Shamima Akter

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.

Dietary patterns and metabolic syndrome in a Japanese working population

BackgroundMetabolic syndrome has become a major public health concern, but the role of diet in the etiology of this syndrome is not well understood. This study investigated the association between major dietary patterns and prevalence of metabolic syndrome in a Japanese working population.MethodsThis cross-sectional study was conducted among 460 municipal employees (284 men and 176 women), aged 21–67 years, who participated in a health survey at the time of periodic checkup. Dietary patterns were derived by using the principal component analysis of the consumption of 52 food and beverage items, which were assessed by a validated brief diet history questionnaire. Metabolic syndrome was defined according to the modified NCEP-ATP III criteria. Logistic regression was used to examine the association between dietary patterns and metabolic syndrome with adjustment of potential confounding variables.ResultsThree dietary patterns were identified. Westernized breakfast pattern characterized by high intakes of bread, confectionaries, and milk and yogurt but low intakes of rice and alcoholic beverages was inversely associated with prevalence of metabolic syndrome and high blood pressure (P for trend = 0.02 and 0.049, respectively). Animal food pattern characterized by high intakes of fish and shellfish, meat, processed meat, mayonnaise, and egg was not associated with prevalence of metabolic syndrome, but was positively associated with high blood glucose (P for trend = 0.03). Healthy Japanese dietary pattern characterized by vegetables and fruits, soy products, mushrooms, and green tea was not appreciably associated with prevalence of metabolic syndrome or its components.ConclusionsThe results suggest that westernized breakfast pattern may confer some protection against metabolic syndrome in Japanese. The causality of these associations needs to be confirmed.

Association of age at menarche with metabolic syndrome and its components in rural Bangladeshi women.

BackgroundEarly age at menarche is associated with increased risk of metabolic syndrome in both China and the West. However, little is known about the impact of age at menarche and metabolic syndrome in South Asian women, including those from low-income country, where age at menarche is also falling. The aim of the present study was to investigate whether age at menarche is inversely associated with metabolic syndrome in Bangladeshi women, who are mostly poor and have limited access to and or poor health care facilities.MethodsThis community-based cross-sectional study was performed using 1423 women aged between 15–75 years from rural Bangladesh in 2009 and 2010. Metabolic syndrome was defined according to standard NCEP-ATP III criteria. Logistic regression was used to estimate the association between age at menarche and metabolic syndrome, with adjustment of potential confounding variables, including age, education, marital status, tobacco users, use of contraceptives and number of pregnancies.ResultsEarly onset of menarche (<12 years) as compared to late onset (>13 years) was found to be associated with a higher prevalence of metabolic syndrome (odds ratio=1.55; 95 % confidence interval =1.05-2.30). Age at onset of menarche was also inversely associated with prevalence of high triglycerides (P for trend <0.01) and low high-density lipoprotein cholesterol (P for trend = 0.01), but positively associated with prevalence of high fasting blood glucose (P for trend =0.02). However, no significant association was found between age at menarche, high blood pressure and elevated waist circumference.ConclusionEarly onset of menarche might promote or trigger development of metabolic syndrome. Thus, knowledge of the history of age at onset of menarche may be critical in identifying women at risk of developing metabolic syndrome and those likely to benefit the most from early interventions.

Quality of diet and mortality among Japanese men and women: Japan Public Health Center based prospective study

Objective To examine the association between adherence to the Japanese Food Guide Spinning Top and total and cause specific mortality. Design Large scale population based prospective cohort study in Japan with follow-up for a median of 15 years. Setting 11 public health centre areas across Japan. Participants 36 624 men and 42 970 women aged 45-75 who had no history of cancer, stroke, ischaemic heart disease, or chronic liver disease. Main outcome measures Deaths and causes of death identified with the residential registry and death certificates. Results Higher scores on the food guide (better adherence) were associated with lower total mortality; the multivariable adjusted hazard ratios (95% confidence interval) of total mortality for the lowest through highest scores were 1.00, 0.92 (0.87 to 0.97), 0.88 (0.83 to 0.93), and 0.85 (0.79 to 0.91) (P<0.001 for trend) and the multivariable adjusted hazard ratio associated with a 10 point increase in food guide scores was 0.93 (0.91 to 0.95; P<0.001 for trend). This score was inversely associated with mortality from cardiovascular disease (hazard ratio associated with a 10 point increase 0.93, 0.89 to 0.98; P=0.005 for trend) and particularly from cerebrovascular disease (0.89, 0.82 to 0.95; P=0.002 for trend). There was some evidence, though not significant, of an inverse association for cancer mortality (0.96, 0.93 to 1.00; P=0.053 for trend). Conclusion Closer adherence to Japanese dietary guidelines was associated with a lower risk of total mortality and mortality from cardiovascular disease, particularly from cerebrovascular disease, in Japanese adults.

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.

Coffee and green tea consumption is associated with insulin resistance in Japanese adults.

