Prasad Katulanda

Validity of a food frequency questionnaire to assess nutritional intake among Sri Lankan adults.

Sri Lanka is undergoing nutritional transition and diet-related chronic diseases are emerging as an important health problem. Currently, no validated food frequency questionnaire (FFQ) exists to measure habitual dietary intake of Sri Lankan adults. The purpose of the study is to assess the validity of a semi-quantitative FFQ and 7-day weighed-intake dietary records (7DWR), designed to assess dietary intake among Sri Lankan adults. Dietary intake was measured using both a FFQ and 7DWR. The FFQ consisted of 8 food groups containing the main foods comprising the diet of Sri Lankan adults, a total of 85 items and 12 color photographs to identify serving size. One hundred healthy adults were randomly recruited from a community sample and administrated the FFQ followed by completion of the 7DWR. Paired sample t tests, Pearson’s correlation coefficients, kappa test and Bland–Altman analysis were conducted to determine correlation and the level of agreement for energy and micronutrients. Seventy-seven participants completed both the FFQ and 7DWR. Estimated mean energy intake (SD) from FFQ (1794xa0±xa0398xa0kcal) and 7DWR (1698xa0±xa0333xa0kcal, pxa0<xa00.001) were significantly different due to a significant overestimation of carbohydrate (11.5xa0g/day, pxa0<xa00.001) and to some extent fat (5.7xa0g/day, ns). Significant positive correlations (pxa0<xa00.05) were found between the FFQ and 7DWR for energy (rxa0=xa00.39), carbohydrate (rxa0=xa00.47), protein (rxa0=xa00.26), fat (rxa0=xa00.17) and dietary fiber (rxa0=xa00.32). Bland–Altman graphs indicated fairly good agreement between methods with no relationship between bias and average intake of each nutrient examined. Based on these findings, the FFQ appears to be an acceptable tool for assessing the nutrient intake of Sri Lankans and will assist proper categorization of individuals by dietary intake.

High dietary diversity is associated with obesity in Sri Lankan adults: an evaluation of three dietary scores

BackgroundDietary diversity is recognized as a key element of a high quality diet. However, diets that offer a greater variety of energy-dense foods could increase food intake and body weight. The aim of this study was to explore association of diet diversity with obesity in Sri Lankan adults.MethodsSix hundred adults aged > 18u2009years were randomly selected by using multi-stage stratified sample. Dietary intake assessment was undertaken by a 24u2009hour dietary recall. Three dietary scores, Dietary Diversity Score (DDS), Dietary Diversity Score with Portions (DDSP) and Food Variety Score (FVS) were calculated. Body mass index (BMI) ≥ 25u2009kg.m-2 is defined as obese and Asian waist circumference cut-offs were used diagnosed abdominal obesity.ResultsMean of DDS for men and women were 6.23 and 6.50 (p=0.06), while DDSP was 3.26 and 3.17 respectively (p=0.24). FVS values were significantly different between men and women 9.55 and 10.24 (p=0.002). Dietary diversity among Sri Lankan adults was significantly associated with gender, residency, ethnicity, education level but not with diabetes status. As dietary scores increased, the percentage consumption was increased in most of food groups except starches. Obese and abdominal obese adults had the highest DDS compared to non obese groups (p<0.05). With increased dietary diversity the level of BMI, waist circumference and energy consumption was significantly increased in this population.ConclusionOur data suggests that dietary diversity is positively associated with several socio-demographic characteristics and obesity among Sri Lankan adults. Although high dietary diversity is widely recommended, public health messages should emphasize to improve dietary diversity in selective food items.

Effects of Zinc supplementation on serum lipids: a systematic review and meta-analysis.

