M. Mostafa Zaman

Angiotensin converting enzyme genetic polymorphism is not associated with hypertension in a cross-sectional sample of a Japanese population : the Shibata Study

Background The studies on the association of deletion/insertion (D/I) polymorphism of angiotensin converting enzyme (ACE) gene with blood pressure and hypertension reported contradictory results. Because there was no population-based study in Japan, we examine the hypothesized association in a cross-sectional sample of a Japanese cohort. Methods and results The blood pressure of 464 men and 876 women aged 40–80 years was measured, and their DNA was analyzed for ACE D/I genotypes. The prevalence of the D allele was 38.7 and 39.2% in men and women, respectively (overall 39%). There was a tendency for higher covariate (age, body mass index, albuminuria, hematocrit, alcohol consumption, smoking, diabetes mellitus, ischemic heart disease and antihypertensive medication) adjusted mean levels of diastolic blood pressure for the DD genotype in men but not in women. However, this tendency disappeared after dichotomization of blood pressure into diagnostic categories (normotension and hypertension). Results did not differ when the subjects were divided into two age groups (⩽ 59 and ⩾ 60 years). Covariate-adjusted odds ratios for hypertension for presence of the D allele were close to the null value of one. ACE genetic variation accounted for only 0.1 and 0.7% of the inter-individual variation in systolic and diastolic blood pressure in men. These estimates were 0.2 and 0.1%, respectively, in women. Conclusion Although there is a tendency of higher diastolic blood pressure in men with DD genotypes, there is no convincing evidence that ACE genotypes are associated with hypertension in this Japanese population.

Prevalence of rheumatic fever and rheumatic heart disease in rural Bangladesh

A community-based study was done on 5923 rural Bangladeshi children aged 5-15 years to determine the prevalence of rheumatic fever (RF) and rheumatic heart disease (RHD). The prevalence was found to be 1.2 (95% confidence interval 0.3-2.1) per 1000 for RF defined by revised Jones criteria and 1.3 (0.4-2.2) per 1000 for Doppler echocardiography-confirmed RHD.

Does rheumatic fever occur usually between the ages of 5 and 15 years

It has long been considered that rheumatic fever usually occurs in children between the ages of 5 and 15 years. However, supporting data from the developing countries are insufficient. It is important to know the age of occurrence of rheumatic fever for clinical and public health purposes. To describe the age distribution of Bangladeshi subjects, we have reviewed the records of all patients who attended with acute rheumatic fever in the outpatient department of the National Center for Control of Rheumatic Fever and Heart Diseases, Dhaka, during June 1990 through November 1995. During this period 630 subjects were diagnosed to have acute rheumatic fever defined by the revised Jones criteria. Of them, 535 (84.9%) presented with first attack. Their age ranged from 3 to 30 years, and a skewness to the right of the age distribution was observed. Thus, we used percentile distribution to determine reference range of age. The 2.5 and 97.5 percentiles were 5 and 22 years, respectively. Their mean (standard deviation) and median age were 12.7 (4.4) and 12 years, respectively. Slightly more than 22% of subjects were older than 15 while less than 1% were younger than 5 years. This finding was supported by multiethnic data from other developing countries. The current analysis warrants reevaluation of the prevailing conviction for age of occurrence of rheumatic fever. In conclusion, the age reference range for occurrence of rheumatic fever in Bangladesh should be considered to be 5 to 22 years but not 5 to 15 years.

Prevalence of Metabolic Syndrome in Rural Bangladeshi Women

The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) (1) defined metabolic syndrome as a presence of any three of the following (in women): 1 ) waist circumference >88 cm, 2 ) high triglycerides (≥150 mg/dl), 3 ) low HDL cholesterol (<50 mg/dl), 4 ) high blood pressure (≥130/85 mmHg or use of antihypertensive therapy), and 5 ) high fasting blood glucose (≥110 mg/dl). This clustering of risk factors in metabolic syndrome ultimately leads to diabetes and premature cardiovascular disease (2). It is imperative to identify individuals with metabolic syndrome early so that lifestyle interventions and treatment may prevent the development of diabetes and/or cardiovascular diseases. The aim …

Association of rheumatic fever with serum albumin concentration and body iron stores in Bangladeshi children: case-control study

Malnutrition in early life may cause metabolic1 and immune2 imbalance and consequently affect tissue reactivity of the child to group A β haemolytic streptococcal infection of the throat, leading to rheumatic fever.1 In developing countries protein and iron deficiencies during childhood are common and cause growth retardation,3 which is also found in rheumatic fever.4 Iron deficiency predisposes to repeated infections,3 which are necessary for a rheumatic attack. We examined whether rheumatic fever is associated with serum protein concentrations and body iron stores in Bangladeshi children. View this table: Mean (SD) concentrations of nutritional markers, with risk of rheumatic fever associated with one unit increase in their serum values Recruitment of subjects and their socioeconomic background are described elsewhere.4 Briefly, 218 consecutive subjects aged 5 to 20 years who had a recent infection with group A β haemolytic streptococci were selected in the outpatient clinic of the National Centre for Control of Rheumatic Fever and Heart Diseases, Dhaka. Of them, 60 had rheumatic fever (as …

