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Zapico AG, Aparicio-Ugarriza R, Quesada-González C, Gómez SF, Wärnberg J, Medrano M, Gusi N, Aznar S, Marín-Cascales E, González-Valeiro MA, Serra-Majem L, Pulgar S, Tur JA, Segu M, Fíto M, Homs C, Benavente-Marín JC, Sánchez-Gómez J, Jiménez-Zazo F, Alcaraz PE, Sevilla-Sánchez M, Herrera-Ramos E, Bouzas C, Sistac C, Schröder H, Gesteiro E, González-Gross M. Lifestyle behaviors clusters in a nationwide sample of Spanish children and adolescents: PASOS study. Pediatr Res 2023; 94:2077-2084. [PMID: 37454185 DOI: 10.1038/s41390-023-02710-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Youth is a vulnerable period. To classify lifestyle behaviors and its relationship with health-related outcomes of Spanish children and adolescents. METHODS Cross-sectional study including 3261 children aged 7.5-17.5 y (52.8% females). Physical activity (PA), screen-time, sleep time, adherence to Mediterranean diet (MD), weight status (WS) by validated methods. Cluster analysis was run considering chronological age. RESULTS Six clusters were identified: C1: high screen time, low adherence to MD and sleep time (n = 431,13.20%); C2: high WS, medium adherence to MD,high sleep time, and low screen time (n = 466,14.30%); C3: young group with low screen time and high PA, adherence to MD and sleep (n = 537,16.40%); C4: worst profile regarding adherence to MD, PA, WS and sleep time (n = 609,18.70%); C5: low screen time and PA, high sleep time (n = 804,24.70%); C6: high PA and screen time, low WS (n = 414,12.70%). Mean absolute values were statistically different among PA levels, screen and sleep time, adherence to MD, age, and WS (all p < 0.001). CONCLUSIONS The most prevalent pattern was low levels of PA, MD, and screen time, and high sleep time. The second most prevalent was characterized by very low levels of PA, sleep time, and adherence to MD, and high screen time, and WS in adolescents. IMPACT STATEMENT The main identified lifestyle behavior was poor physical activity, low adherence to Mediterranean Diet and high screen and sleep time. Children should increase physical activity levels, adherence to Mediterranean diet, decrease screen and sleep the appropriate hours per day. Families, schools, and medical communities must work together to gloss over present and future diseases. Sleep time had not been previously included in cluster analysis with physical activity, sedentary behaviors, obesity, and nutritional status, thus the present data open a new perspective in Spanish population. Health policies should focus on promoting physical activity, Mediterranean diet, adequate sleep and reducing screen time.
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Affiliation(s)
- Augusto G Zapico
- ImFINE Research Group. Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain.
- Department of Language, Arts and Physical Education, Universidad Complutense de Madrid, Madrid, Spain.
| | - Raquel Aparicio-Ugarriza
- ImFINE Research Group. Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
- Biomedical Research Center on Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Carlos Quesada-González
- ImFINE Research Group. Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
- Departamento de Matemática Aplicada a las Tecnologías de la Información y la Comunicación, Universidad Politécnica de Madrid, 28031, Madrid, Spain
| | - Santiago Felipe Gómez
- Gasol Foundation, Sant Boi de Llobregat, Spain
- Biomedical Research Networking Center on Epidemiology and Public Health studies (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Nursing and Physiotherapy Department, University of Lleida, Lleida, Spain
| | - Julia Wärnberg
- Biomedical Research Center on Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- EpiPHAAN Research Group. Faculty of Health Sciences, University of Málaga-Institute of Biomedical Research of Malaga (IBIMA), Málaga, Spain
| | - María Medrano
- ELIKOS group, Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD). CIBEROBN, ISCIII Navarra, Public University of Navarra, Navarra, Spain
| | - Narcís Gusi
- Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Sciences, Universidad de Extremadura, Cáceres, Spain
| | - Susana Aznar
- PAFS Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha, Toledo, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES). Institute of Health Carlos III, Madrid, Spain
| | - Elena Marín-Cascales
- Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain
- Faculty of Sport Sciences, UCAM, Catholic University of Murcia, Murcia, Spain
| | | | - Lluís Serra-Majem
- Biomedical Research Center on Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas, Spain
- Preventive Medicine Service, Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, Las Palmas, Spain
| | - Susana Pulgar
- Regional Unit of Sports Medicine, Municipal Sports Foundation of Avilés, Asturias, Spain
| | - Josep A Tur