Zinc is a mineral that plays a vital role in many biological processes and plays an important role in insulin action and carbohydrate metabolism. It may also have a protective role in the prevention of atherogenesis. Numerous studies have evaluated the effects of Zinc supplementation on serum lipids in humans and have demonstrated varying results. We systematically evaluated the literature and performed a meta-analysis on the effects of Zinc supplementation on serum lipids. A five staged comprehensive search of the literature was conducted in the following databases; PubMed, Web of Science and SciVerse Scopus for studies published before 31st December 2014. All controlled clinical trial in humans, that included a Zinc supplement intervention, either alone or in combination with other micronutrients and evaluated effects on serum lipids (total cholesterol [TC], triglycerides [TG], LDL cholesterol [LDL-c] and HDL cholesterol [HDL-c]). A meta-analysis of selected studies was performed using RevMan v5.3. The Jaded scale was used to assess the methodological quality of the trials included in the systematic review. A total of 24 studies were included in Meta analysis, which included a total of 33 Zinc interventions, in a total of 14,515 participants in the Zinc intervention or control group. The duration of Zinc supplementation ranged from 1xa0month to 7.5xa0years. The dose of elemental Zinc supplemented ranged from 15–240xa0mg/day. The pooled mean difference for TC between Zinc supplemented and placebo groups from random effects analysis was −10.92xa0mg/dl (95 % CI: −15.33, −6.52; pu2009<u20090.0001, I2u2009=u200983xa0%), while for HDL cholesterol it was 2.12xa0mg/dl (95 % CI: −0.74, 4.98; pu2009=u20090.15, I2u2009=u200983xa0%). The pooled mean difference for LDL-c between Zinc supplemented and placebo group from random effect analysis was −6.87xa0mg/dl (95 % CI: −11.16,-2.58; pu2009<u20090.001, I2u2009=u200931) and for TG it was −10.92xa0mg/dl (95 % CI: −18.56, − 3.28; pu2009<u20090.01, I2u2009=u200969xa0%). In conclusion, Zinc supplementation has favourable effects on plasma lipid parameters. Zinc supplementation significantly reduced total cholesterol, LDL cholesterol and triglycerides. Therefore it may have the potential to reduce the incidence of atherosclerosis related morbidity and mortality.

Energy and nutrient intakes among Sri Lankan adults

Introduction The epidemic of nutrition related non-communicable diseases such as type 2 diabetes mellitus and obesity has reached to epidemic portion in the Sri Lanka. However, to date, detailed data on food consumption in the Sri Lankan population is limited. The aim of this study is to identify energy and major nutrient intake among Sri Lankan adults. Methods A nationally-representative sample of adults was selected using a multi-stage random cluster sampling technique. Results Data from 463 participants (166 Males, 297 Females) were analyzed. Total energy intake was significantly higher in males (1913u2009±u2009567 kcal/d) than females (1514u2009±u2009458 kcal/d). However, there was no significant gender differences in the percentage of energy from carbohydrate (Male: 72.8u2009±u20096.4%, Female: 73.9u2009±u20096.7%), fat (Male: 19.9u2009±u20096.1%, Female: 18.5u2009±u20095.7%) and proteins (Male: 10.6u2009±u20092.1%, Female: 10.9u2009±u20095.6%). Conclusion The present study provides the first national estimates of energy and nutrient intake of the Sri Lankan adult population.

Prevalence of retinopathy among adults with self-reported diabetes mellitus: the Sri Lanka diabetes and Cardiovascular Study

BackgroundAt present there are no large scale nationally-representative studies from Sri Lanka on the prevalence and associations of Diabetic Retinopathy (DR). The present study aims to evaluate the prevalence and risk factors for DR in a community-based nationally-representative sample of adults with self-reported diabetes mellitus from Sri Lanka.MethodsA cross-sectional community-based national study among 5,000 adults (≥18 years) was conducted in Sri Lanka, using a multi-stage stratified cluster sampling technique. An interviewer-administered questionnaire was used to collect data. Ophthalmological evaluation of patients with ‘known’ diabetes (previously diagnosed at a government hospital or by a registered medical practitioner) was done using indirect ophthalmoscopy. A binary-logistic regression analysis was performed with ‘presence of DR’ as the dichotomous dependent variable and other independent covariates.ResultsCrude prevalence of diabetes was 12.0% (nu2009=u2009536), of which 344 were patients with ‘known’ diabetes. Mean age was 56.4u2009±u200910.9 years and 37.3% were males. Prevalence of any degree of DR was 27.4% (Males-30.5%, Females-25.6%; pu2009=u20090.41). In patients with DR, majority had NPDR (93.4%), while 5.3% had maculopathy. Patients with DR had a significantly longer duration of diabetes than those without. In the binary-logistic regression analysis in all adults duration of diabetes (OR:1.07), current smoking (OR:1.67) and peripheral neuropathy (OR:1.72) all were significantly associated with DR.ConclusionsNearly 1/3rd of Sri Lankan adults with self-reported diabetes are having retinopathy. DR was associated with diabetes duration, cigarette smoking and peripheral neuropathy. However, further prospective follow up studies are required to establish causality for identified risk factors.

