Sarah Krull Abe

Prevalence of diabetes and prediabetes and their risk factors among Bangladeshi adults: a nationwide survey

OBJECTIVE To estimate the prevalence of diabetes and prediabetes in Bangladesh using national survey data and to identify risk factors. METHODS Sociodemographic and anthropometric data and data on blood pressure and blood glucose levels were obtained for 7541 adults aged 35 years or more from the biomarker sample of the 2011 Bangladesh Demographic and Health Survey (DHS), which was a nationally representative survey with a stratified, multistage, cluster sampling design. Risk factors for diabetes and prediabetes were identified using multilevel logistic regression models, with adjustment for clustering within households and communities. FINDINGS The overall age-adjusted prevalence of diabetes and prediabetes was 9.7% and 22.4%, respectively. Among urban residents, the age-adjusted prevalence of diabetes was 15.2% compared with 8.3% among rural residents. In total, 56.0% of diabetics were not aware they had the condition and only 39.5% were receiving treatment regularly. The likelihood of diabetes in individuals aged 55 to 59 years was almost double that in those aged 35 to 39 years. Study participants from the richest households were more likely to have diabetes than those from the poorest. In addition, the likelihood of diabetes was also significantly associated with educational level, body weight and the presence of hypertension. The prevalence of diabetes varied significantly with region of residence. CONCLUSION Almost one in ten adults in Bangladesh was found to have diabetes, which has recently become a major public health issue. Urgent action is needed to counter the rise in diabetes through better detection, awareness, prevention and treatment.

Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis

BACKGROUND Anemia is a leading cause of maternal deaths and adverse pregnancy outcomes in developing countries. OBJECTIVES We conducted a systematic review and meta-analysis to estimate the pooled prevalence of anemia, the association between maternal anemia and pregnancy outcomes, and the population-attributable fraction (PAF) of these outcomes that are due to anemia in low- and middle-income countries. DESIGN PubMed, EMBASE, CINAHL, and the British Nursing Index were searched from inception to May 2015 to identify cohort studies of the association between maternal anemia and pregnancy outcomes. The anemic group was defined as having hemoglobin concentrations <10 or <11 g/dL or hematocrit values <33% or <34% depending on the study. A metaregression and stratified analysis were performed to assess the effects of study and participant characteristics on adverse pregnancy risk. The pooled prevalence of anemia in pregnant women by region and country-income category was calculated with the use of a random-effects meta-analysis. RESULTS Of 8182 articles reviewed, 29 studies were included in the systematic review, and 26 studies were included in the meta-analysis. Overall, 42.7% (95% CI: 37.0%, 48.4%) of women experienced anemia during pregnancy in low- and middle-income countries. There were significantly higher risks of low birth weight (RR: 1.31; 95% CI: 1.13, 1.51), preterm birth (RR: 1.63; 95% CI: 1.33, 2.01), perinatal mortality (RR: 1.51; 95% CI: 1.30, 1.76), and neonatal mortality (RR: 2.72; 95% CI: 1.19, 6.25) in pregnant women with anemia. South Asian, African, and low-income countries had a higher pooled anemia prevalence than did other Asian and upper-middle-income countries. Overall, in low- and middle-income countries, 12% of low birth weight, 19% of preterm births, and 18% of perinatal mortality were attributable to maternal anemia. The proportion of adverse pregnancy outcomes attributable to anemia was higher in low-income countries and in the South Asian region. CONCLUSION Maternal anemia remains a significant health problem in low- and middle-income countries.

