Babies of South Asian and European Ancestry Show Similar Associations With Genetic Risk Score for Birth Weight Despite the Smaller Size of South Asian Newborns

Size at birth is known to be influenced by various fetal and maternal factors, including genetic effects. South Asians have a high burden of low birth weight and cardiometabolic diseases, yet studies of common genetic variations underpinning these phenotypes are lacking. We generated independent, weighted fetal genetic scores (fGSs) and maternal genetic scores (mGSs) from 196 birth weight-associated variants identified in Europeans and conducted an association analysis with various fetal birth parameters and anthropometric and cardiometabolic traits measured at different follow-up stages (5-6-year intervals) from seven Indian and Bangladeshi cohorts of South Asian ancestry. The results from these cohorts were compared with South Asians in UK Biobank and the Exeter Family Study of Childhood Health, a European ancestry cohort. Birth weight increased by 50.7 g and 33.6 g per SD of fGS (P = 9.1 × 10-11) and mGS (P = 0.003), respectively, in South Asians. A relatively weaker mGS effect compared with Europeans indicates possible different intrauterine exposures between Europeans and South Asians. Birth weight was strongly associated with body size in both childhood and adolescence (P = 3 × 10-5 to 1.9 × 10-51); however, fGS was associated with body size in childhood only (P < 0.01) and with head circumference, fasting glucose, and triglycerides in adults (P < 0.01). The substantially smaller newborn size in South Asians with comparable fetal genetic effect to Europeans on birth weight suggests a significant role of factors related to fetal growth that were not captured by the present genetic scores. These factors may include different environmental exposures, maternal body size, health and nutritional status, etc. Persistent influence of genetic loci on size at birth and adult metabolic syndrome in our study supports a common genetic mechanism that partly explains associations between early development and later cardiometabolic health in various populations, despite marked differences in phenotypic and environmental factors in South Asians.

Evaluation of knowledge regarding gestational diabetes mellitus: a Bangladeshi study

OBJECTIVE

The aim of this study was to evaluate the level of knowledge about gestational diabetes mellitus (GDM) in Bangladeshi people.

STUDY DESIGN

Cross-sectional study.

METHODS

This study involving 1374 participants was conducted in 15 outpatient clinics of Diabetic Association of Bangladesh and its affiliated associations, Bangabandhu Sheikh Mujib Medical University and four medical college hospitals in Bangladesh from August 2015 to December 2015. A pretested interviewer-administered questionnaire was used to obtain information related to sociodemographic status, level of education, types of profession, and medical history. The questionnaire included eight questions on GDM. Level of knowledge (mean ± 1 standard deviation [SD]) was categorized as poor, average, and good. Descriptive, Chi-squared, and regression analysis were performed to express the results.

RESULTS

Of total knowledge score of 8, participants' mean knowledge score (±SD) was 2.7 ± 1.5. The levels of good, average, and poor knowledge were 26.3%, 63.1%, and 10.6%, respectively. In multivariate analysis, participants aged below 30 years (P < 0.001), male gender (P < 0.001), high-income group (P < 0.001), having university education (P < 0.001), health professionals (P < 0.001), capital Dhaka city residents (P < 0.001), those with family history of diabetes (P = 0.007), and participants with diabetes (P = 0.007) were found to be significantly associated with the good knowledge score.

CONCLUSIONS

Participants in this study had average knowledge about GDM. New innovative strategies should be developed to improve the knowledge of GDM among health professionals and general population.

HbA(1c) as a diagnostic tool for diabetes and pre-diabetes: the Bangladesh experience

AIMS

To evaluate HbA(1c) as a tool for the diagnosis of diabetes and pre-diabetes (impaired glucose tolerance and/or impaired fasting glucose) and to identify the optimal cut-off values suitable for a Bangladeshi population.

METHODS

In this cross-sectional survey in a rural community, 2293 randomly selected individuals aged ≥ 20 years without prior history of diabetes were included. HbA(1c) and other clinical covariates necessary for the diagnosis of diabetes were recorded. Diabetes and pre-diabetes were defined according to the World Health Organization 1999 criteria. The receiver operating characteristic curve was used to determine the performance of HbA(1c).

RESULTS

The prevalences of diabetes and pre-diabetes were 7.9 and 8.6%, respectively. Based on receiver operating characteristic curve analysis, an HbA(1c) cut-off value of ≥ 42 mmol/mol (≥ 6.0%) gave an optimal sensitivity of 86.2% and specificity of 93.3%, with an area under the curve of 0.949 to predict diabetes using the oral glucose tolerance test as the gold standard; a cut-off value of ≥ 38 mmol/mol (≥ 5.6%) gave an optimal sensitivity of 68.0% and specificity of 66.4%, with an area under the curve of 0.714 to predict pre-diabetes. In subjects at high risk of diabetes, HbA(1c) ≥ 42 mmol/mol (≥ 6.0%) showed higher sensitivity than fasting plasma glucose ≥ 7.0 mmol/l, 2-h plasma glucose ≥ 11.1 mmol/l and HbA(1c) ≥ 48 mmol/mol (≥ 6.5%).

