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Jeyaparam S, Agha-Jaffar R, Mullins E, Pinho-Gomes AC, Khunti K, Robinson S. Retrospective cohort study of the association between socioeconomic deprivation and incidence of gestational diabetes and perinatal outcomes. BMC Public Health 2024; 24:184. [PMID: 38225599 PMCID: PMC10790393 DOI: 10.1186/s12889-023-17261-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 11/18/2023] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION Socioeconomic disparities have been shown to correlate with perinatal mortality and the incidence of type 2 diabetes. Few studies have explored the relationship between deprivation and the incidence of gestational diabetes (GDM). We aimed to identify the relationship between deprivation and incidence of GDM, after adjusting for age, BMI, and ethnicity. We also examined for relationships between deprivation and perinatal outcomes. METHODS A retrospective cohort analysis of 23,490 pregnancies from a major National Health Service Trust in Northwest London was conducted. The 2019 English Indices of Multiple Deprivation was used to identify the deprivation rank and decile for each postcode. Birthweight centile was calculated from absolute birthweight after adjusting for ethnicity, maternal height, maternal weight, parity, sex and outcome (live birth/stillbirth). Logistic regression and Kendall's Tau were used to identify relationships between variables. RESULTS After controlling for age, BMI & ethnicity, Index of Multiple Deprivation postcode decile was not associated with an increased risk of developing gestational diabetes. Each increase in decile of deprivation was associated with an increase in birthweight centile by 0.471 (p < 0.001). After adjusting for confounders, age was associated with a 7.1% increased GDM risk (OR: 1.076, p < 0.001); BMI increased risk by 5.81% (OR: 1.059, p < 0.001). There was no significant correlation between Index of Multiple Deprivation rank and perinatal outcomes. DISCUSSION Our analysis demonstrates that socioeconomic deprivation was not associated with incidence of GDM or adverse perinatal outcomes. Factors such as genetic predisposition and lifestyle habits may likely play a larger role in the development of GDM compared to socioeconomic deprivation alone.
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Affiliation(s)
- Srirangan Jeyaparam
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK.
| | - Rochan Agha-Jaffar
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
- Department of Metabolic Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Edward Mullins
- Department of Obstetrics & Gynaecology, Imperial College Healthcare NHS Trust, London, UK
- The George Institute for Global Health, London, UK
| | | | | | - Stephen Robinson
- Department of Metabolic Medicine, Imperial College Healthcare NHS Trust, London, UK
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Azami G, Ebrahimy B. Letter to the editor: alarming prevalence of comorbid conditions in adults with type 2 diabetes in Iran. J Diabetes Metab Disord 2023; 22:1809-1811. [PMID: 37975112 PMCID: PMC10638339 DOI: 10.1007/s40200-023-01254-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 06/07/2023] [Indexed: 11/19/2023]
Abstract
One of the key challenges that healthcare continues to face is the ongoing epidemiological transition from communicable diseases to non-communicable diseases. In Iran, it is expected that the number of patients with non-communicable diseases will increase because of the growing prevalence of the Western lifestyle, nutritional transition, and the aging of society. As the elderly population continues to grow, cardiovascular diseases have progressively replaced communicable diseases as the leading cause of mortality. In 2016, ischemic heart diseases, cerebrovascular accidents, hypertension, and diabetes were the first, second, fourth, and sixth leading causes of mortality respectively. Like many patients with a chronic disease, most Iranians with diabetes have at least one comorbid condition. Diabetes-related comorbidities increase the healthcare demands, cost, and risk of poor patient outcomes. Although a growing body of evidence indicates that the type and severity of the comorbid conditions matter, less attention has been paid to studying how they influence diabetes care. Further research should continue to focus on furthering our understanding of management strategies to enhance the quality of care for diabetes patients having comorbidities. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01254-w.
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Affiliation(s)
- Golnaz Azami
- Department of Emergency Medical Sciences, Faculty of Paramedical Sciences, Kurdistan University of Medical Sciences, Sanandaj, 6617913446 IR Iran
| | - Boshara Ebrahimy
- Department of Emergency Medicine, Faculty of Paramedical Sciences, Kurdistan University of Medical Sciences, Sanandaj, 6617913446 IR Iran
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Aktar MF, Chowdhury MH, Rahman MS. A quantile regression approach to identify risk factors for high blood glucose levels among Bangladeshi individuals. Health Sci Rep 2023; 6:e1772. [PMID: 38116173 PMCID: PMC10728372 DOI: 10.1002/hsr2.1772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
Background and Aims Diabetes mellitus, characterized by high blood glucose, is an overwhelming public health concern globally, including in Bangladesh. The implication of this trend may pose a significant challenge to the health systems due to the lack of awareness and improper management of this chronic disease. To formulate strategies for public health planning, this study aims to explore the potential risk factors for elevated blood glucose levels among Bangladeshi individuals using advanced statistical methods and a nationally representative data set. Methods This study utilized data from the 2017-18 Bangladesh Demographic and Health Survey and included 11,863 individuals. A nonparametric Kruskal-Wallis test assessed the significant association between fasting plasma glucose levels and various risk factors. Additionally, a robust quantile regression model was applied to examine the net effects of each risk factor at different quantiles of the distribution. Results The prevalence of diabetes is 8.1% among individuals in the study population, with variations observed across different administrative divisions in the country. Respondents from the Dhaka division respondents had a higher likelihood (24.1%) of having elevated plasma glucose and the Rangpur division had a lower risk (10.3%) of developing diabetes disease. This study identified several potential risk factors associated with elevated blood glucose levels, including hypertensive disease, overweight and obese body mass index, higher economic status, reduced physical activities, and older age, significantly contributing to develop diabetes mellitus. Conclusion This study recommends promoting healthy lifestyles, increased physical activity, effective hypertension management, obesity reduction, and nationwide screening programs to control diabetes and noncommunicable diseases in Bangladesh. These preventive measures are crucial for reducing the existing prevalence of diabetes and working toward achieving the Sustainable Development Goals by 2030.
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Affiliation(s)
- Mst. Farjana Aktar
- Department of StatisticsMawlana Bhashani Science and Technology UniversitySantoshBangladesh
| | - Mashfiqul Huq Chowdhury
- Department of StatisticsMawlana Bhashani Science and Technology UniversitySantoshBangladesh
- School of Mathematics and StatisticsVictoria University of WellingtonWellingtonNew Zealand
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Sultana M, Islam MM, Hossain MM, Rahman MA, Das SC, Barman DN, Mitu FS, Gupta SD. Association of CAPN10 gene (rs3842570) polymorphism with the type 2 diabetes mellitus among the population of Noakhali region in Bangladesh: a case-control study. Genomics Inform 2023; 21:e33. [PMID: 37813629 PMCID: PMC10584643 DOI: 10.5808/gi.23023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/14/2023] [Accepted: 07/02/2023] [Indexed: 10/11/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a multifactorial, polygenic, and metabolically complicated disease. A large number of genes are responsible for the biogenesis of T2DM and calpain10 (CAPN10) is one of them. The association of numerous CAPN10 genetic polymorphisms in the development of T2DM has been widely studied in different populations and noticed inconclusive results. The present study is an attempt to evaluate the plausible association of CAPN10 polymorphism SNP-19 (rs3842570) with T2DM and T2DM-related anthropometric and metabolic traits in the Noakhali region of Bangladesh. This case-control study included 202 T2DM patients and 75 healthy individuals from different places in Noakhali. A significant association (p < 0.05) of SNP-19 with T2DM in co-dominant 2R/3R vs. 3R/3R (odds ratio [OR], 2.7; p=0.0014) and dominant (2R/3R) + (2R/2R) vs. 3R/3R (OR, 2.47; p=0.0011) genetic models was observed. High-risk allele 2R also showed a significant association with T2DM in the allelic model (OR, 1.67; p=0.0109). The genotypic frequency of SNP-19 variants showed consistency with Hardy-Weinberg equilibrium (p > 0.05). Additionally, SNP-19 genetic variants showed potential associations with the anthropometric and metabolic traits of T2DM patients in terms of body mass index, systolic blood pressure, diastolic blood pressure, total cholesterol, and triglycerides. Our approach identifies the 2R/3R genotype of SNP-19 as a significant risk factor for biogenesis of T2DM in the Noakhali population. Furthermore, a large-scale study could be instrumental to correlate this finding in overall Bangladeshi population.
