P=0.002). In MCI compared to controls, a greater increase in the TIS of renin angiotensin-aldosterone system blockers (0.05; 95% CI (0.02, 0.07); P<0.001) and calcium channel blockers (0.03; 95% CI (0.00, 0.05);p=0.031) , and in the number of antihypertensive medications (0.11, 95% CI (0.02, 0.19);P=0.016) was observed. CONCLUSIONS: In rural communities in Bangladesh, Pakistan, and Sri Lanka, MCI led to a greater increase in antihypertensive medication intensification compared to the usual care among adults with hypertension. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02657746. KEYWORDS: South Asia; community health workers; hypertension; medications intensification; multicomponent intervention; physicians.Item Physical activity tracking among Sri Lankan adults: findings from a 7-year follow-up of the Ragama Health Study(SAGE Publications, 2021) Pinidiyapathirage, J.; Kasturiratne, A.; Bennie, J.A.; Pathmeswaran, A.; Biddle, S.J.H.; de Silva, H.J.; Chackrewarthy, S.; Dassanayake, A.S.; Ranawaka, U.; Kato, N.; Wickremasinghe, A.R.ABSTRACT: Limited data are available on physical activity tracking among adults in low- and middle-income countries. Using a longitudinal design, we assessed trends and correlates of physical activity among Sri Lankan adults. Individuals selected through age-stratified random sampling, were screened initially in 2007 (n = 2986) and reevaluated in 2014 (n = 2148). On both occasions, structured interviews and clinical measurements were completed. Approximately 40% of the participants engaged in recommended levels of physical activity both at baseline and follow-up. One-fifth reported increased physical activity at follow-up, a similar proportion reported being persistently inactive or a reduction in physical activity. In the adjusted analysis, being persistently active was associated with male sex, a lower educational level and income, being free of any chronic disease conditions, better self-rated health, and sitting time <8 hours. Our findings support public health interventions to help maintain recommended physical activity levels over time, particularly for subgroups at high-risk of physical inactivity. KEYWORDS: Sri Lanka; lower middle-income countries; non-communicable diseases; physical activity; population studies.Item The clinical utility of accurate NAFLD ultrasound grading: Results from a community-based, prospective cohort study(Elsevier Science Ireland Ltd, 2021) Niriella, M.A.; Ediriweera, D.S.; Kasturiratne, A.; Gunasekara, D.; de Silva, S.T.; Dassanayake, A.S.; de Silva, A.P.; Kato, N.; Pathmeswaran, A.; Wickremasinghe, A.R.; de Silva, H.J.OBJECTIVES: Despite its widespread use there is no consensus on ultrasound criteria to diagnose fatty liver. METHOD: In an ongoing, cohort-study, participants were initially screened in 2007 and reassessed in 2014 by interview, anthropometric measurements, liver ultrasonography, and blood tests. We evaluated utility of increased hepatic echogenicity alone (intermediate) compared to using additional criteria which included signal attenuation and/or vascular blunting along with increase of hepatic echogenicity (moderate-severe), to diagnose fatty liver in NAFLD. We made a comparison of the two radiologically defined groups, in order to choose a classification method for NAFLD, which may better predict baseline adverse metabolic traits (MT), and adverse metabolic and cardiovascular events (CVE) after 7-year of follow-up. RESULTS: Of 2985 recruited in 2007, 940 (31.5 %) had moderate-severe NAFLD, 595 (19.9 %) intermediate NAFLD, and 957 (32.1 %) were controls (no fatty liver). 2148 (71.9 %) attended follow-up in 2014; they included 708 who had moderate-severe NAFLD, 446 intermediate NAFLD and 674 controls, at baseline (in 2007). At baseline, adverse anthropometric indices and MTs were significantly higher in both moderate-severe NAFLD and intermediate NAFLD compared to controls, except for low HDL. They were commoner in moderate-severe NAFLD than in intermediate NAFLD. After seven years, the odds of developing new-onset metabolic traits and CVEs were significantly higher compared to controls only in moderate-severe NAFLD. CONCLUSIONS: Only moderate-severe NAFLD predicted risk of incident adverse MTs and CVEs. However, both moderate-severe and intermediate NAFLD were associated with higher prevalence of adverse anthropometric and metabolic traits, thereby identifying individuals who need medical intervention even among those with milder degrees of fatty liver. We therefore recommend using increased hepatic echogenicity, and not only the more stringent criteria (which include signal attenuation and/or vascular blunting), for the diagnosis of fatty liver in individuals with NAFLD. KEYWORDS: Cardiovascular events; Fatty liver; NAFLD; Outcomes; Ultrasonography; Ultrasound criteria.Item Community as a learning opportunity(College of Medical Educations., 2020) Kasturiratne, A.; Chandratilake, M.No abstract available