Maternal body mass index and risk of birth and maternal health outcomes in low‐ and middle‐income countries: a systematic review and meta‐analysis

We conducted a systematic review and meta‐analysis of population‐based cohort studies of maternal body mass index (BMI) and risk of adverse birth and health outcomes in low‐ and middle‐income countries. PubMed, Embase, CINAHL and the British Nursing Index were searched from inception to February 2014. Forty‐two studies were included. Our study found that maternal underweight was significantly associated with higher risk of preterm birth (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01–1.27), low birthweight (OR, 1.66; 95% CI, 1.50–1.84) and small for gestational age (OR, 1.85; 95% CI, 1.69–2.02). Compared with mothers with normal BMI, overweight or obese mothers were at increased odds of gestational diabetes, pregnancy‐induced hypertension, pre‐eclampsia, caesarean delivery and post‐partum haemorrhage. The population‐attributable risk (PAR) indicated that if women were entirely unexposed to overweight or obesity during the pre‐pregnancy or early pregnancy period, 14% to 35% fewer women would develop gestational diabetes, pre‐eclampsia or pregnancy‐induced hypertension in Brazil, China, India, Iran or Thailand. The highest PAR of low birthweight attributable to maternal underweight was found in Iran (20%), followed by India (18%), Thailand (10%) and China (8%). Treatment and prevention of maternal underweight, overweight or obesity may help reduce the burden on maternal and child health in developing countries.

Awareness, treatment, and control of diabetes in Bangladesh: a nationwide population-based study.

Objectives To examine awareness, treatment, and control of diabetes mellitus among the adult population in Bangladesh. Methods The study used data from the 2011 nationally representative Bangladesh Demographic and Health Survey (BDHS). The BDHS sample is comprised of 7,786 adults aged 35 years or older. The primary outcome variables were fasting blood glucose, diagnosis, treatment, and control of diabetes. Multilevel logistic regression models were used to identify the risk factors for diabetes awareness. Results Overall, age-standardized prevalence of diabetes was 9.2%. Among subjects with diabetes, 41.2% were aware of their condition, 36.9% were treated, and 14.2% controlled their condition. A significant inequality in diabetes management was found from poor to wealthy households: 18.2% to 63.2% (awareness), 15.8% to 56.6% (treatment), and 8.2% to 18.4% (control). Multilevel models suggested that participants who had a lower education and lower economic condition were less likely to be aware of their diabetes. Poor management was observed among non-educated, low-income groups, and those who lived in the northwestern region. Conclusions Diabetes has become a national health concern in Bangladesh; however, treatment and control are quite low. Improving detection, awareness, and treatment strategies is urgently needed to prevent the growing burden associated with diabetes.

Fish, n − 3 polyunsaturated fatty acids and n − 6 polyunsaturated fatty acids intake and breast cancer risk: The Japan Public Health Center-based prospective study

Limited and inconsistent studies exist on the association between the intake of fish, n − 3 polyunsaturated fatty acids (PUFA) and n − 6 PUFA and breast cancer. Fish and n − 3 PUFA support various body functions and are thought to reduce the carcinogenesis risk while n − 6 PUFA may have a positive association with cancer risk. We examined the association between intake of fish, n − 3 PUFA [including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), docosapentaenoic acid (DPA) and alpha‐linolenic acid (ALA)] and n − 6 PUFA and breast cancer with subanalyses on estrogen (ER) and progesterone receptor (PR) status. We investigated 38,234 Japanese women aged 45–74 years from the Japan Public Health Center‐based prospective study (JPHC study), and during 14.1 years of follow‐up time, 556 breast cancer cases were newly diagnosed. Breast cancer risk was not associated with the intake of total fish, n − 3 PUFA and n − 6 PUFA when analyzed in totality through multivariable Cox proportional hazards regression models with age as the time scale. Intake of total n − 6 was positively associated with the development of ER+PR+ tumors [multivariable‐adjusted HR Q4 vs. Q1 = 2.94 (95% CI: 1.26–6.89; ptrend = 0.02)]. Intake of EPA was associated with a decreased breast cancer risk for ER+PR+ tumors [multivariable‐adjusted HR Q2 vs. Q1 = 0.47 (95% CI: 0.25–0.89; ptrend =0.47)]. While the overall association between the intake of total fish, n − 3 PUFA and n − 6 PUFA and breast cancer risk is null, for ER+PR+ tumors, a positive association was seen between n − 6 intake and breast cancer, and a marginally significant inverse association was observed for EPA intake.

Prevalence and control of hypertension in Bangladesh: a multilevel analysis of a nationwide population-based survey.