- Biomedical Research Center on Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Research Group of Community Nutrition & Oxidative Stress, University of the Balearic Islands-IUNICS & Health Research Institute of the Balearic Islands (IDISBA), Palma de Mallorca, Spain
| | | | - Montserrat Fíto
- Biomedical Research Center on Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Clara Homs
- Gasol Foundation, Sant Boi de Llobregat, Spain
- GRoW, Global Research on Wellbeing, Blanquerna School of Life Sciences, University Ramon Llull, Barcelona, Spain
| | - Juan Carlos Benavente-Marín
- EpiPHAAN Research Group. Faculty of Health Sciences, University of Málaga-Institute of Biomedical Research of Malaga (IBIMA), Málaga, Spain
| | - Jesús Sánchez-Gómez
- Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Sciences, Universidad de Extremadura, Cáceres, Spain
| | - Fabio Jiménez-Zazo
- PAFS Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Pedro E Alcaraz
- Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain
- Faculty of Sport Sciences, UCAM, Catholic University of Murcia, Murcia, Spain
| | | | - Estefanía Herrera-Ramos
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Cristina Bouzas
- Biomedical Research Center on Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Research Group of Community Nutrition & Oxidative Stress, University of the Balearic Islands-IUNICS & Health Research Institute of the Balearic Islands (IDISBA), Palma de Mallorca, Spain
| | | | - Helmut Schröder
- Biomedical Research Networking Center on Epidemiology and Public Health studies (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Eva Gesteiro
- ImFINE Research Group. Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
| | - Marcela González-Gross
- ImFINE Research Group. Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
- Biomedical Research Center on Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
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Islam SMS, Uddin R, Das S, Ahmed SI, Zaman SB, Alif SM, Hossen MT, Sarker M, Siopis G, Livingstone KM, Mehlman ML, Rahman MM, Chowdhury RI, Alim MA, Choudhury SR, Ahmed SM, Adhikary RK, Anjum A, Banik PC, Chowdhury FR, Faruk MO, Gupta RD, Hannan MA, Haque MN, Haque SE, Hasan MT, Hossain MB, Hossain MM, Hossain M, Hossain S, Hossain SJ, Khan MN, Khan MJ, Mamun MA, Mokdad AH, Moni MA, Murray CJL, Rahman M, Rahman MM, Rahman M, Ratan ZA, Ripon RK, Saif-Ur-Rahman KM, Sayeed A, Siraj MS, Sultana S, Maddison R, Hay SI, Naghavi M. The burden of diseases and risk factors in Bangladesh, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Glob Health 2023; 11:e1931-e1942. [PMID: 37973341 PMCID: PMC10664824 DOI: 10.1016/s2214-109x(23)00432-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/07/2023] [Accepted: 09/06/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Bangladesh has made substantial progress in improving socioeconomic and health indicators over the past 50 years, but data on national disease burden are scarce. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to estimate the burden of diseases and risk factors in Bangladesh from 1990 to 2019. METHODS For this systematic analysis, we analysed data from vital registration systems, surveys, and censuses using multistage modelling processes to estimate life expectancy at birth, mortality rate, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). Additionally, we compared the health status of Bangladesh with that of the other countries in the GBD south Asia region-Bhutan, India, Nepal, and Pakistan. FINDINGS Life expectancy at birth in Bangladesh increased from 58·2 years (95% uncertainty interval 57·1-59·2) in 1990 to 74·6 years (72·4-76·7) in 2019. Between 1990 and 2019, the age-standardised mortality rate decreased from 1509·3 (1428·6-1592·1) to 714·4 (604·9-838·2) deaths per 100 000 population. In 2019, non-communicable diseases represented 14 of the top 20 causes of death; the leading three causes were stroke, ischaemic heart disease, and chronic obstructive pulmonary disease. High blood pressure, high fasting plasma glucose, and smoking were the top three risk factors. From 1990 to 2019, the rate of all-cause DALYs decreased by 54·9% (48·8-60·4). In 2019, the leading causes of DALYs and YLLs were neonatal disorders, stroke, and ischaemic heart disease, whereas musculoskeletal disorders, depressive disorders, and low back pain were the leading causes of YLDs. Bangladesh has the lowest age-standardised rates of mortality, YLDs, and YLLs and the highest life expectancy at birth in south Asia. INTERPRETATION Over the past 30 years, mortality rates have reduced by more than half in Bangladesh. Bangladesh must now address the double burden of communicable and non-communicable diseases. Cost-effective, multisectoral efforts are needed to prevent and control non-communicable diseases, promote healthy lifestyles, and prevent premature mortality and disabilities. FUNDING Bill & Melinda Gates Foundation. TRANSLATION For the Bangla translation of the abstract see Supplementary Materials section.