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Affiliation(s)
- Munia Sultana
- Department of Biotechnology and Genetic Engineering, Noakhali Science and Technology University, Noakhali 3814, Bangladesh
| | - Md. Mafizul Islam
- Department of Biotechnology and Genetic Engineering, Noakhali Science and Technology University, Noakhali 3814, Bangladesh
| | - Md. Murad Hossain
- Department of Biotechnology and Genetic Engineering, Noakhali Science and Technology University, Noakhali 3814, Bangladesh
| | - Md. Anisur Rahman
- Department of Biotechnology and Genetic Engineering, Noakhali Science and Technology University, Noakhali 3814, Bangladesh
| | - Shuvo Chandra Das
- Department of Biotechnology and Genetic Engineering, Noakhali Science and Technology University, Noakhali 3814, Bangladesh
| | - Dhirendra Nath Barman
- Department of Biotechnology and Genetic Engineering, Noakhali Science and Technology University, Noakhali 3814, Bangladesh
| | - Farhana Siddiqi Mitu
- Department of Biotechnology and Genetic Engineering, Noakhali Science and Technology University, Noakhali 3814, Bangladesh
| | - Shipan Das Gupta
- Department of Biotechnology and Genetic Engineering, Noakhali Science and Technology University, Noakhali 3814, Bangladesh
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Motamed B, Mosafer A, Attarchi M. Assessment of the work ability related factors in diabetic patients. Heliyon 2022; 8:e11467. [DOI: 10.1016/j.heliyon.2022.e11467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/16/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
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Rashid M, Alkhodari M, Mukit A, Ahmed KIU, Mostafa R, Parveen S, Khandoker AH. Machine Learning for Screening Microvascular Complications in Type 2 Diabetic Patients Using Demographic, Clinical, and Laboratory Profiles. J Clin Med 2022; 11:jcm11040903. [PMID: 35207179 PMCID: PMC8879306 DOI: 10.3390/jcm11040903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/23/2022] [Accepted: 01/30/2022] [Indexed: 12/30/2022] Open
Abstract
Microvascular complications are one of the key causes of mortality among type 2 diabetic patients. This study was sought to investigate the use of a novel machine learning approach for predicting these complications using only the patient demographic, clinical, and laboratory profiles. A total of 96 Bangladeshi participants with type 2 diabetes were recruited during their routine hospital visits. All patient profiles were assessed by using a chi-squared (χ2) test to statistically determine the most important markers in predicting three microvascular complications: cardiac autonomic neuropathy (CAN), diabetic peripheral neuropathy (DPN), and diabetic retinopathy (RET). A machine learning approach based on logistic regression, random forest (RF), and support vector machine (SVM) algorithms was then developed to ensure automated clinical testing for microvascular complications in diabetic patients. The highest prediction accuracies were obtained by RF using diastolic blood pressure, albumin–creatinine ratio, and gender for CAN testing (98.67%); microalbuminuria, smoking history, and hemoglobin A1C for DPN testing (67.78%); and hemoglobin A1C, microalbuminuria, and smoking history for RET testing (84.38%). This study suggests machine learning as a promising automated tool for predicting microvascular complications in diabetic patients using their profiles, which could help prevent those patients from further microvascular complications leading to early death.
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Affiliation(s)
- Mamunur Rashid
- Department of Electrical and Electronic Engineering, United International University, Dhaka 1212, Bangladesh; (M.R.); (A.M.); (K.I.U.A.); (R.M.)
| | - Mohanad Alkhodari
- Healthcare Engineering Innovation Center (HEIC), Department of Biomedical Engineering, Khalifa University, Abu Dhabi 127788, United Arab Emirates;
- Correspondence:
| | - Abdul Mukit
- Department of Electrical and Electronic Engineering, United International University, Dhaka 1212, Bangladesh; (M.R.); (A.M.); (K.I.U.A.); (R.M.)
- Department of Electrical and Computer Engineering, University of Oklahoma, Tulsa, OK 74135, USA
| | - Khawza Iftekhar Uddin Ahmed
- Department of Electrical and Electronic Engineering, United International University, Dhaka 1212, Bangladesh; (M.R.); (A.M.); (K.I.U.A.); (R.M.)
| | - Raqibul Mostafa
- Department of Electrical and Electronic Engineering, United International University, Dhaka 1212, Bangladesh; (M.R.); (A.M.); (K.I.U.A.); (R.M.)
| | - Sharmin Parveen
- Department of Health Informatics, Bangladesh University of Health Sciences, Dhaka 1216, Bangladesh;
| | - Ahsan H. Khandoker
- Healthcare Engineering Innovation Center (HEIC), Department of Biomedical Engineering, Khalifa University, Abu Dhabi 127788, United Arab Emirates;
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Hossain MB, Khan JR, Das Gupta R. Role of hypertension in the association of overweight and obesity with diabetes among adults in Bangladesh: a population-based, cross-sectional nationally representative survey. BMJ Open 2021; 11:e050493. [PMID: 34330863 PMCID: PMC8327840 DOI: 10.1136/bmjopen-2021-050493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIMS Overweight and obesity (OWOB) is a modifiable risk factor for both hypertension and diabetes. However, the association between OWOB and diabetes among Bangladeshi adults and how hypertension may mediate this relationship are not well explored. This study aimed to examine (1) whether OWOB is independently associated with diabetes among Bangladeshi adults, (2) whether this association is mediated by hypertension, and (3) the effect modification by wealth status and place of residence in the relationships. RESEARCH DESIGN AND METHODS We used data of 9305 adults aged ≥18 years from the most recent nationally representative cross-sectional study of Bangladesh Demographic and Health Survey 2017-2018. Design-based logistic regression was used to assess the association between OWOB and diabetes, and counterfactual framework-based weighting approach was used to evaluate the mediation effect of hypertension in the OWOB-diabetes relationship. We used stratified analyses for the effect modifications. RESULTS The prevalence of OWOB, diabetes and hypertension was 48.5%, 11.7% and 30.3%, respectively. We observed a significant association between OWOB and diabetes and a mediating role of hypertension in the OWOB-diabetes association. The odds of diabetes was 51% higher among adults with OWOB than those without OWOB (adjusted OR: 1.51, 95% CI 1.29 to 1.77). We observed that 18.64% (95% CI 9.84% to 34.07%) of the total effect of OWOB on the higher odds of diabetes was mediated through hypertension, and the mediation effect was higher among adults from non-poor households and from both rural and urban areas. CONCLUSIONS Adult OWOB status is independently associated with diabetes in Bangladesh, and hypertension mediates this association. Therefore, prevention policies should target adults with both OWOB and hypertension, particularly those from non-poor households and from both rural and urban areas, to reduce the growing burden of diabetes and its associated risk.
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Affiliation(s)
- Md Belal Hossain
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jahidur Rahman Khan
- Biomedical Research Foundation, Dhaka, Bangladesh
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, Canberra, Australia
| | - Rajat Das Gupta
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Akhtar S, Nasir JA, Sarwar A, Nasr N, Javed A, Majeed R, Salam MA, Billah B. Prevalence of diabetes and pre-diabetes in Bangladesh: a systematic review and meta-analysis. BMJ Open 2020; 10:e036086. [PMID: 32907898 PMCID: PMC7482481 DOI: 10.1136/bmjopen-2019-036086] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 06/02/2020] [Accepted: 07/24/2020] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The purpose of this paper is to perform a systematic review and meta-analysis in order to summarise the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh. DESIGN Systematic review and meta-analysis. PARTICIPANTS General population of Bangladesh. DATA SOURCES PubMed, Medline, Embase, Bangladesh Journals Online, Science Direct, Scopus, Cochrane Library and Web of Science were used to search for studies, published between 1st of January 1995 and 31st of August 2019, on the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh. Only articles published in the English language articles were considered. Two authors independently selected studies. The quality of the articles was also assessed. RESULTS Out of 996 potentially relevant studies, 26 population-based studies, which together involved a total of 80 775 individuals, were included in the meta-analysis. The pooled prevalence of diabetes in the general population was 7.8% (95% CI: 6.4-9.3). In a sample of 56 452 individuals, the pooled prevalence of pre-diabetes was 10.1% (95% CI: 6.7-14.0; 17 studies). The univariable meta-regression analyses showed that the prevalence of diabetes is associated with the factors: the year of study, age of patients and presence of hypertension. The prevalence of diabetes was significantly higher in urban areas compared with rural areas, while there was no significant gender difference. CONCLUSIONS This meta-analysis suggests a relatively high prevalence of pre-diabetes and diabetes in Bangladesh, with a significant difference between rural and urban areas. The main factors of diabetes include urbanisation, increasing age, hypertension and time period. Further research is needed to identify strategies for early detecting, prevention and treatment of people with diabetes in the population. PROSPERO REGISTRATION NUMBER CRD42019148205.