Knowledge and perceptions about diet and physical activity among Sri Lankan adults with diabetes mellitus: a qualitative study.

BackgroundDiabetes mellitus (DM) is a rapidly growing health concern in Sri Lanka. Diet and physical activity are important modifiable risk factors affecting the incidence, severity and management of DM. The present study aims to evaluate the knowledge and perceptions about dietary patterns and physical activity among a group of adults with DM in Sri Lanka using qualitative research methods.MethodsFifty adults from a cohort of diabetic patients attending the medical clinics at the National Hospital of Sri Lanka were invited for the study. Data were collected via 10 Focus Group Discussions. Verbatim recording and documenting emotional responses were conducted by two independent observers. Directed content analysis of qualitative data was done with the help of NVIVO v10.0.ResultsMean age was 61.2u2009±u20099.9xa0years and 46xa0% were males. Mean duration of diabetes was 10.4u2009±u20097.5xa0years. All were aware of the importance of diet in the management of DM. But most had difficulty in incorporating this knowledge into their lives mostly due to social circumstances. The majority described a list of ‘good foods’ and ‘bad foods’ for DM. They believed that ‘good’ foods can be consumed at all times, irrespective of quantity and ‘bad’ foods should be completely avoided. Many believed that fruits were bad for diabetes, while vegetables were considered as a healthy food choice. The majority thought that there were ‘special’ foods that help to control blood glucose, the most common being curry leaves and bitter-gourd. Most study participants were aware of the importance of being physical active. However, there was lack of consensus and clarity with regards to type, duration, timing and frequency of physical activity.ConclusionsDespite understanding the importance of dietary control and physical activity in the management of diabetes, adherence to practices were poor, mainly due to lack of clarity of information provided. There were many myths with regards to diet, some of which have originated from health care professionals. More evidence is needed to support or refute the claims about ‘special’ foods that the participants believe as being good for diabetes.

The influence of family history of diabetes on disease prevalence and associated metabolic risk factors among Sri Lankan adults.

To describe the influence of family history on diabetes prevalence and associated metabolic risk factors in a nationally representative sample from Sri Lanka.

The facts, figures, and reality of the diabetes epidemic in Sri Lanka: a systematic review

Prevalence of diabetes mellitus (DM) has reached epidemic proportions in Sri Lanka. We aim to systematically review the literature for studies on DM published by Sri Lankan authors and provide a comprehensive analysis of its prevalence, trends, and risk factors. Retrieval of diabetes-related research articles conducted in Sri Lanka was by a comprehensive systematic search of the literature in the following medical bibliographical databases: PubMed, Web of Science, SciVerse Scopus, CINAHL, and Cochrane Library. Studies published before January 6, 2012 was included. Search terms used were “Sri Lanka,” “Lanka,” “Ceylon,” “pre-diabetes,” “diabetes,” “type-2 diabetes,” “type-1 diabetes,” “diabetes mellitus,” “dysglycaemia,” and “glucose intolerance”. Studies not in English, conference proceedings, and abstracts were excluded. The number of studies included in the present systematic review is 96 (journal articles—82, dissertation—14). Our results based on the available latest national data (2005–2006) show that Sri Lanka is facing a significant burden of both diabetes (prevalence 10.3xa0%) and pre-diabetes (prevalence 11.5xa0%). Urban residency and familial inheritance appear to be important factors associated with diabetes in Sri Lanka. There were a number of ethno-medical studies done by Sri Lankan authors evaluating herbal products in diabetes treatment. DM is a major health problem in Sri Lanka, with an unprecedented current level of prevalence. Considering the gravity of the health issue and the economical burden, very little local research has been conducted to combat the epidemic. Future studies should be focused on the causes of this high prevalence, such as genetic characteristics, dietary habits, body composition, and level of physical activity.