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Kundu LR, Al Masud A, Islam Z, Hossain J. Clustering of health risk behaviors among school-going adolescents in Mymensingh district, Bangladesh. BMC Public Health 2023; 23:1850. [PMID: 37740226 PMCID: PMC10517506 DOI: 10.1186/s12889-023-16766-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Adolescents frequently engage in risky behaviors that negatively influence their health and pose a serious public health concern. This study aimed to examine the clustering pattern of health risk behaviors among school-going adolescents in Bangladesh. METHODS A cross-sectional study was conducted from 15 April to 27 June 2022 among 412 school-going adolescents in Mymensingh district of Bangladesh through a convenience sampling technique. Data were collected via face-to-face interviews using a modified Global School-Based Student Health Survey (GSHS) 2021 questionnaire. Cluster membership was identified using the k-means clustering algorithm. The chi-square test was adopted to explore the association between sociodemographic variables and each cluster membership. The ordinal logistic regression model was employed to examine the predictors associated with cluster membership. RESULTS Most of the respondents were female (55.3%) and belonged to the 16-19 years (74.5%) age group. Three behavioral clusters were identified, including Cluster 1: Low-risk taker (50.2%), Cluster 2: Moderate risk taker (39.6%), and Cluster 3: High-risk taker (10.2%). Influential factors of high-risk behavior among adolescents were significantly associated with their age (p = 0.03), father's education who were illiterate (p = 0.02), monthly family income >30000 BDT (p = 0.04), parent's those were understanding their child's problems in most of the time (p = 0.001). CONCLUSIONS The study found that high-risk behaviors are significantly higher among late adolescents, those whose fathers are illiterate, whose monthly income is higher, those whose parents or guardians never realize their child's complications and worries, and those whose parents or guardians never recognize what they did in their leisure time. These findings will help to develop intervention programs, policies, strategies, and curricula in school by the experts following the necessity to adopt the adolescent toward healthy behavior and help to reduce the prevalence of health risk behavior.
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Affiliation(s)
- Lakshmi Rani Kundu
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh.
| | - Abdullah Al Masud
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Zohurul Islam
- Department of Public Health, Hamdard University Bangladesh, Gazaria, Munshiganj, 1510, Bangladesh
| | - Jamil Hossain
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
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Alosaimi N, Sherar LB, Griffiths P, Pearson N. Clustering of diet, physical activity and sedentary behaviour and related physical and mental health outcomes: a systematic review. BMC Public Health 2023; 23:1572. [PMID: 37596591 PMCID: PMC10436445 DOI: 10.1186/s12889-023-16372-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/24/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Physical activity (PA), sedentary behaviour (SB) and diet play an important role in the physical and mental health of young people. Understanding how these behaviours cluster, and the impact of clusters on health is important for the development of public health interventions. This review examines the prevalence of clusters of PA, sedentary time, and dietary behaviours, and how clusters relate to physical and mental health indicators among children, adolescents and young adults. METHODS Electronic (PubMed, Web of Science and Scopus) and manual searches were conducted for articles that were (i) observational studies including children, adolescents and/or young adults aged 5-24 years, (ii) examined the 'patterning', 'clustering', or 'co-existence' of each of PA, dietary behaviour and SB, and (iii) published in English up to and including July 2022. In addition to information on clustering, data on physical and mental health outcomes were extracted where reported. Included studies were assessed using the Cochrane risk of bias for observational studies. A narrative synthesis was conducted due to high heterogeneity. This review was registered with PROSPERO (CRD42021230976). RESULTS Forty-nine cross-sectional studies and four prospective cohort studies from eighteen countries reporting data from 778,415 individual participants were included. A broad range of clusters (n = 172) were found (healthy, unhealthy, and mixed). Mixed clusters were common (n = 98), and clusters of high diet quality, low PA and high SB were more prevalent in girls, while mixed clusters of high PA, high SB and low diet quality were more prevalent in boys. Unhealthy clusters comprising low moderate to vigorous PA, low consumption of fruits and vegetables, and high screen time were prevalent, particularly in those from lower socioeconomic status families. Compared to those with healthy behavioural clusters, those with unhealthy and mixed clusters had a higher adiposity, higher risk of cardiovascular disease, poorer mental health scores, and lower cardiorespiratory fitness. CONCLUSIONS PA, SB and diet cluster in healthy, unhealthy and mixed patterns in young people that differ across sociodemographic characteristics. Unhealthy clusters are associated with poorer health outcomes. Intervention strategies targeting un-clustering multiple unhealthy behaviours should be developed and evaluated for their impact on health outcomes.