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Affiliation(s)
- Sohail Akhtar
- Deaprtment of Statistics, Government College University Lahore, Lahore, Punjab, Pakistan
| | - Jamal Abdul Nasir
- Deaprtment of Statistics, Government College University Lahore, Lahore, Punjab, Pakistan
| | - Aqsa Sarwar
- Deaprtment of Statistics, Government College University Lahore, Lahore, Punjab, Pakistan
| | - Nida Nasr
- Deaprtment of Statistics, Government College University Lahore, Lahore, Punjab, Pakistan
| | - Amara Javed
- Deaprtment of Statistics, Government College University Lahore, Lahore, Punjab, Pakistan
- School of Statistics, Minhaj University, Lahore, Pakistan
| | - Rizwana Majeed
- Deaprtment of Statistics, Government College University Lahore, Lahore, Punjab, Pakistan
| | - Muhammad Abdus Salam
- Deaprtment of Statistics, Government College University Lahore, Lahore, Punjab, Pakistan
| | - Baki Billah
- SPHPM, Monash University, Melbourne, Victoria, Australia
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Afroz A, Alam K, Ali L, Karim A, Alramadan MJ, Habib SH, Magliano DJ, Billah B. Type 2 diabetes mellitus in Bangladesh: a prevalence based cost-of-illness study. BMC Health Serv Res 2019; 19:601. [PMID: 31455307 PMCID: PMC6712789 DOI: 10.1186/s12913-019-4440-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The economic burden of type 2 diabetes has not been adequately investigated in many low- and lower middle-income countries, including Bangladesh. The aim of this study was to estimate the cost-of-illness of type 2 diabetes and to find its determinants in Bangladesh. METHODS A cross-sectional study was conducted in 2017 to recruit 1253 participants with type 2 diabetes from six diabetes hospitals, providing primary to tertiary health care services, located in the northern and central regions of Bangladesh. A structured questionnaire was used for face-to-face interviewing to collect non-clinical data. Patients' medical records were reviewed for clinical data and hospital records were reviewed for hospitalisation data. Cost was calculated from the patient's perspective using a bottom-up methodology. The direct costs for each patient and indirect costs for each patient and their attendants were calculated. The micro-costing approach was used to calculate direct cost and the human capital approach was used to calculate indirect cost. Median regression analysis was performed to identify the determinants of average annual cost. RESULTS Among the participants, 54% were male. The mean (±SD) age was 55.1 ± 12.5 years and duration of diabetes was 10.7 ± 7.7 years. The average annual cost was US$864.7 per patient. Medicine cost accounted for 60.7% of the direct cost followed by a hospitalisation cost of 27.7%. The average annual cost for patients with hospitalisation was 4.2 times higher compared to those without hospitalisation. Being females, use of insulin, longer duration of diabetes, and presence of diabetes complications were significantly related to the average annual cost per patient. CONCLUSIONS The cost of diabetes care is considerably high in Bangladesh, and it is primarily driven by the medicine and hospitalisation costs. Optimisation of diabetes management by positive lifestyle changes is urgently required for prevention of comorbidities and complications, which in turn will reduce the cost.
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Affiliation(s)
- Afsana Afroz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St. Kilda Rd., Level 4, Melbourne, VIC, 3004, Australia
| | - Khurshid Alam
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Liaquat Ali
- Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
| | - Afsana Karim
- Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Mohammed J Alramadan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St. Kilda Rd., Level 4, Melbourne, VIC, 3004, Australia
| | - Samira Humaira Habib
- Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Dianna J Magliano
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St. Kilda Rd., Level 4, Melbourne, VIC, 3004, Australia.,BakerIDI Heart and Diabetes Institute, Melbourne, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St. Kilda Rd., Level 4, Melbourne, VIC, 3004, Australia.
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Bishwajit G, Yaya S, Seydou I. Diabetes mellitus and high blood pressure in relation to BMI among adult non-pregnant women in Bangladesh. Diabetes Metab Syndr 2017; 11 Suppl 1:S217-S221. [PMID: 27993540 DOI: 10.1016/j.dsx.2016.12.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/12/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the association between overweight and obesity (in terms of BMI) and diabetes, HBP and diabetes-HBP comorbidity among adult women non-pregnant in Bangladesh. METHODS Information about demographics, socioeconomic, blood pressure and blood glucose levels were collected for 2022 women ageing above 35 years were collected from Bangladesh Demographic and Health Survey (BDHS 2011). The primary outcome variables were diabetes and high blood pressure. Diabetes was defined as fasting plasma glucose value ≥7.0mmol/L and HBP as systolic blood pressure ≥140mmHg or diastolic blood pressure ≥90mmHg. Blood pressure and plasma glucose measurement were performed by standard clinical procedures. Data were analysed using cross-tabulation, chi-square tests and logistic regression methods. RESULTS Mean age of the participants was 41.42 (SD=4.37). 38.7% of the women had BMI values ≥25. The prevalence of HBP, diabetes, and diabetes-HBP comorbidity was respectively 18% and 5.1%, and 2%. The adjusted odds of having diabetes, HBP and Diabetes-HBP comorbidity were respectively 2.14 (p=0.002; 95%CI=1.31-3.48), 2.3 (p=<0.0001; 95%CI=1.70-2.98), and 3.4 (p=0.004; 95%CI=1.47-7.81) times higher among overweight/obese women compared to those with normal weight. CONCLUSIONS Overweight and obesity account for a major proportion of diabetes, HBP and the comorbidity of these two among non-pregnant women. There remains a considerable risk for future expansion of diabetes and HBP as the prevalence of overweight/obesity is rising constantly. Maintaining a healthy BMI needs to be regarded as among the most important diabetes and HBP preventive strategies among Bangladeshi women.
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Affiliation(s)
- Ghose Bishwajit
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka 1000, Bangladesh; School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Canada.
| | - Ide Seydou
- Interdisciplinary School of Health Sciences, University of Ottawa, Canada.
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Jayawardana NWIA, Jayalath WATA, Madhujith WMT, Ralapanawa U, Jayasekera RS, Alagiyawanna SASB, Bandara AMKR, Kalupahana NS. Lifestyle factors associated with obesity in a cohort of males in the central province of Sri Lanka: a cross-sectional descriptive study. BMC Public Health 2017; 17:27. [PMID: 28056898 PMCID: PMC5217224 DOI: 10.1186/s12889-016-3963-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 12/20/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Obesity has become a global epidemic. The prevalence of obesity has also increased in the South Asian region in the last decade. However, dietary and lifestyle factors associated with obesity in Sri Lankan adults are unclear. The objective of the current study was to investigate the association of dietary and lifestyle patterns with overweight and obesity in a cohort of males from the Central Province of Sri Lanka. METHODS A total of 2469 males aged between 16 and 72 years ([Formula: see text]) were included in the study. The sample comprised individuals who presented for a routine medical examination at the National Transport Medical Institute, Kandy, Sri Lanka. The Body Mass Index (BMI) cutoff values for Asians were used to categorize the participants into four groups as underweight, normal weight, overweight or obese. The data on dietary and lifestyle patterns such as level of physical activity, smoking, alcohol consumption, sleeping hours and other socio demographic data were obtained using validated self-administered questionnaires. Multinomial logistic regression model was fitted to assess the associations of individual lifestyle patterns with overweight and obesity. RESULTS The mean BMI of the study group was 22.7 kg m-2 and prevalence rates of overweight and obesity were 31.8 and 12.3%, respectively. Mean waist circumference of the participants was 78.6 cm with 17.1% of them being centrally obese. After adjusting for potential confounders, weight status was associated with older age (P < 0.0001), ethnicity (P = 0.0033) and higher income (P = 0.0006). While higher physical activity showed a trend for being associated with lower odds of being obese (odds ratio: 0.898 - confidence interval: 0.744-1.084), alcohol intake, consumption of fruits, level of education, sleeping hours, smoking, consumption of fish, meat, dairy, sweets or fried snacks were not significantly associated with the weight status. CONCLUSION The high prevalence rates of overweight and obesity in working-age males is a threatening sign for Sri Lanka. Since the prevalence rate is higher in certain ethnic groups and higher-income groups, targeted interventions for these groups may be necessary.
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Affiliation(s)
- N W I A Jayawardana
- Department of Animal and Food Sciences, Faculty of Agriculture, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - W A T A Jayalath
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - W M T Madhujith
- Department of Food Science and Technology, Faculty of Agriculture, University of Peradeniya, Peradeniya, Sri Lanka
| | - U Ralapanawa
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - S A S B Alagiyawanna
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - A M K R Bandara
- Department of Agricultural Systems, Faculty of Agriculture, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - N S Kalupahana
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
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Biswas T, Islam A, Rawal LB, Islam SMS. Increasing prevalence of diabetes in Bangladesh: a scoping review. Public Health 2016; 138:4-11. [PMID: 27169347 DOI: 10.1016/j.puhe.2016.03.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 01/18/2016] [Accepted: 03/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The prevalence of type 2 diabetes is increasing rapidly in Bangladesh. However, studies documenting the increasing trend of diabetes prevalence are scarce. The aim of this study was to conduct a scoping review of published literature to ascertain the changing patterns of diabetes prevalence in Bangladesh. METHODOLOGY We conducted a scoping review based on York scoping reviews framework and performed a comprehensive search of published literature through Medline, BanglaJOL, and Google Scholar published between 1994 and 2013. We summarised and calculated the time trends and pooled prevalence for type 2 diabetes among adults (≥18 years) in both urban and rural areas in Bangladesh. RESULTS Of 152 studies identified, we included 22 studies for the scoping review which met the inclusion criteria. Overall, 11 studies (50%) were conducted in rural areas, eight in urban (36%) and three (14%) in semi-urban, semi-rural and tribal areas. The overall prevalence of type 2 diabetes ranged between 4.5% and 35.0%. The final estimate of diabetes prevalence obtained after pooling of data from individual studies among 51,252 participants was 7.4% (95% CI 7.2-7.7%). The prevalence of diabetes was higher in males compared to females in urban areas and vice-versa in rural areas. Analyses of exponential trend revealed an increasing trend of diabetes prevalence among urban and rural population at a rate of 0.05% (R = 0.18) and 0.06% (R = 0.35) per year, respectively. CONCLUSION The prevalence of type 2 diabetes showed an increasing trend in both urban and rural population in Bangladesh. Our findings suggest the need for an all-out effort by the government and stakeholders to implement preventive strategies for diabetes in Bangladesh.