Objectives: We investigated the prevalence, awareness, treatment, and control of hypertension and associated risk factors in the Bangladeshi adult population. Methods: The data for this study were extracted from the nationally-representative 2011 Bangladesh Demographic and Health Survey. Socio-demographic profiles, height, weight, blood pressure measurements, and management were recorded from 7876 adults aged 35 years or older. Multilevel logistic regression models were used to identify the risk factors for hypertension awareness, treatment, and control. Results: Overall, age-standardized prevalence of prehypertension and hypertension were 27.1 and 24.4%, respectively. Among patients with hypertension, 50.1% were aware of their condition, 41.2% were in treatment, but only 31.4% had controlled hypertension. There was a wide disparity in hypertension management between the poor and the wealthy households. Rich households were more likely to be aware of their hypertension [odds ratio (OR) 1.92, 95% confidence interval (CI) 0.97–3.79, P = 0.06], receiving treatment (OR 3.34, 95% CI 1.55–7.18, P < 0.001) and controlling their condition (OR 2.88, 95% CI 1.28–6.46, P = 0.01), as compared to the poor residents. Participants who had lower education were less likely to be aware of, in treatment for, and in control of their condition. Conclusion: One in four adults had hypertension in Bangladesh, and awareness and treatment of hypertension are quite low. Improvements in detection and treatment strategies are needed to prevent the growing disease burden associated with hypertension.

Population health and regional variations of disease burden in Japan, 1990–2015: a systematic subnational analysis for the Global Burden of Disease Study 2015

Summary Background Japan has entered the era of super-ageing and advanced health transition, which is increasingly putting pressure on the sustainability of its health system. The level and pace of this health transition might vary across regions within Japan and concern is growing about increasing regional variations in disease burden. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides a comprehensive, comparable framework. We used data from GBD 2015 with the aim to quantify the burden of disease and injuries, and to attribute risk factors in Japan at a subnational, prefecture-level. Methods We used data from GBD 2015 for 315 causes and 79 risk factors of death, disease, and injury incidence and prevalence to measure the burden of diseases and injuries in Japan and in the 47 Japanese prefectures from 1990 to 2015. We extracted data from GBD 2015 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), life expectancy, and healthy life expectancy (HALE) in Japan and its 47 prefectures. We split extracted data by prefecture and applied GBD methods to generate estimates of burden, and attributable burden due to known risk factors. We examined the prefecture-level relationships of common health system inputs (eg, health expenditure and workforces) to the GBD outputs in 2015 to address underlying determinants of regional health variations. Findings Life expectancy at birth in Japan increased by 4·2 years from 79·0 years (95% uncertainty interval [UI] 79·0 to 79·0) to 83·2 years (83·1 to 83·2) between 1990 and 2015. However, the gaps between prefectures with the lowest and highest life expectancies and HALE have widened, from 2·5 to 3·1 years and from 2·3 to 2·7 years, respectively, from 1990 to 2015. Although overall age-standardised death rates decreased by 29·0% (28·7 to 29·3) from 1990 to 2015, the rates of mortality decline in this period substantially varied across the prefectures, ranging from −32·4% (−34·8 to −30·0) to −22·0% (−20·4 to −20·1). During the same time period, the rate of age-standardised DALYs was reduced overall by 19·8% (17·9 to 22·0). The reduction in rates of age-standardised YLDs was very small by 3·5% (2·6 to 4·3). The pace of reduction in mortality and DALYs in many leading causes has largely levelled off since 2005. Known risk factors accounted for 34·5% (32·4 to 36·9) of DALYs; the two leading behavioural risk factors were unhealthy diets and tobacco smoking in 2015. The common health system inputs were not associated with age-standardised death and DALY rates in 2015. Interpretation Japan has been successful overall in reducing mortality and disability from most major diseases. However, progress has slowed down and health variations between prefectures is growing. In view of the limited association between the prefecture-level health system inputs and health outcomes, the potential sources of regional variations, including subnational health system performance, urgently need assessment. Funding Bill & Melinda Gates Foundation, Japan Ministry of Education, Science, Sports and Culture, Japan Ministry of Health, Labour and Welfare, AXA CR Fixed Income Fund and AXA Research Fund.