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Affiliation(s)
- Noura Alosaimi
- School of Sport, Exercise & Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, Leicestershire, UK.
| | - Lauren B Sherar
- School of Sport, Exercise & Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, Leicestershire, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Paula Griffiths
- School of Sport, Exercise & Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, Leicestershire, UK
| | - Natalie Pearson
- School of Sport, Exercise & Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, Leicestershire, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
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Biswas T, Townsend N, Huda MM, Maravilla J, Begum T, Pervin S, Ghosh A, Mahumud RA, Islam S, Anwar N, Rifhat R, Munir K, Gupta RD, Renzaho AM, Khusun H, Wiradnyani LAA, Radel T, Baxter J, Rawal LB, McIntyre D, Mørkrid K, Mamun A. Prevalence of multiple non-communicable diseases risk factors among adolescents in 140 countries: A population-based study. EClinicalMedicine 2022; 52:101591. [PMID: 36016694 PMCID: PMC9396043 DOI: 10.1016/j.eclinm.2022.101591] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Modifiable non-communicable disease (NCD) risk factors are becoming increasingly common among adolescents, with clustering of these risk factors in individuals of particular concern. The aim of this study was to assess global status of clustering of common modifiable NCD risk factors among adolescents. METHODS We used latest available data from nationally representative survey for 140 countries, namely the Global School-based Student Health Survey, the Health Behaviour in School-Aged Children and the longitudinal study of Australian Children. Weighted mean estimates of prevalence with corresponding 95% confidence intervals of nine NCD risk factors - physical inactivity, sedentary behaviour, insufficient fruits and vegetable consumption, carbonated soft drink consumption, fast food consumption, tobacco use, alcohol consumption and overweight/obesity - were calculated by country, region and sex. FINDINGS Over 487,565 adolescents, aged 11-17 years, were included in this study. According to trend analysis, prevalence of four or more NCD risk factors increased gradually over time. Prevalence of four or more NCD risk factors was 14.8% in 2003-2007 and increased to 44% in 2013-2017, an approximately three-fold increase (44.0%). Similar trends were also observed for three and two risk factors. Large variation between countries in the prevalence of adolescents with four or more risk factors was found in all regions. The country level range was higher in the South-East Asia Region (minimum Sri Lanka = 8%, maximum Myanmar = 84%) than Western Pacific Region (minimum China = 3%, maximum Niue = 72%), European Region (minimum Sweden = 13.9%, maximum Ireland = 66.0%), African Region (minimum Senegal = 0.8%, maximum Uganda = 82.1%) and Eastern Mediterranean Region (minimum Libya = 0.2%, maximum Lebanon = 80.2%). Insufficient vegetable consumption, insufficient fruit consumption and physically inactivity were three of the four most prevalent risk factors in all regions. INTERPRETATION Our results suggest a high prevalence of four or more NCD risk factors in adolescents globally, although variation was found between countries. Results from our study indicate that efforts to reduce adolescent NCD risk factors and the associated health burden need to be improved. These findings can assist policy makers to target the rollout of country- specific interventions. FUNDING None.