OBJECTIVE Higher coffee and green tea consumption has been suggested to decrease risk of type 2 diabetes, but their roles in insulin resistance (IR) and insulin secretion remain unclear. This study examined the association between habitual consumption of these beverages and markers of glucose metabolism in a Japanese working population. MATERIALS/METHODS Participants were 1440 Japanese employees (1151 men and 289 women) aged 18-69years. Consumption of coffee and green tea was ascertained via a validated brief diet history questionnaire. Multilevel linear regression was used to estimate means (95% confidence intervals) of fasting insulin, fasting plasma glucose, homeostatic model assessment of IR (HOMA-IR), homeostatic model assessment of β-cell function (HOMA-β) and glycated hemoglobin (HbA1c) with adjustment for potential confounding variables. RESULTS Coffee consumption was significantly, inversely associated with HOMA-IR (P for trend=0.03), and the association appeared to be confined to overweight subjects (BMI≥25kg/m(2)) (P for trend=0.01, P for interaction=0.08). Unexpectedly, green tea consumption was positively associated with HOMA-IR (P for trend=0.02), though there was no dose-response relationship among daily consumers of green tea. Neither coffee nor green tea consumption was associated with HOMA-β and HbA1c. CONCLUSIONS Our findings indicate that coffee consumption may be associated with decreased IR, but not with insulin secretion. The positive association between green tea consumption and IR warrants further investigation.

Serum ferritin is associated with markers of insulin resistance in Japanese men but not in women

OBJECTIVE Several epidemiological studies have reported that high concentrations of circulating ferritin, a marker of iron stores, are related to insulin resistance (IR); however, questions remain regarding inconsistent data between Asian men and women and the inadequate consideration of potential confounding effects on the relationship between ferritin and IR. Our aim was to examine the relationship between serum ferritin concentrations and IR markers in the Japanese population. MATERIALS/METHODS We analyzed data (n=493) from a cross-sectional survey conducted in 2009 among a Japanese working population aged 20-68years. Fasting serum ferritin and insulin levels and fasting plasma glucose levels were determined, and the homeostatic model assessment of IR (HOMA-IR) was calculated. Multiple regression analysis was performed with adjustments for demographic and lifestyle factors, body mass index and serum C-reactive protein. RESULTS Fasting insulin and HOMA-IR significantly increased with increasing levels of serum ferritin after adjustment for covariates in men (P for trend=.005 and .001, respectively). Compared with men in the lowest tertile of serum ferritin, those in the highest tertile had a 24% higher HOMA-IR score. Additional data suggested a positive association between iron intake and HOMA-IR (P for trend=.07) in men. Neither serum ferritin nor iron intake was related to IR markers in women, even in postmenopausal women. CONCLUSIONS Serum ferritin concentrations were positively associated with fasting insulin and HOMA-IR in men but not in women, suggesting an important role of iron storage in the pathogenesis of IR in Japanese men.

Dairy consumption is associated with decreased insulin resistance among the Japanese.

Beneficial effects of dairy consumption in preventing obesity and metabolic syndrome have been suggested, but the association between dairy intake and insulin resistance (IR) is not clear. To test the hypothesis that higher dairy consumption is associated with lower insulin resistance, the authors investigated the association between dairy intake (taking fat content into consideration) and markers of IR in a Japanese working population. A cross-sectional study was conducted in 2009 among 496 subjects aged 20-68 years who participated in a health survey during a periodic checkup. Dairy consumption was assessed using a validated brief dietary history questionnaire. Multiple regression analysis was used to assess the association between fasting serum insulin, plasma glucose, and the homeostatic model assessment of IR (HOMA-IR) and dairy consumption with adjustment for potential confounding variables. The subjects in the highest quartile for total dairy intake showed the lowest mean IR markers compared to those in other categories, although the difference was not statistically significant. Intake of full-fat dairy products was inversely associated with HOMA-IR (P for trend = 0.02). The multivariable adjusted mean HOMA-IR values (with 95% confidence intervals) for the four groups, from those who consumed the fewest to those who consumed the most servings of full-fat dairy products, were 1.04 (0.96-1.12), 1.04 (0.96-1.13), 1.00 (0.91-1.08), and 0.86 (0.76-0.96), respectively. Low-fat dairy intake was not significantly associated with any IR markers. The results suggest that the consumption of full-fat dairy products may be associated with lower IR among Japanese adults.

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.

High Dietary Acid Load Score Is Associated with Increased Risk of Type 2 Diabetes in Japanese Men: The Japan Public Health Center–based Prospective Study

BACKGROUND Diet-induced metabolic acidosis has been linked to cardiometabolic abnormalities in Westerners, but the evidence on this issue is scarce in Asians. OBJECTIVE The present study prospectively examined the association between dietary acid load and type 2 diabetes (T2D) in Japanese adults. METHODS Study participants were 27,809 men and 36,851 women, aged 45-75 y, who completed a dietary questionnaire of the second survey of the Japan Public Health Center-based Prospective Study and had no previous history of T2D. Dietary intake was assessed by using a validated 147-item food-frequency questionnaire. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores were derived from the nutrient intake. A multilevel logistic regression model was used to estimate ORs and 95% CIs of self-reported, physician-diagnosed T2D over 5 y, with adjustment for potential confounding variables. RESULTS A total of 1191 cases of newly diagnosed T2D were reported. PRAL score was positively associated with T2D in men; the multivariable-adjusted ORs (95% CIs) for the lowest through the highest quartiles of PRAL were 1.00, 1.09 (0.87, 1.36), 1.10 (0.88, 1.37), and 1.25 (1.01, 1.55) (P-trend = 0.047). Further adjustment for dietary intake strengthened the association. NEAP score was not associated with the risk of T2D (P-trend = 0.20). In stratified analyses, the positive association between PRAL and T2D was confined to younger men (age <50 y; P-trend = 0.046). There was no association between dietary acid load score and T2D in women. CONCLUSION A high dietary acid load score is associated with an increased risk of T2D in Japanese men.