Hepatitis B and C virus infection and risk of lymphoid malignancies: A population-based cohort study (JPHC Study).

BACKGROUND Several studies have assessed the association between hepatitis B virus (HBV) and hepatitis C virus (HCV) and non-Hodgkins lymphoma. However, few studies are cohort by design, conducted within the Asian context and even fewer studies consider other lymphoid malignancies. The aim of this study was to assess the association between HBV and HCV and the risk of lymphoid malignancies among Japanese adults. MATERIALS AND METHODS The Japan Public Health Center prospective-based Study Cohort II was initiated in 1993/1994. 20,360 subjects with available data on HBV and HCV infection status from blood samples were followed up until the end of 2010 for an average of 16 years. During 324,139 person-years, 120 newly diagnosed cases of lymphoid malignancies were identified. Cox proportional hazards models were employed to calculate hazard ratios (HRs) and 95% confidence intervals (95%CIs). RESULTS Of 20,360 subjects, 508 were HBsAg positive, 11,035 were anti-HBc positive, and 1,129 subjects were anti-HCV positive at baseline. The presence of HBsAg was positively associated with malignant lymphoma, especially with non-Hodgkins lymphoma (HR=3.56, 95%CI=1.37-9.18) and diffuse large B-cell lymphoma (HR=7.22, 95%CI=2.34-22.29). In contrast, no clear association was observed between the presence of anti-HBc and anti-HCV. CONCLUSION In conclusion, HBsAg but not anti-HBc or anti-HCV was positively associated with malignant lymphoma, particularly non-Hodgkins lymphoma and diffuse large B-cell lymphoma in Japanese adults.

Nationwide Survey of Prevalence and Risk Factors for Diabetes and Prediabetes in Bangladeshi Adults

Diabetes is a major noncommunicable disease, ranking as a leading cause of death and disability worldwide (1). Globally, the prevalence of diabetes is ∼8%, and nearly 80% of patients with diabetes live in low- and middle-income countries (2). Like many developing countries, prevalence of diabetes in Bangladesh increased substantially from 4% in 1990 to 10% in 2011 and is projected to reach 13% by 2030 (3,4). Despite this heavy burden, currently there are no epidemiologic studies in Bangladesh that investigate prevalence of diabetes and risk factors using nationally representative data. Therefore, we estimated the prevalence of diabetes and prediabetes and identified associated risk factors using Bangladesh nationwide survey data by multilevel logistic regression models. Our analysis was based on the 2011 Bangladesh Demographic and Health Survey. Data were available as of February 2013, including 8,835 residents (4,524 men and 4,311 women) aged …

Hepatitis B and C Virus Infection and Risk of Pancreatic Cancer: A Population-Based Cohort Study (JPHC Study Cohort II)

Background: The aim of this study was to assess the association between hepatitis B virus (HBV) and hepatitis C virus (HCV) and the risk of pancreatic cancer among Japanese adults. Methods: A total of 20,360 subjects of the Japan Public Health Center (JPHC)–based prospective study cohort II with available data on HBV and HCV infection status from blood samples were followed up until the end of 2010 for an average of 16 years. Cox proportional hazards models were employed to calculate HRs and 95% confidence intervals (CI). Results: During 324,394 person-years, 116 newly diagnosed cases of pancreatic cancer were identified. Compared with individuals without a positive infection marker, the multivariate-adjusted HRs were 1.22 (95% CI, 0.81–1.84) for anti-HBc and 0.69 (95% CI, 0.28–1.69) for anti-HCV. There were no pancreatic cancer cases among HBsAg-positive participants. Conclusion: In the JPHC study, we did not observe a statistically significant association between hepatitis B or C and the risk of pancreatic cancer. Impact: Our results do not support an association between hepatitis B or C and the risk of pancreatic cancer. Cancer Epidemiol Biomarkers Prev; 25(3); 555–7. ©2015 AACR.