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Affiliation(s)
- Tuhin Biswas
- Institute for Social Science Research, The University of Queensland, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Queensland, Australia
- UQ Poche Centre, University of Queensland, Queensland, Australia
- Corresponding author at: UQ Poche Centre, University of Queensland, Queensland, Australia.
| | - Nick Townsend
- Department for Health, University of Bath, Bath BA2 7AY, UK
| | - M. Mamun Huda
- Institute for Social Science Research, The University of Queensland, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Queensland, Australia
- UQ Poche Centre, University of Queensland, Queensland, Australia
| | - Joemer Maravilla
- Institute for Social Science Research, The University of Queensland, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Queensland, Australia
- Institute of Nursing, Far Eastern University, Manila, Philippines
| | - Tahmina Begum
- Institute for Social Science Research, The University of Queensland, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Queensland, Australia
- UQ Poche Centre, University of Queensland, Queensland, Australia
| | - Sonia Pervin
- Institute for Social Science Research, The University of Queensland, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Queensland, Australia
| | - Arpita Ghosh
- The George Institute for Global Health, UNSW Sydney, New Delhi, India
| | - Rashidul Alam Mahumud
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Shariful Islam
- Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Novera Anwar
- Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh
| | - Rukaiya Rifhat
- Department of Soil, Water and Environment, University of Dhaka, Dhaka-1, Bangladesh
| | - Kerim Munir
- Developmental Medicine Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rajat Das Gupta
- Department of Epidemiology and Biostatistics, University of South Carolina, USA
| | - Andre M.N. Renzaho
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Helda Khusun
- SEAMEO Regional Center for Food and Nutrition (RECFON) - Pusat Kajian Gizi Regional Universitas Indonesia (PKGR UI), Jakarta, Indonesia
| | - Luh Ade Ari Wiradnyani
- SEAMEO Regional Center for Food and Nutrition (RECFON) - Pusat Kajian Gizi Regional Universitas Indonesia (PKGR UI), Jakarta, Indonesia
| | - Tim Radel
- Institute for Social Science Research, The University of Queensland, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Queensland, Australia
| | - Janeen Baxter
- Institute for Social Science Research, The University of Queensland, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Queensland, Australia
| | - Lal B. Rawal
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney Campus, Australia
| | - David McIntyre
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney Campus, Australia
| | - Kjersti Mørkrid
- Mater Clinical Unit, The University of Queensland Brisbane, Australia
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Abdullah Mamun
- Institute for Social Science Research, The University of Queensland, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Queensland, Australia
- UQ Poche Centre, University of Queensland, Queensland, Australia
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Biswas T, Azzopardi P, Anwar SN, de Vries TD, Encarnacion-Cruz LM, Hasan MM, Huda MM, Pervin S, Das Gupta R, Mitra DK, Rawal LB, Al Mamun A. Assuring Bangladesh's future: non-communicable disease risk factors among the adolescents and the existing policy responses. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2022; 41:22. [PMID: 35578321 PMCID: PMC9109415 DOI: 10.1186/s41043-022-00294-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 04/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study is to assess the current status of non-communicable disease (NCD) risk factors amongst adolescents in Bangladesh. We also critically reviewed the existing policy responses to NCD risk among adolescents in Bangladesh. METHODS This study used a mixed method approach. To quantify the NCD risk burden, we used data from the Global School-based Student Health Survey conducted in Bangladesh. To understand policy response, we reviewed NCD-related policy documents introduced by the Government of Bangladesh between 1971 and 2018 using the WHO recommended NCD Action Plan 2013-2020as study framework. Information from the policy documents was extracted using a matrix, mapping each document against the six objectives of the WHO 2013-2020 Action Plan. RESULTS Almost all adolescents in Bangladesh had at least one NCD risk factor, and there was a high prevalence of concurrent multiple NCD risk factors; 14% had one NCD risk factor while 22% had two, 29% had three, 34% had four or more NCD risk factors. Out of 38 policy documents, eight (21.1%) were related to research and/or surveys, eight (21.1%) were on established policies, and eleven (29%) were on legislation acts. Three policy documents (7.9%) were related to NCD guidelines and eight (21.1%) were strategic planning which were introduced by the government and non-government agencies/institutes in Bangladesh. CONCLUSIONS The findings emphasize the needs for strengthening NCD risk factors surveillance and introducing appropriate intervention strategies targeted to adolescents. Despite the Government of Bangladesh introducing several NCD-related policies and programs, the government also needs more focus on clear planning, implementation and monitoring and evaluation approaches to preventing NCD risk factors among the adolescents in Bangladesh.