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Affiliation(s)
- T Biswas
- International Center for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - A Islam
- International Center for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh; School of Health Policy & Management, Faculty of Health, York University, Toronto, Canada
| | - L B Rawal
- International Center for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - S M S Islam
- International Center for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh; Center for International Health (CIH), Ludwig-Maximilians-Universität (LMU), Munich, Germany; Cardiovascular Division, The George Institute for Global Health, University of Sydney, Sydney, Australia.
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Alam DS, Talukder SH, Chowdhury MAH, Siddiquee AT, Ahmed S, Pervin S, Khan S, Hasan K, Koehlmoos TLP, Niessen LW. Overweight and abdominal obesity as determinants of undiagnosed diabetes and pre-diabetes in Bangladesh. BMC OBESITY 2016; 3:19. [PMID: 27004127 PMCID: PMC4797177 DOI: 10.1186/s40608-016-0099-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 03/09/2016] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Dewan S Alam
- School of Kinesiology and Health Science, Faculty of Health York University, Room 362, Stong College, 4700 Keele St, Toronto, ON M3J 1P3 Canada
| | - Shamim H Talukder
- Eminence, Hena Nibash, 3/6, Asad Avenue, Mohammadpur, Dhaka 1207 Bangladesh
| | | | | | - Shyfuddin Ahmed
- Centre for Control of Chronic Diseases, icddr,b, Mohakhali, Dhaka, Bangladesh
| | - Sonia Pervin
- Centre for Control of Chronic Diseases, icddr,b, Mohakhali, Dhaka, Bangladesh
| | - Sushmita Khan
- Eminence, Hena Nibash, 3/6, Asad Avenue, Mohammadpur, Dhaka 1207 Bangladesh
| | - Khaled Hasan
- Centre for Control of Chronic Diseases, icddr,b, Mohakhali, Dhaka, Bangladesh
| | - Tracey L P Koehlmoos
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland, 20814-4799 USA
| | - Louis W Niessen
- Centre for Apllied Health Research and Delivery, Liverpool School of Tropical Medicine, Pembroke Place, L3 6PQ Liverpool, UK
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Islam FMA, Chakrabarti R, Islam MT, Wahab M, Lamoureux E, Finger RP, Shaw JE. Prediabetes, diagnosed and undiagnosed diabetes, their risk factors and association with knowledge of diabetes in rural Bangladesh: The Bangladesh Population-based Diabetes and Eye Study. J Diabetes 2016; 8:260-8. [PMID: 25851830 DOI: 10.1111/1753-0407.12294] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/12/2015] [Accepted: 03/22/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of the present study was to determine the prevalence and risk factors of prediabetes and diagnosed and undiagnosed diabetes mellitus (DM) in rural Bangladesh. METHODS Using a population-based cluster random sampling strategy, 3104 adults aged ≥30 years were recruited. Fasting capillary blood glucose, blood pressure, height, weight, waist circumference, and knowledge, attitudes, and practice related to diabetes were recorded. Diabetes was defined as fasting glucose (FG) ≥7.0 mmol/L or a self-reported diagnosis of diabetes; impaired FG (IFG) was defined as FG ≥ 6.1 and <7.0 mmol/L. RESULTS The overall crude prevalence of DM was 7.2% (95% confidence interval [CI] 6.3%-8.1%; n = 222), of which 55% (n = 123) was previously undiagnosed (UDM). The prevalence of IFG was 5.3% (95% CI 4.5%-6.1%; n = 163). The age-standardized prevalence of DM and IFG was 6.6% and 5.0%, respectively. The prevalence of UDM was higher in people of lower socioeconomic status (59% vs. 31%; P < 0.001). Of those with known DM, 56% had poor glycemic control (FG ≥ 7.0 mmol/L) and 37% were not on medication. Overall knowledge of DM was poor; only 16.3%, 17.8%, and 13.4% of those with UDM, IFG, and normal FG knew that diabetes causes eye disease, compared with 55.6% of those with known DM (Ptrend < 0.001). CONCLUSIONS In this rural Bangladeshi community, UDM was high. Lower socioeconomic status was associated with a higher risk of UDM. Overall knowledge of DM was poor. Public health programmes should target those of low socioeconomic status and aim to increase knowledge of DM in rural Bangladesh.
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Affiliation(s)
- Fakir M Amirul Islam
- Department of Statistics, Data Science and Epidemiology, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Victoria, Australia
- Organisation for Rural Community Development (ORCD), Dariapur, Bangladesh
| | - Rahul Chakrabarti
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Organisation for Rural Community Development (ORCD), Dariapur, Bangladesh
| | - M Tauhidul Islam
- Organisation for Rural Community Development (ORCD), Dariapur, Bangladesh
| | - Mohammad Wahab
- Organisation for Rural Community Development (ORCD), Dariapur, Bangladesh
| | - Ecosse Lamoureux
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Duke-National University of Singapore, Graduate Medical School
- Singapore Eye Research Institute, Singapore
| | - Robert P Finger
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Kreatsoulas C, Corsi DJ, Subramanian SV. Commentary: The salience of socioeconomic status in assessing cardiovascular disease and risk in low- and middle-income countries. Int J Epidemiol 2015; 44:1636-47. [PMID: 26493737 DOI: 10.1093/ije/dyv182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Daniel J Corsi
- Ottawa Hospital Research Institute, Ottawa, ON, Canada and
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Chowdhury MAB, Uddin MJ, Khan HMR, Haque MR. Type 2 diabetes and its correlates among adults in Bangladesh: a population based study. BMC Public Health 2015; 15:1070. [PMID: 26483053 PMCID: PMC4610042 DOI: 10.1186/s12889-015-2413-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 10/12/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Type 2 diabetes is one of the most prevalent non-communicable diseases in Bangladesh. However, the correlates of type 2 diabetes among adults in Bangladesh remain unknown. We aimed to investigate the correlates of type 2 diabetes among the adults in Bangladesh. METHODS We conducted a cross-sectional study using data from the nationally representative 2011 Bangladesh Demographic and Health Survey. A random sample of 7,543 (3,823 women and 3,720 men) adults of age 35 years and older from both urban and rural areas, who participated in the survey was included. Diabetes was defined as having a fasting plasma blood glucose level of ≥ 7 mm/L or taking diabetes medication during the survey. Hypothesized factors, e.g., age, sex, education, place of residence, social status, body mass index, and hypertension were considered in the analyses. Multivariable logistic regression models were used to identify the important correlates of type 2 diabetes. RESULTS Among the respondents, the overall prevalence of diabetes was 11 %, and the prevalence was slightly higher in women (11.2 %) than men (10.6 %). Respondents with the age group of 55-59 years had higher odds of having diabetes (odds ratios (OR) = 2.37, 95 % confidence interval (CI): 1.76-3.21) than the age group of 35-39 years. Moreover, respondents who had higher educational attainment (OR = 1.67, 95 % CI: 1.18-2.36) and higher social status (OR = 2.01, 95 % CI: 1.50-2.70) had higher odds of having diabetes than the respondents with no education and lower social status, respectively. We also found socioeconomic status, place of residence (rural or urban), regions of residence (different divisions), overweight and obesity, and hypertension as significant correlates of type 2 diabetes in Bangladesh. CONCLUSIONS Our study shows that older age, higher socioeconomic status, higher educational attainment, hypertension, and obesity were found to be significant correlates of type 2 diabetes. Need-based policy program strategies including early diagnosis, awareness via mass media, and health education programs for changing lifestyles should be initiated for older age, wealthy, and/or higher educated individuals in Bangladesh. Moreover, area-specific longitudinal research is necessary to find out the underlying causes of regional variations.
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Affiliation(s)
- Muhammad Abdul Baker Chowdhury
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA.
| | - Md Jamal Uddin
- Department of Statistics, Shahjalal University of Science & Technology, Sylhet, 3114, Bangladesh.
| | - Hafiz M R Khan
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA.
| | - Md Rabiul Haque
- Department of Population Sciences, University of Dhaka, Dhaka, 1000, Bangladesh.
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Beigi T, Shafaei A, Khoshnia M, Marjani A. Serum Fetuin A Level, Liver Enzymes Activities and Insulin Resistance in Patients with Type 2 Diabetes. JOURNAL OF MEDICAL SCIENCES 2015. [DOI: 10.3923/jms.2015.229.234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Ashtari S, Pourhoseingholi MA, Zali MR. Non-alcohol fatty liver disease in Asia: Prevention and planning. World J Hepatol 2015; 7:1788-1796. [PMID: 26167252 PMCID: PMC4491908 DOI: 10.4254/wjh.v7.i13.1788] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 12/03/2014] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To review all of epidemiological aspects of non-alcoholic fatty liver disease (NAFLD) and also prevent this disease is examined.
METHODS: We conducted a systematic review according to the PRISMA guidelines. All searches for writing this review is based on the papers was found in PubMed (MEDLINE), Cochrane database and Scopus in August and September 2014 for topic of NAFLD in Asia and the way of prevention of this disease, with no language limitations. All relevant articles were accessed in full text and all relevant materials was evaluated and reviewed.