CONCLUSIONS

An HbA(1c) cut-off value of ≥ 42 mmol/mol (≥ 6.0%) was highly sensitive and specific in diagnosing diabetes mellitus. This optimal cut-off level may be suitable as a diagnostic criterion for diabetes in a Bangladeshi population.

Prevalence of depression and diabetes: a population-based study from rural Bangladesh

AIMS

To determine the extent of depressive symptoms in a rural community of Bangladesh and its association with newly recognized diabetes.

METHODS

Depressive symptoms were assessed in 184 newly diagnosed diabetic subjects and 768 randomly selected individuals without diabetes. The Montogomery and Aasberg Depression Rating Scale (MADRS) was used to assess depressive symptoms. A structured interview was performed to obtain socio-demographic and economic information and anthropometric measures were collected. Fasting plasma glucose was measured by the HemoCue glucose analyser.

RESULTS

Twenty-nine percent of male and 30.5% of female participants with diabetes and 6.0% of male and 14.6% of female subjects without diabetes had depressive symptoms rating > or = 20 on the MADRS. An association between depressive symptoms and diabetes was found (P < 0.01). After controlling for potential confounding factors including age, gender, fasting plasma glucose > 7.0 mmol/l and waist-hip ratio, the association of depression with diabetes remained significant.

CONCLUSIONS

An unexpectedly high level of unrecognized depressive symptoms was found in the general rural population of Bangladesh. These are among the first data to suggest that depressive symptoms in this culture are common, especially in women. Depression is particularly common in those with diabetes. Psychiatric intervention may be necessary in addition to lifestyle changes to prevent the exponential increase in the occurrence of Type 2 diabetes. In addition, a common approach including psychiatric treatment in diabetes care may be necessary to achieve improved glycaemic control in this population.

Prevalence of type 2 diabetes in urban slums of Dhaka, Bangladesh

This cross-sectional study was conducted to estimate the prevalence of type 2 diabetes along with its risk factors in urban slum population of Dhaka, Bangladesh. A random sample of 1555 slum dwellers of Dhaka city (age > or = 20 years) were included in the study. Capillary blood glucose levels, fasting and 2-h after 75g oral glucose load (for a selected subjects, n = 476), were measured. Height, weight, waist and hip circumferences, blood pressure and some other important socio-demographic information on age, sex, education, income, and occupation status were collected. The overall prevalence of type 2 diabetes was found to be 8.1 percent, and the prevalence for men and women were 7.7 percent and 8.5 percent respectively. Prevalence of diabetes was found to be lower following 2-h glucose values in the selected population compared to the FBG procedure. Age, sex, literacy and waist to hip ratio for men were found as significant risk factors following both fasting blood glucose and 2-h post glucose values adjusted for a number of confounding variables. Poor to moderate agreement was observed between fasting blood glucose and 2-h glucose (kappa 0.41, p < 0.001). The agreement was even poorer between impaired fasting glucose and impaired glucose tolerance. Poor agreement between FBG and 2-h BG may raise concern for the dependability of diagnostic procedures. Higher prevalence of type 2 diabetes in the urban slum may indicate an epidemiological transition due to fast urban migration and possibly urbanization. However, this issue needs further exploration.

Urinary iodine status and thyroid dysfunction: a Bangladesh perspective

Iodine deficiency is endemic in Bangladesh. Compulsory iodization of table salt was introduced since 1993 to prevent and improve thyroid disorders in the country. Urinary iodine status, thyroid function and antithyroid antibodies were studied in 397 newly diagnosed thyroid patients and 94 age-sex matched controls. Among thyroid patients, 96 were hyperthyroid, 185 euthyroid and 116 hypothyroid. Mean and median urinary iodine were higher (p=0.075) in thyroid patients (26.13+/-0.91 and 23.03) than controls (22.65+/-1.47 and 18.59); in hyperthyroid and euthyroid than hypothyroid (p=0.020); in multinodular (28.08+/-2.80 and 26.94) and diffuse (27.35+/-1.19 and 26.71) goitre than uninodular (23.91+/-2.37 and 19.14) and nongoitrous (NG, 21.5+/-2.05 and 18.27) (p=0.098) patients but no sex difference (p=0.466). Antimicrosomal (26.7%) and antithyroglobulin (34%) antibodies were more frequently positive among thyroid patients than controls (6.4% and 12.8% respectively) (p=0.00002 and p=0.00005 respectively). Antibody positivity was higher in diffuse (82/228) and multinodular (20/47) goitre than nongoitrous (20/56) and uninodular (13/66) goitre (p=0.046) as well as in hypothyroid (55.2%) and hyperthyroid (36.5%) than euthyroid (19.5%) patients (P<0.001). Urinary iodine correlated neither with antimicrosomal (thyroid patients: p=0.597 and control: p=0.112) nor with antithyroglobulin (thyroid patients: p=0.388 and control: p=0.195) antibody. Thyroid autoimmunity and dysfunction seems common; and interaction of salt iodization with iodine status and thyroid disorders may be important in Bangladesh.