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Affiliation(s)
- Tuhin Biswas
- Institute for Social Science Research, The University of Queensland, QLD, Australia.
- ARC Centre of Excellence for Children and Families Over the Life Course, The University of Queensland, QLD, Australia.
| | | | | | | | | | - Md Mehedi Hasan
- Institute for Social Science Research, The University of Queensland, QLD, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course, The University of Queensland, QLD, Australia
| | - M Mamun Huda
- Institute for Social Science Research, The University of Queensland, QLD, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course, The University of Queensland, QLD, Australia
| | - Sonia Pervin
- Institute for Social Science Research, The University of Queensland, QLD, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course, The University of Queensland, QLD, Australia
- Maternal and Child Health Division (MCHD), icddr,b, Dhaka, Bangladesh
| | - Rajat Das Gupta
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Dipak Kumar Mitra
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Lal B Rawal
- School of Health, Medical and Applied Sciences, CQ University, Sydney, Australia
| | - Abdullah Al Mamun
- Institute for Social Science Research, The University of Queensland, QLD, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course, The University of Queensland, QLD, Australia
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Olufayo OE, Ajayi IO, Ngene SO. Clustering of cardiovascular disease risk factors among first-year students at the University of Ibadan, Nigeria: a cross-sectional study. SAO PAULO MED J 2022; 141:98-106. [PMID: 36043679 PMCID: PMC10005463 DOI: 10.1590/1516-3180.2021.0998.11052022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 05/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the second leading cause of death in sub-Saharan Africa. Globally, there is substantial evidence that modifiable risk factors for CVD are increasing in adolescents. Unfortunately, there is a paucity of information on the prevalence and clustering of these risk factors in adolescents. OBJECTIVES This study explores the modifiable risk factors for CVD among first-year students at the University of Ibadan, Nigeria. DESIGN AND SETTING This cross-sectional study was conducted at the University of Ibadan, Nigeria. METHODS A total of 546 newly admitted students at the University of Ibadan, Nigeria, were recruited using stratified random sampling. An interviewer-administered questionnaire was used to obtain information from study participants between January and February 2016. RESULTS The mean age of respondents was 19 ± 2.2 years with a male-to-female ratio of 1:1. The reported risk factors for CVD were smoking (1.6%), abdominal obesity (3.3%), alcohol consumption (3.7%), overweight/obesity (20.7%), unhealthy diet (85.3%), and physical inactivity (94.5%). Clustering of ≥ 2 risk factors was reported in 23.4% of students. Female students were twice as probably overweight/obese as male students (adjusted odds ratio [AOR] = 2.2; confidence interval [CI] = 1.41-3.43). Students whose fathers were skilled workers were 3.5 times more likely to be physically inactive (AOR = 1.7; CI = 0.97-2.96). The clustering of ≥ 2 risk factors was significantly higher among women and Muslims in bivariate analysis, whereas no significant association was found in multivariate analysis. CONCLUSIONS Public health strategies to prevent CVD risk factors should begin in schools and extend to the entire community.
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Affiliation(s)
- Olumide Ebenezer Olufayo
- MD, MSc. Post-Master's Student, Department of Epidemiology and
Medical Statistics, College of Medicine, University of Ibadan, Ibadan,
Nigeria
| | - Ikeoluwapo Oyeneye Ajayi
- MD, PhD. Professor, Department of Epidemiology and Medical
Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria; Medical
Consultant, Epidemiology and Biostatistics Research Unit, Institute for Advanced
Medical Research and Training, College of Medicine, University of Ibadan,
Ibadan, Nigeria
| | - Samuel Osobuchi Ngene
- MD, MPH. Research Coordinator, Department of Epidemiology and
Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria;
Research Office, Division of Cardiothoracic Surgery, Department of Surgery,
University College Hospital, Ibadan, Nigeria
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Clustering of Lifestyle Risk Factors among Algerian Adolescents: Comparison between Urban and Rural Areas: GSHS Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137072. [PMID: 34281010 PMCID: PMC8297194 DOI: 10.3390/ijerph18137072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
Objective: Compare the clustering of LBRs between urban and rural Algerian adolescents. Design: Data of this cross-sectional study was derived from the Global School-based Health Survey (GSHS). A self-administered, anonymous questionnaire was filled out by 4532 adolescents (11–16 years), which addressed LBRs of NCDs. Life style behavioral risk factors (LBRs) clustering was measured by the ratios of observed (O) and expected (E) prevalence of one or more simultaneously occurring LBRs for urban and rural areas separately. Multivariate logistic regression was performed to examine the association of LBRs as dependent variable with demographic variables (location, age, gender). Results: The most common LBR was physical inactivity (84.6%: 50.9% for urban and 49.1% for rural). Adolescents in urban areas had a higher prevalence of two (56.8% vs. 