RESULTS: NAFLD is the most common liver disorder in worldwide, with an estimated with 20%-30% prevalence in Western countries and 2%-4% worldwide. The prevalence of NAFLD in Asia, depending on location (urban vs rural), gender, ethnicity, and age is variable between 15%-20%. According to the many studies in the world, the relationship between NAFLD, obesity, diabetes mellitus, and metabolic syndrome (MS) is quiet obvious. Prevalence of NAFLD in Asian countries seems to be lower than the Western countries but, it has increased recently due to the rise of obesity, type 2 diabetes and MS in this region. One of the main reasons for the increase in obesity, diabetes and MS in Asia is a lifestyle change and industrialization. Today, NAFLD is recognized as a major chronic liver disease in Asia. Therefore, prevention of this disease in Asian countries is very important and the best strategy for prevention and control of NAFLD is lifestyle modifications. Lifestyle modification programs are typically designed to change bad eating habits and increase physical activity that is associated with clinically significant improvements in obesity, type 2 diabetes and MS.
CONCLUSION: Prevention of NAFLD is very important in Asian countries particularly in Arab countries because of high prevalence of obesity, diabetes and MS.
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Natasha K, Hussain A, Azad Khan AK, Bhowmik B. Prevalence of Depression and Glucose Abnormality in an Urbanizing Rural Population of Bangladesh. Diabetes Metab J 2015; 39:218-29. [PMID: 26124992 PMCID: PMC4483607 DOI: 10.4093/dmj.2015.39.3.218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 11/17/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Depression and glucose abnormality are increasing in Bangladesh including its rural area. This study was designed to determine the prevalence of depression in an urbanizing rural population of Bangladesh with or without glucose abnormality (including diabetes mellitus [DM], and pre-diabetes which combines impaired fasting glucose and impaired glucose tolerance pre-DM). METHODS A total of 2,293 subjects aged ≥20 years were investigated. Sociodemographic and anthropometric details, blood pressure, fasting (fasting plasma glucose) and 2 hours after 75 g plasma glucose (2-hour plasma glucose), were studied. Montgomery-Asberg Depression Rating Scale was used to assess depression. RESULTS The overall prevalence of DM was 7.9% and pre-DM was 8.6%. Prevalence of depression was 15.31% (n=351; 95% confidence interval [CI], 1.59 to 1.36) with mean depressive score 17.62±3.49. Female were more likely to have depression (17.16%). The 22.35% of male and 29.46% of female with pre-DM and 26.58% male and 36.27% female with DM had depressive symptoms. There was no significant variation in the mean age of different groups (healthy, depressed and with glucose abnormality). Depression was significantly associated with age, marital status, occupation, high physical activity, and low body mass index. The odds ratio (OR) for depression was significantly increased in patients with glucose abnormality compared with those without pre-DM (OR, 2.49; 95% CI, 1.76 to 3.51; P<0.000) and DM (OR, 3.27; 95% CI, 2.33 to 4.60; P<0.000). CONCLUSION Prevalence of depression found alarming in our study area though lesser than previous studies and it is significantly related to glucose abnormality. The study reveals that mental health should get more focused specially along with metabolic diseases.
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Affiliation(s)
- Khurshid Natasha
- Institute of Health and Society, Section for International Health, University of Oslo, Oslo, Norway
- Bangladesh University of Health Sciences, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Akhtar Hussain
- Institute of Health and Society, Section for International Health, University of Oslo, Oslo, Norway
| | - A. K. Azad Khan
- Bangladesh University of Health Sciences, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Bishwajit Bhowmik
- Institute of Health and Society, Section for International Health, University of Oslo, Oslo, Norway
- Bangladesh University of Health Sciences, Diabetic Association of Bangladesh, Dhaka, Bangladesh
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Shah SM, Loney T, Dhaheri SA, Vatanparast H, Elbarazi I, Agarwal M, Blair I, Ali R. Association between acculturation, obesity and cardiovascular risk factors among male South Asian migrants in the United Arab Emirates--a cross-sectional study. BMC Public Health 2015; 15:204. [PMID: 25885030 PMCID: PMC4358865 DOI: 10.1186/s12889-015-1568-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/17/2015] [Indexed: 12/02/2022] Open
Abstract
Background Approximately 65% of the United Arab Emirates (UAE) population are economic migrants from the low- and middle-income countries of South Asia. Emerging evidence suggests that expatriate populations from low or middle-income countries that migrate to high-income countries acculturate their lifestyle with the obesogenic behaviours of the host country. Previous research has focussed on migrant populations in the United States. The objective of this study was to assess the prevalence of obesity and explore the relationship between years of residency (surrogate measure for acculturation) and obesity among South Asian (from India, Pakistan and Bangladesh) male immigrants residing in the UAE. Methods A random sample of 1375 males was recruited from a mandatory residency visa health screening centre in Abu Dhabi (UAE). Employing a cross-sectional design, participants completed an interviewer-led adapted version of the World Health Organisation STEPS questionnaire, and anthropometric and blood pressure measurements were collected. Glycated haemoglobin (HbA1c) was measured in a random sub-sample (n = 100). Logistic regression was used to determine risk factors for being classified as obese, and to assess the relationship between years of residency and adiposity. Results The overall prevalence of body mass index-derived overweight and obesity estimates and waist-to-hip-derived central obesity rates was 615 (44.7%) and 917 (66.7%) males, respectively. Hypertension was present in 419 (30.5%) of the sample and diabetes in 9 (9.0%) of the sub-sample. Living in the UAE for six to 10 years or more than 10 years was independently associated with being classified with central obesity (adjusted odds ratio [AOR] 1.63 95% confidence intervals [CI] 1.13 - 2.35, p < 0.008; AOR 1.95 95% CI 1.26 - 3.01, p < 0.002; respectively) compared to residing in the UAE for one to five years. Conclusions Our study revealed a high prevalence of overweight, central obesity and hypertension amongst a young South Asian male migrant population in the UAE. Study findings suggest a diminished ‘Healthy Migrant Effect’ with increased years of residency possibly due to greater acculturation and a transition in lifestyle behaviours. Health initiatives targeting the maintenance of a healthy body size, coupled with regular assessments of glucose control and blood pressure are urgently required in this population.
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Affiliation(s)
- Syed M Shah
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
| | - Tom Loney
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
| | | | - Hassan Vatanparast
- School of Public Health, College of Nutrition and Pharmacy, University of Saskatchewan, Saskatchewan, Canada.
| | - Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
| | - Mukesh Agarwal
- Department of Pathology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
| | - Iain Blair
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
| | - Raghib Ali
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
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Abstract
People of South Asian origin are at a high risk of developing diabetes compared to that of other ethnic groups. Recent evidence suggests an emerging epidemic of youth-onset type 2 diabetes (T2DM) in the region, in parallel with the childhood obesity epidemic. Many risk factors such as foetal and early-life influences, the South Asian phenotype, family history of diabetes and environment factors are responsible for the early occurrence of T2DM in South Asia. The high risk supports the need for the opportunistic screening of children and adolescents for diabetes in South Asian countries. Early detection, lifestyle modification, weight reduction and drugs are central to the care of children with T2DM. Both population-based preventive strategies and interventions targeting children and adolescents with obesity and impaired glucose tolerance are required to combat the epidemic of youth-onset T2DM in South Asia.
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Affiliation(s)
- P A Praveen
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India,
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Khan MMH, Gruebner O, Kraemer A. The geography of diabetes among the general adults aged 35 years and older in Bangladesh: recent evidence from a cross-sectional survey. PLoS One 2014; 9:e110756. [PMID: 25356781 PMCID: PMC4214709 DOI: 10.1371/journal.pone.0110756] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/19/2014] [Indexed: 12/03/2022] Open
Abstract
Objective To report geographical variations of sex-specific diabetes by place of residence (large cities/city corporations, small towns/other urban areas, rural areas) and region of residence (divided into seven divisions) among general adults (35+ years of age) in Bangladesh. Methods The recent cross-sectional data, extracted from the nationally representative Bangladesh Demographic and Health Survey 2011, was used. A total of 3,720 men and 3,823 women aged 35+ years, who participated in the fasting blood sugar testing, were analysed. Any person with either fasting plasma glucose level (mmol/L) ≥7.0 or taking medication for diabetes was considered as a person with diabetes. Results The prevalence of diabetes was 10.6% in men and 11.3% in women. Bivariable analyses indicated significant variations of diabetes by both geographical variables. The prevalence was highest in city corporations (men 18.0%, women 22.3%), followed by small towns (men 13.6%, women 15.2%) and rural areas (men 9.3%, women 9.5%). Regional disparities in diabetes prevalence were also remarkable, with the highest prevalence in Chittagong division and lowest prevalence in Khulna division. Multivariable logistic regression analyses provided mixed patterns of geographical disparities (depending on the adjusted variables). Some other independent risk factors for diabetes were advancing age, higher level of education and wealth, having TV (a proxy indicator of physical activity), overweight/obesity and hypertension. Conclusions Over 10% of the general adults aged 35 years and older were having diabetes. Most of the persons with diabetes were unaware of this before testing fasting plasma glucose level. Although significant disparities in diabetes prevalence by geographical variables were observed, such disparities are very much influenced by the adjusted variables. Finally, we underscore the necessities of area-specific strategies including early diagnosis and health education programmes for changing lifestyles to reduce the risk of diabetes in Bangladesh.