Plasma lipids in a rural population of Bangladesh

Background Plasma lipids are associated with cardiovascular diseases. Population-based data on plasma lipids are scarce in Bangladesh. Methods We investigated plasma lipid levels in a rural population of Bangladesh in 2001. Fasting blood was collected in 447 adults (157 men and 290 women) aged 20–79 years (mean ± standard deviation 40 ± 11 years in men, and 39 ± 10 in women). Results The mean total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides and total cholesterol/HDL cholesterol ratio levels were 182 ± 56, 39 ± 10, 115 ± 53, 139 ± 72 mg/dl and 4.8 ± 1.8, respectively. The prevalence of abnormal lipid levels were as follows: hypercholesterolemia (total cholesterol >240 mg/dl) 16.1%, high LDL cholesterol (>160 mg/dl) 20.4%, low HDL cholesterol (>40mg/dl) 66.4%, hypertriglyceridemia (>200mg/dl) 15.0% and total cholesterol/HDL cholesterol ratio (>5.5) 32.7%. Conclusions The prevalence of dyslipidemias, especially in the case of low HDL cholesterol, appears to be high even in this rural population of Bangladesh. Eur J Cardiovasc Prev Rehabil 13:444–448

Burden of Cardio- and Cerebro-vascular Diseases and the Conventional Risk Factors in South Asian Population

Similar to most populations, South Asian countries are also witnessing the dramatic transitions in health during the last few decades with the major causes of adverse health shifting from a predominance of nutritional deficiencies and infectious diseases to chronic diseases such as cardio and cerebrovascular disease (CVD). We summarized the available information of the burden of CVD and risk factors in the South Asian populations. The prevalence of conventional cardiovascular has been increasing among all South Asian populations. Extensive urbanization, shift in dietary pattern and sedentary daily life style is contributing towards the worsening of the CVD risk factor scenario. The burdens of the chronic cardiovascular risk factors are much prevalent in the South Asian populations. These are also rising alarmingly which ought to influence the already existed heavy CVD burden. Similar to the rest of the world, management for the conventional cardiovascular risk factors is very important for the prevention of CVD in South Asia.

Declining trend of rheumatic fever observed in Bangladesh, 1991-1997.

present study fungal elements were seen in three of four samples by direct microscopy. Strict aseptic precautions taken during collection and isolation of A. pullulans in more than one culture media as pure growth makes the possibility of contamination negligible. The fungal infections were treated by topical natamycin. Fungi are important causes of corneal infection not because of the difficulty in diagnosing and treating them but because of the serious ocular consequences. An ongoing comprehensive survey is therefore necessary to assess the specific epidemiological characteristics which are unique to each region for rapid referral, diagnosis, treatment and prevention. Declining trend of rheumatic fever observed in Bangladesh, 1991-1997

Prevalence, treatment patterns, and risk factors of hypertension and pre-hypertension among Bangladeshi adults

In Bangladesh, morbidity and mortality due to non-communicable diseases (NCDs) has increased over the last few decades. Hypertension is an important risk factor for NCDs, specifically cardiovascular disease. The objective of this study was to assess prevalence and risk factors for hypertension and pre-hypertension among adults in Bangladesh. Data for this analysis were collected during the national NCD Risk Factor Survey of Bangladesh conducted in 2010 from a representative sample of men and women, aged 25 years or above. The survey adopted a multistage, geographically clustered, probability-based sampling approach. WHO STEPS questionnaire was used to collect data on demographics, behavioral risk factors, and physical measurements. Overall, 20% of the study population were hypertensive at study measurement. The prevalence of hypertension increased with age and body mass index (BMI). Twelve percent of the population were previously diagnosed with hypertension. Among these individuals, nearly half were not taking any medications to control their hypertension. Additionally, the prevalence of pre-hypertension was 43%, with higher levels among males, older age groups, and those with higher education, higher wealth index and high BMI. Predictors of hypertension, included older age, high BMI, and diabetes comorbidity. Based on this study, we estimate that 1 out of 5 Bangladeshi adults have hypertension. The risk of hypertension increases with older age and high BMI. Additionally, prevalence of pre-hypertension is high in Bangladesh in both rural and urban areas. Findings from this study can be used to inform public health programming to control the spread of NCDs in Bangladesh.

Salt Intake in an Adult Population of Bangladesh

Salt Intake in an Adult Population of Bangladesh High dietary salt intake is an important risk factor of hypertension and other noncommunicable diseases (NCD). Therefore it has been identified as an indicator of global monitoring framework for NCD control [1]. Under this framework, a 30% relative reduction of dietary salt intake (compared with the 2010 baseline) has been targeted by 2025. Along with 8 other targets of risk reduction and the health system’s response, a 25% relative reduction of premature mortality of NCD is expected. The World Health Organization and Food and Agricultural Organization recommend an intake of <5 gm of sodium chloride from all sources. However, dietary salt intake ismuch higher than this inmany of the countries. On the other hand,many countries do not have representative population data on dietary salt intake. Bangladesh is one of these countries. Intakes as high as 15 g/day and 21 g/day were reported based on industrial output and hospital patient data reports [2], respectively. A campaign on salt reduction in Bangladesh has already started. However, a 2010 baseline for evaluating progress on salt reduction is not available for the Bangladeshi population. We have done this study to estimate themean level salt intake in the Bangladeshi adult population. A cross-sectional study was done in 2009 in a rural community (Ekhlaspur village of Chandpur district) and an urban worksite (National Heart Foundation Hospital and Research Institute, Dhaka). A total of 200 (100 rural and 100 urban) persons aged 20 years or older volunteered to participate in this study in response to an invitation to all adults of Ekhlaspur and all personnel of the National Heart Foundation. Equal numbers of men and women were recruited in consecutive order until we achieved the targeted number. A questionnaire was used to collect data on their habit of adding salt during meals. Information was also requested about the usual amount of monthly salt purchased for the household. Number of household members both children ( 12 years) and older children and adults (>12 years) were noted. Children were assigned a 50% weight of an adult to estimate per capita consumption of purchased salt. The amount of salt (in grams) purchased for the household in a month was divided by the weighted number of household members to get the quantity of added salt taken (added during cooking and while eating a meal) by an individual per