43.2%) and three and more (61.3% vs. 38.7%) LBRs than in rural areas. In urban areas, a significant positive association was found between (low fruit and vegetable consumption + physical inactivity) [2.06 (1.61–2.64)] and (high SB + smoking) [2.10 (1.54–2.76)], while (physical inactivity + high SB) [0.70 (0.54–0.91)] showed a significant negative association. In rural areas, (high SB + overweight/obesity) [1.49 (1.09–2.04)] had a significant positive association. While, (low fruit and vegetable consumption + high SB) [0.75 (0.60–0.94)], (physical inactivity + high SB) [0.65 (0.49–0.86)], and (physical inactivity + smoking) [0.70 (0.49–0.99)] had a negative association. Conclusions: Several socio-demographic factors have been identified to play a role in LBRs clustering among Algerian adolescents. Results of the study suggest the development of intervention aiming to tackle different LBRs rather than focusing on a single LBR.
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Pengpid S, Peltzer K. Multiple behavioural risk factors of non-communicable diseases among adolescents in four Caribbean countries: prevalence and correlates. Int J Adolesc Med Health 2021; 33:305-312. [PMID: 34142510 DOI: 10.1515/ijamh-2021-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/29/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The study assessed the prevalence and associated factors of behavioural risk factors of non-communicable diseases (NCDs) among adolescents in four Caribbean countries. CONTENT In all 9,143 adolescents (15 years = median age) participated in the cross-sectional "2016 Dominican Republic, 2016 Suriname, 2017 Jamaica, and 2017 Trinidad and Tobago Global School-Based Student Health Survey (GSHS)". Eight behavioural risk factors of NCDs were assessed by a self-administered questionnaire. SUMMARY Prevalence of each behavioural NCD risk factor was physical inactivity (84.2%), inadequate fruit and vegetable intake (82.2%), leisure-time sedentary behaviour (49.6%), daily ≥2 soft drinks intake (46.8%), ever drunk (28.6%), twice or more days a week fast food consumption (27.6%), having overweight/obesity (27.4%), and current tobacco use (13.8%). Students had on average 3.6 (SD=1.4), and 79.0% had 3-8 behavioural NCD risk factors. In multivariable linear regression, psychological distress and older age increased the odds, and attending school and parental support decreased the odds of multiple behavioural NCD risk factors. OUTLOOK A high prevalence and co-occurrence of behavioural risk factors of NCDs was discovered and several factors independently contributing to multiple behavioural NCD risk factors were identified.
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Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Nakhon Pathom, Thailand.,Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa
| | - Karl Peltzer
- Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa.,Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Salwa M, Subaita F, Choudhury SR, Khalequzzaman M, Al Mamun MA, Bhuiyan MR, Haque MA. Fruit and vegetables consumption among school-going adolescents: Findings from the baseline survey of an intervention program in a semi-urban area of Dhaka, Bangladesh. PLoS One 2021; 16:e0252297. [PMID: 34101740 PMCID: PMC8186781 DOI: 10.1371/journal.pone.0252297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 05/10/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Interventions aimed at promoting healthy eating habits in adolescence can help prevent chronic diseases and promote healthy ageing. The aim of this paper is to describe the fruit and vegetables consumption habits of adolescents in Dhaka, Bangladesh as well as to identify the socio-environmental, personal, and behavioral factors that influence these habits. MATERIALS AND METHODS The baseline data from an intervention study involving 823 grade ten students from two randomly selected secondary schools in a semi-urban area of Dhaka were analyzed. The intake of fruit and vegetables was measured in terms of serving size per day. Hierarchical multiple regression was used to assess the ability of socio-environmental factors such as social support, perceived barriers, and living with patient with chronic diseases; personal factors such as knowledge, self-rated practice, behavioral intention, and body mass index; and behavioral factors such as physical activity, sedentary hours, and sleep duration to predict the level of daily fruit and vegetables intake, after controlling the effect of demographic characteristics of adolescents. RESULTS The average daily consumption of fruit and vegetables was 1.22 and 1.99 servings, respectively. Only one-fifth of the respondents (21%) reported eating five servings of fruit and vegetables a day. Inaccessibility at home was reported as the most perceived barrier for both fruit and vegetables intake. Adolescents' higher fruit and vegetables intake was found to be associated with higher maternal educational attainment, more social support, adequate self-rated practice, positive behavioral intention, higher body mass index, better physical activity, and adequate daily sleeping. CONCLUSION The findings revealed insufficient fruit and vegetables intake among adolescents in a semi-urban area of Bangladesh and associated socio-environmental, personal, and behavioral factors that were utilized in developing an intervention program for this transient age group. TRIAL REGISTRATION Trial was registered at ClinicalTrials.gov (NCT03975335) https://clinicaltrials.gov/ct2/show/NCT03975335 on June 01, 2019.