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Affiliation(s)
- Md. Mobarak Hossain Khan
- Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany
- * E-mail:
| | - Oliver Gruebner
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Alexander Kraemer
- Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany
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Zaman FA, Borang A. Prevalence of diabetes mellitus amongst rural hilly population of North Eastern India and its relationship with associated risk factors and related co-morbidities. J Nat Sci Biol Med 2014; 5:383-8. [PMID: 25097420 PMCID: PMC4121920 DOI: 10.4103/0976-9668.136195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CONTEXT Diabetes has emerged as pandemic health problem and its prevalence is increasing at an alarming rate. AIMS The aim of the following study was carried out to understand the prevalence of diabetes mellitus, its associated risk factors and related co-morbidities amongst persons residing in rural hilly terrain of Upper Siang district of Arunachal Pradesh, India. SETTINGS AND DESIGN Population based cross-sectional study on 1370 participants in the field practice area of a private Nursing School in Yingkion in Upper Siang district of Arunachal Pradesh, India was conducted during April 2009-March, 2010. MATERIALS AND METHODS The clinico-social data related to diabetes was gathered by personal interview. Body weight, height, waist circumference and blood pressure were measured and blood glucose was estimated in fasting venous blood samples. RESULTS Diabetes mellitus was observed among 19.78% of the participants with additional 12.04% patients with impaired glucose tolerance (IGT). Diabetes mellitus was most prevalent among 50-59 years age group (32.10%). Hypertension was observed among participants with diabetes and IGT was 65.13% (hypertensive diabetics) and 53.94% (diabetics only). Mean body mass index and associated family history was added risk factors in prevalence of diabetes. CONCLUSIONS Effective primary prevention strategies are to be intensified among the high-risk population groups to promote awareness through behavior change communication.
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Affiliation(s)
- Forhad Akhtar Zaman
- Department of Community Medicine, Sikkim Manipal Institute of Medical Sciences and Central Referral Hospital, Tadong, Gangtok, Sikkim, India
| | - Anita Borang
- Department of Community Nursing, Siang Nursing School, Yingkiong, Upper Siang, Arunachal Pradesh, India
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Saquib N, Khanam MA, Saquib J, Anand S, Chertow GM, Barry M, Ahmed T, Cullen MR. High prevalence of type 2 diabetes among the urban middle class in Bangladesh. BMC Public Health 2013; 13:1032. [PMID: 24172217 PMCID: PMC3924340 DOI: 10.1186/1471-2458-13-1032] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 10/23/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The prevalence of type-2 diabetes and metabolic syndrome are increasing in the developing world; we assessed their prevalence among the urban middle class in Bangladesh. METHODS In this cross-sectional survey (n = 402), we randomly selected consenting adults (≥ 30 years) from a middle-income neighborhood in Dhaka. We assessed demography, lifestyle, and health status, measured physical indices and blood pressure and obtained blood samples. We evaluated two primary outcomes: (1) type-2 diabetes (fasting blood glucose ≥ 7.0 mmol/L or hemoglobin A1C ≥ 6.5% (48 mmol/mol) or diabetes medication use) and (2) insulin resistance (type-2 diabetes or metabolic syndrome using International Diabetes Federation criteria). RESULTS Mean age and Quételet's (body mass) index were 49.4 ± 12.6 years and 27.0 ± 5.1 kg/m²; 83% were married, 41% had ≥12 years of education, 47% were employed, 47% had a family history of diabetes. Thirty-five percent had type-2 diabetes and 45% had metabolic syndrome. In multivariate models older age and family history of diabetes were significantly associated with type-2 diabetes. Older age, female sex, overweight or obese, high wealth index and positive family history of diabetes were significantly associated with insulin resistance. Participants with type-2 diabetes or insulin resistance had significantly poorer physical health only if they had associated cardiovascular disease. CONCLUSIONS The prevalence of type-2 diabetes and metabolic syndrome among the middle class in Dhaka is alarmingly high. Screening services should be implemented while researchers focus on strategies to lessen the incidence and morbidity associated with these conditions.
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Affiliation(s)
| | | | | | | | | | | | | | - Mark R Cullen
- Stanford University School of Medicine, General Medical Disciplines, Stanford University, Stanford, CA, USA.
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Antihyperglycemic effects of short term resveratrol supplementation in type 2 diabetic patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:851267. [PMID: 24073011 PMCID: PMC3773903 DOI: 10.1155/2013/851267] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 07/25/2013] [Indexed: 12/16/2022]
Abstract
The objective of this study was to examine the effectiveness of resveratrol in lowering blood glucose in the presence of standard antidiabetic treatment in patients with type 2 diabetes, in a randomized placebo-controlled double-blinded parallel clinical trial. A total of 66 subjects with type 2 diabetes were enrolled in this study and randomly assigned to intervention group which was supplemented with resveratrol at a dose 1 g/day for 45 days and control group which received placebo tablets. Body weight, blood pressure, fasting blood glucose, haemoglobin A1c, insulin, homeostatic assessments for insulin resistance, triglycerides, total cholesterol, low density lipoprotein, high density lipoprotein, and markers of liver and kidney damage were measured at baseline and after 45 days of resveratrol or placebo supplementation. Resveratrol treatment significantly decreased systolic blood pressure, fasting blood glucose, haemoglobin A1c, insulin, and insulin resistance, while HDL was significantly increased, when compared to their baseline levels. On the other hand, the placebo group had slightly increased fasting glucose and LDL when compared to their baseline levels. Liver and kidney function markers were unchanged in the intervention group. Overall, this study showed that resveratrol supplementation exerted strong antidiabetic effects in patients with type 2 diabetes.
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Izadi N, Malek M, Aminian O, Saraei M. Medical risk factors of diabetes mellitus among professional drivers. J Diabetes Metab Disord 2013; 12:23. [PMID: 23725484 PMCID: PMC3674897 DOI: 10.1186/2251-6581-12-23] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 05/21/2013] [Indexed: 11/10/2022]
Abstract
Background Road transport drivers are one of the professional groups whose activities have a strong impact of public safety. In view of the natural professional activity, the drivers are at a higher risk of obesity, hypertension and hyperlipidemia, and carbohydrate metabolism disorders such as diabetes mellitus. Materials and methods Medical documentation was the source of data for the reported study. It derived from medical examinations of 1903 drivers applying for driving license. Results Hyperglycemia was found in 52.1% of the drivers, 9.1% of them were in diabetic stage, and with HbA1C criteria 77.6% of these drivers were in this stage. Excessive body weight was recorded in 65.6% of the study population, 44.8% were diagnosed with overweight and 20.8% with obesity. High blood pressure was recorded in 16.4% of drivers. Conclusion High prevalence of excessive body weight and high blood pressure and hyperlipidemia are risk factors for diabetes mellitus in professional drivers that indicates a need to undertake multidimensional actions target on this particular profession and involving various health care sectors. Prophylactic and detailed pre-placement examinations should be considered, depending on the rate and the intensity of disorders. These should be coupled with an introduction of primary and secondary prophylactic activities and monitoring of relevant treatment.
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Affiliation(s)
- Nazanin Izadi
- Center for Research on Occupational Diseases, Tehran University of Medical Sciences, Tehran, Iran.
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Bhowmik B, Binte Munir S, Ara Hossain I, Siddiquee T, Diep LM, Mahmood S, Mahtab H, Khan AKA, Hussain A. Prevalence of type 2 diabetes and impaired glucose regulation with associated cardiometabolic risk factors and depression in an urbanizing rural community in bangladesh: a population-based cross-sectional study. Diabetes Metab J 2012; 36:422-32. [PMID: 23275936 PMCID: PMC3530713 DOI: 10.4093/dmj.2012.36.6.422] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 09/03/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To determine the prevalence of type 2 diabetes (T2DM) and impaired glucose regulation (impaired fasting glucose [IFG] and impaired glucose tolerance [IGT]) in an urbanizing rural population of Bangladesh and associated cardiometabolic risk indicators and depression. METHODS A total of 2,293 subjects aged ≥20 years in an urbanizing rural Bangladeshi community were investigated. Socio-demographic and anthropometric details, blood pressure, fasting plasma glucose (FPG), 2 hours after 75 g plasma glucose (2hPG), glycosylated hemoglobin, fasting serum insulin and lipid profiles were studied. Presence of depressive symptoms using Montogomery-Asberg Depression Rating Scale was also assessed. RESULTS The prevalence of IFG, IGT, IFG+IGT, and T2DM were 3.4%, 4.0%, 1.2%, and 7.9%, respectively. The prevalence of T2DM and impaired glucose regulation differed between males and females, but, both increased with age in both sexes. FPG and 2hPG had positive correlation. Employing logistic regression, it was found that increased age, waist to hip ratio, systolic blood pressure, total cholesterol, triglycerides, and depression were independent risk indicators for diabetes. Both insulin resistance and β-cell deficiency were significantly related for causation of diabetes. Among the study population, 26.2% had general obesity, 39.8% central obesity, 15.5% hypertension, 28.7% dyslipidemia, 17.6% family history of diabetes, and 15.3% had depression. Physical inactivity and smoking habits were significantly higher in male. CONCLUSION Rising prevalence of diabetes and impaired glucose regulation in this urbanizing rural population exist as a significant but hidden public health problem. Depression and other cardiometabolic risk indicators including obesity, hypertension, and dyslipdemia were also prevalent in this population.
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Affiliation(s)
- Bishwajit Bhowmik
- Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sanjida Binte Munir
- Executive Diabetes Care Centre, NHN, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Israt Ara Hossain
- Department of Biochemistry & Cell Biology, Bio-Medical Research Group, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Tasnima Siddiquee
- Diabetes Prevention Intervention Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Lien My Diep
- Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sharif Mahmood
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Hajera Mahtab
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - A. K. Azad Khan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Akhtar Hussain
- Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
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Vaz NC, Ferreira A, Kulkarni M, Vaz FS, Pinto N. Prevalence of diabetic complications in rural goa, India. Indian J Community Med 2012; 36:283-6. [PMID: 22279258 PMCID: PMC3263148 DOI: 10.4103/0970-0218.91330] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 09/20/2011] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To determine the prevalence of diabetes mellitus (DM) and its associated diabetic complications in rural Goa, India. MATERIALS AND METHODS A community-based study was carried out in a rural setting in Goa, India. About 1,266 participants were selected by systematic random sampling. The participants were interviewed using a semi-structured questionnaire and were subjected to anthropometric, clinical evaluation and biochemical investigations. American Diabetes Association criteria were used to determine the prevalence of diabetes and standard operational definitions were used to define the diabetic complications. Data was analyzed using SPSS version 14.0 while chi-square and chi-square for trend were the tests used. RESULTS Among the total 1,266 study participants about 130 (10.3%) were diabetics. The prevalence of the associated diabetic complications were as follows viz. neuropathy (60%), CHD (32.3%) and cataract (20%), retinopathy (15.4%), peripheral vascular disease (11.5%) and cerebrovascular accidents (CVAs) (6.9%). A significant rising trend in the prevalence of all diabetic complications was observed with advancing duration of diabetes. CONCLUSION The prevalence of DM and its associated complications was higher among the diabetic individuals in the rural setting of Goa, India. All the associated diabetic complications observed need to be addressed with appropriate prevention and control strategies.
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Affiliation(s)
- Nafisa C Vaz
- Department of Preventive and Social Medicine, Goa Medical College, Bambolim, Goa, India
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Saquib N, Saquib J, Ahmed T, Khanam MA, Cullen MR. Cardiovascular diseases and type 2 diabetes in Bangladesh: a systematic review and meta-analysis of studies between 1995 and 2010. BMC Public Health 2012; 12:434. [PMID: 22694854 PMCID: PMC3487781 DOI: 10.1186/1471-2458-12-434] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 05/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Belief is that chronic disease prevalence is rising in Bangladesh since death from them has increased. We reviewed published cardiovascular (CVD) and Type 2 Diabetes Mellitus (T2DM) studies between 1995 and 2010 and conducted a meta-analysis of disease prevalence. METHODS A systematic search of CVD and T2DM studies yielded 29 eligible studies (outcome: CVD only = 12, T2DM only = 9, both = 8). Hypertension (HTN) was the primary outcome of CVD studies. HTN and T2DM were defined with objective measures and standard cut-off values. We assessed the study quality based on sampling frame, sample size, and disease evaluation. Random effects models calculated pooled disease prevalence (95% confidence interval) in studies with general population samples (n = 22). RESULTS The pooled HTN and T2DM prevalence were 13.7% (12.1%-15.3%) and 6.7% (4.9%-8.6%), respectively. Both diseases exhibited a secular trend by 5-year intervals between 1995 and 2010 (HTN = 11.0%, 12.8%, 15.3%, T2DM = 3.8%, 5.3%, 9.0%). HTN was higher in females (M vs. F: 12.8% vs.16.1%) but T2DM was higher in males (M vs. F: 7.0% vs. 6.2%) (non-significant). Both HTN and T2DM were higher in urban areas (urban vs. rural: 22.2% vs. 14.3% and 10.2% vs. 5.1% respectively) (non-significant). HTN was higher among elderly and among working professionals. Both HTN and T2DM were higher in 'high- quality' studies. CONCLUSIONS There is evidence of a rising secular trend of HTN and T2DM prevalence in Bangladesh. Future research should focus on the evolving root causes, incidence, and prognosis of HTN and T2DM.
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Affiliation(s)
- Nazmus Saquib
- School of Medicine, Stanford University, Stanford, USA
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Islam MR, Khan I, Hassan SMN, McEvoy M, D’Este C, Attia J, Peel R, Sultana M, Akter S, Milton AH. Association between type 2 diabetes and chronic arsenic exposure in drinking water: a cross sectional study in Bangladesh. Environ Health 2012; 11:38. [PMID: 22676249 PMCID: PMC3403856 DOI: 10.1186/1476-069x-11-38] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 06/07/2012] [Indexed: 05/08/2023]
Abstract
BACKGROUND Chronic exposure to high level of inorganic arsenic in drinking water has been associated with Type 2 Diabetes (T2D). Most research has been ecological in nature and has focused on high levels of arsenic exposure with few studies directly measuring arsenic levels in drinking water as an index of arsenic exposure. The effect of low to moderate levels of arsenic exposure on diabetes risk is largely unknown thus our study is adding further knowledge over previous works. METHODS This cross sectional study was conducted in 1004 consenting women and men from 1682 eligible participants yielding a participation rate of 60%. These participants are aged >30 years and were living in Bangladesh and had continuously consumed arsenic-contaminated drinking water for at least 6 months. T2D cases were diagnosed using glucometer following the new diagnostic criteria (Fasting Blood Glucose > 126 mg/dl) from the WHO guideline (WHO 2006), or a self-reported physician diagnosis of type 2 diabetes. Association between T2D and chronic arsenic exposure was estimated by multiple logistic regression with adjustment for age, sex, education, Body Mass Index (BMI) and family history of T2D. RESULTS A total of 1004 individuals participated in the study. The prevalence of T2D was 9% (95% CI 7-11%). After adjustment for diabetes risk factors, an increased risk of type 2 diabetes was observed for arsenic exposure over 50 μg/L with those in the highest category having almost double the risk of type 2 diabetes (OR=1.9 ; 95% CI 1.1-3.5). For most levels of arsenic exposure, the risk estimates are higher with longer exposure; a dose-response pattern was also observed. CONCLUSIONS These findings suggest an association between chronic arsenic exposure through drinking water and T2D. Risks are generally higher with longer duration of arsenic exposure. The risk of T2D is highest among those who were exposed to the highest concentration of arsenic for more than 10 years.
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Affiliation(s)
- Md Rafiqul Islam
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Ismail Khan
- Department of Pharmacology, Dhaka Medical College, Dhaka, Bangladesh
| | - Sheikh Md Nazmul Hassan
- Department of Public Health, Atish Dipankar University of Science & Technology, Dhaka, Dhanmondi, Bangladesh
| | - Mark McEvoy
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Catherine D’Este
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - John Attia
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Roseanne Peel
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Munira Sultana
- Centre for Health and Development (CHAD), Gopalgonj, Bangladesh
| | - Shahnaz Akter
- Institute of Child and Mother Health (ICMH), Dhaka, Bangladesh
| | - Abul Hasnat Milton
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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Hwang CK, Han PV, Zabetian A, Ali MK, Narayan KMV. Rural diabetes prevalence quintuples over twenty-five years in low- and middle-income countries: a systematic review and meta-analysis. Diabetes Res Clin Pract 2012; 96:271-85. [PMID: 22261096 DOI: 10.1016/j.diabres.2011.12.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 11/15/2011] [Accepted: 12/01/2011] [Indexed: 01/29/2023]
Abstract
AIMS To verify the assertions that diabetes pandemic may be spreading across rural parts of low- and middle-income countries (LMICs), we performed a systematic review of published studies reporting diabetes prevalence in rural parts of LMICs. METHODS Electronic databases (EMBASE and MEDLINE) were searched for papers published from 1990 to 2011. Two independent reviewers screened the articles using structured criteria for inclusion and performed full-text reviews. Pooled prevalence of diabetes was estimated using meta-analysis. Potential factors influencing the estimates were identified by meta-regression and used for sensitivity analyses. RESULTS Rural prevalence of diabetes of LMICs was 5.6% (95% CI=4.6-6.6), and similar between men and women. This estimate remained robust in separate sensitivity analyses accounting for study quality, level of heterogeneity, age, and sex. In a multivariate meta-regression analysis, pooled prevalence varied by study year and region. Diabetes prevalence increased over time, from 1.8% (1.0-2.6) in 1985-1989, 5.0% (3.8-6.3) in 1990-1994, 5.2% (4.1-6.2) in 1995-1999, 6.4% (5.1-7.7) in 2000-2004, and to 8.6% (6.4-10.7) for 2005-2010 (p=0.001 for secular trend). CONCLUSIONS Prevalence of diabetes in rural parts of LMICs has risen dramatically. As 55% of LMIC populations live in rural areas, this trend has enormous implications for the global burden of diabetes.
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Katikireddi SV, Morling JR, Bhopal R. Is there a divergence in time trends in the prevalence of impaired glucose tolerance and diabetes? A systematic review in South Asian populations. Int J Epidemiol 2011; 40:1542-53. [PMID: 22158665 DOI: 10.1093/ije/dyr159] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Recently, diabetes prevalence has increased in South Asians making it a global public health priority. There are suggestions that pre-diabetes, including impaired glucose tolerance (IGT), may not be increasing. We conducted a systematic review to explore the paradox. Research Design and Methods We searched electronic databases from inception to June 2009 for cross-sectional studies providing prevalence of pre-diabetes (using WHO criteria) in South Asian adult populations. Two reviewers independently screened articles, performed data extraction, quality appraisal and study classification with any discrepancies resolved by consensus. Repeated cross-sectional studies, categorized by pre-specified criteria, were used for the primary analysis, supplemented by analysis of comparable and all studies. RESULTS In total, 79 cross-sectional data sets (from 69 published studies) were identified resulting in the inclusion of 179 408 people. Four sets of repeated cross-sectional studies, conducted in Chennai, rural Tamil Nadu, Mauritius and Singapore (n = 30,399), provided time trend information. Three of them showed an increase in diabetes prevalence (P < 0.001) whereas IGT fell in two (P < 0.05), and was stable in the remainder. A similar pattern was seen among three other sets of comparable studies (n = 58,820) and in scatterplots of all 79 data sets. CONCLUSION This novel systematic review is the first to assess secular trends of pre-diabetes in any population. The data show diabetes prevalence is rising, whereas IGT prevalence is stable or falling. Explanations include: recent environmental or lifestyle changes favouring an increased rate of conversion from IGT to diabetes, or a cohort effect with improving maternal and infant nutrition resulting in reduced IGT with a fall in diabetes to follow.
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Affiliation(s)
- Srinivasa V Katikireddi
- Department of Public Health and Health Policy, NHS Lothian, Waverley Gate, Waterloo Place, Edinburgh.
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Asghar S, Khan AKA, Ali SMK, Sayeed MA, Bhowmik B, Diep ML, Shi Z, Hussain A. Incidence of diabetes in Asian-Indian subjects: a five year follow-up study from Bangladesh. Prim Care Diabetes 2011; 5:117-124. [PMID: 21306967 DOI: 10.1016/j.pcd.2011.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 05/11/2010] [Accepted: 01/07/2011] [Indexed: 12/19/2022]
Abstract
AIMS To determine the incidence of Type 2 diabetes and its risk factors. Further, to examine the effect of relative changes in obesity (BMI and waist circumference). METHODS A sample of 2011 non-diabetic adults aged 20 and above were randomly selected and followed from 1999 to 2004. Fasting blood glucose including biophysical and anthropometric measures was measured. RESULTS The overall 5 year cumulative incidence of diabetes was 16.4 per 1000 person-years and 65.1 per 1000 person-years in those with impaired fasting glucose adjusted for age and sex. Among obesity measures, only waist >85in. increased the risk for diabetes in males (RR=3.0). Relative changes stratified by loss in BMI and WC ≥5% or gain of BMI >15% from the baseline values for men were significantly associated with the incidental cases of diabetes. Increased hip circumference for men was significantly associated with a protective effect while an opposite association was observed for women. CONCLUSION Relative change in both loss and excessive gain of BMI were risks for increased diabetes. Targeted intervention in those with impaired fasting blood glucose will expectedly reduce the incidental cases. Further investigations are needed for non obese related diabetes in Asian Indian subjects.
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Affiliation(s)
- Shaheen Asghar
- Inst of Health and Society/Dept. of International Health, University of Oslo, Oslo, Norway
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New food composition data on selected ethnic foods consumed in Europe. Eur J Clin Nutr 2010; 64 Suppl 3:S82-7. [DOI: 10.1038/ejcn.2010.216] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Pierce BL, Kalra T, Argos M, Parvez F, Chen Y, Islam T, Ahmed A, Hasan R, Rakibuz-Zaman M, Graziano J, Rathouz PJ, Ahsan H. A prospective study of body mass index and mortality in Bangladesh. Int J Epidemiol 2009; 39:1037-45. [PMID: 20032266 DOI: 10.1093/ije/dyp364] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Body mass index (BMI) (kg/m(2)) has a U- or J-shaped relationship with all-cause mortality in Western and East Asian populations. However, this relationship is not well characterized in Bangladesh, where the BMI distribution is shifted towards lower values. METHODS Using data on 11,445 individuals (aged 18-75 years) participating in the Health Effects of Arsenic Longitudinal Study (HEALS) in Araihazar, Bangladesh, we prospectively examined associations of BMI (measured at baseline) with all-cause mortality during approximately 6 years of follow-up. We also examined this relationship within strata of key covariates (sex, age, smoking, education and arsenic exposure). Cox proportional hazards models adjusted for these covariates and BMI-related illnesses were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for BMI categories defined by the World Health Organization. RESULTS Low BMI was strongly associated with increased mortality in this cohort (P-trend < 0.0001). Severe underweight (BMI < 16 kg/m(2); HR 2.06, CI 1.53-2.77) and moderate underweight (16.0-16.9 kg/m(2); HR 1.39, CI 1.01-2.90) were associated with increased all-cause mortality compared with normal BMI (18.6-22.9 kg/m(2)). The highest BMI category (> or =23.0 kg/m(2)) did not show a clear association with mortality (HR 1.10, CI 0.77-1.53). The BMI-mortality association was stronger among individuals with <5 years of formal education (interaction P = 0.02). CONCLUSIONS Underweight (presumably due to malnutrition) is a major determinant of mortality in the rural Bangladeshi population.
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Affiliation(s)
- Brandon L Pierce
- Department of Health Studies, The University of Chicago, Chicago, IL 60637, USA
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The Asian enigma: predisposition for low adult BMI among people of South Asian descent. Public Health Nutr 2008; 12:507-16. [PMID: 18507888 DOI: 10.1017/s1368980008002826] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the Asian enigma, the phenomenon of relatively high levels of undernutrition among children and adult women in South Asia, despite more favourable records with respect to infant mortality, women's education, food availability or other aspects of living conditions in comparison with, for example, sub-Saharan Africa. DESIGN Literature has been explored to identify countries outside South Asia that are home to sizeable population segments from different ethnic backgrounds, including people of South Asian and African descent, and to compare prevalence rates of undernutrition in combination with indicators of standard of living between these various population segments. RESULTS Data on adult undernutrition prevalence rates among population groups of different ethnic descent living in the same country (South Africa, Fiji and the USA) generally reveal the highest prevalence rates of low BMI among adults, males and females, from South Asian background. The relatively high rates of low BMI among adults from South Asian background cannot be explained by less favourable socio-economic characteristics, such as lower income or less access to food. CONCLUSION It is hypothesized that there exists among adults of South Asian descent an ethnic predisposition for a low BMI. Other factors that may contribute to high levels of undernutrition in South Asia are discrimination of women and a poor dietary quality of poor households' food composition pattern. The question needs to be addressed whether the commonly used cut-off point for adult underweight (BMI < 18.5 kg/m2) is universally applicable or whether ethnic differences should be taken into account.
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Rahim MA, Khan AKA, Ali SMK, Nahar Q, Shaheen A, Hussain A. Glucose tolerance in a rural population of Bangladesh. Int J Diabetes Dev Ctries 2008; 28:45-50. [PMID: 19902047 PMCID: PMC2772011 DOI: 10.4103/0973-3930.43098] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
CONTEXT The prevalence of type 2 diabetes is increasing in the Bangladeshi population. However, there is little information available on the prevalence of glucose intolerance, ie, type 2 diabetes, impaired glucose tolerance, and impaired fasting glucose. AIMS The main aim of this study is to determine the prevalence of different categories of glucose intolerance and their relationship with different anthropometric and demographic characteristics. SETTINGS AND DESIGN This cross-sectional study was performed in a rural area of Bangladesh. MATERIALS AND METHODS A random sample of 5000 persons aged >/= 20 years was included in this study. Fasting blood glucose was measured in 3981 individuals and 2-h post-glucose blood glucose was measured in 3954 subjects after the known cases of diabetes (n = 27) were excluded. Height, weight, waist and hip circumference, and blood pressure were measured. STATISTICAL ANALYSIS Pearson Chi-squared test and correlation test were used for analysis as appropriate. RESULTS The prevalence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and diabetes (DM) were 1.3, 2.0, and 7.0%, respectively. IFG, IGT, and IFG + IGT were more prevalent in females. Age showed a significant positive relationship with increasing levels of glucose intolerance. Body mass index, waist circumference, and waist-to-hip ratio were higher in the glucose-intolerant group than in the normal glucose tolerance (NGT) group. There was a positive correlation between FBG and 2-h BG in NGT and DM subjects. CONCLUSION The FBG value identified more people with glucose intolerance than the 2-h BG. These findings will help developing diabetes preventive strategy in rural populations.
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Affiliation(s)
- M. A. Rahim
- Institute of General Practice and Community Medicine, Department of International Health, University of Oslo, Norway
| | - A. K. Azad Khan
- Department of Epidemiology and Biostatistics, Research Division, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - S. M. K. Ali
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| | - Q. Nahar
- Center on the Family, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - A. Shaheen
- Institute of Psychiatric Research University of Oslo, Norway
| | - A. Hussain
- Institute of General Practice and Community Medicine, Department of International Health, University of Oslo, Norway
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