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Affiliation(s)
- Marium Salwa
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Fatima Subaita
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Sohel Reza Choudhury
- Department of Epidemiology & Research, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Md Khalequzzaman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Mohammad Abdullah Al Mamun
- Department of Epidemiology & Research, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Mahfuzur Rahman Bhuiyan
- Department of Epidemiology & Research, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - M. Atiqul Haque
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
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Beta-Arrestins in the Treatment of Heart Failure Related to Hypertension: A Comprehensive Review. Pharmaceutics 2021. [DOI: 10.3390/pharmaceutics13060838
expr 929824082 + 956151497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Heart failure (HF) is a complicated clinical syndrome that is considered an increasingly frequent reason for hospitalization, characterized by a complex therapeutic regimen, reduced quality of life, and high morbidity. Long-standing hypertension ultimately paves the way for HF. Recently, there have been improvements in the treatment of hypertension and overall management not limited to only conventional medications, but several novel pathways and their pharmacological alteration are also conducive to the treatment of hypertension. Beta-arrestin (β-arrestin), a protein responsible for beta-adrenergic receptors’ (β-AR) functioning and trafficking, has recently been discovered as a potential regulator in hypertension. β-arrestin isoforms, namely β-arrestin1 and β-arrestin2, mainly regulate cardiac function. However, there have been some controversies regarding the function of the two β-arrestins in hypertension regarding HF. In the present review, we try to figure out the paradox between the roles of two isoforms of β-arrestin in the treatment of HF.
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Rakib A, Eva TA, Sami SA, Mitra S, Nafiz IH, Das A, Tareq AM, Nainu F, Dhama K, Emran TB, Simal-Gandara J. Beta-Arrestins in the Treatment of Heart Failure Related to Hypertension: A Comprehensive Review. Pharmaceutics 2021; 13:pharmaceutics13060838. [PMID: 34198801 PMCID: PMC8228839 DOI: 10.3390/pharmaceutics13060838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 12/24/2022] Open
Abstract
Heart failure (HF) is a complicated clinical syndrome that is considered an increasingly frequent reason for hospitalization, characterized by a complex therapeutic regimen, reduced quality of life, and high morbidity. Long-standing hypertension ultimately paves the way for HF. Recently, there have been improvements in the treatment of hypertension and overall management not limited to only conventional medications, but several novel pathways and their pharmacological alteration are also conducive to the treatment of hypertension. Beta-arrestin (β-arrestin), a protein responsible for beta-adrenergic receptors’ (β-AR) functioning and trafficking, has recently been discovered as a potential regulator in hypertension. β-arrestin isoforms, namely β-arrestin1 and β-arrestin2, mainly regulate cardiac function. However, there have been some controversies regarding the function of the two β-arrestins in hypertension regarding HF. In the present review, we try to figure out the paradox between the roles of two isoforms of β-arrestin in the treatment of HF.
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Affiliation(s)
- Ahmed Rakib
- Department of Pharmacy, Faculty of Biological Sciences, University of Chittagong, Chittagong 4331, Bangladesh; (A.R.); (T.A.E.); (S.A.S.)
| | - Taslima Akter Eva
- Department of Pharmacy, Faculty of Biological Sciences, University of Chittagong, Chittagong 4331, Bangladesh; (A.R.); (T.A.E.); (S.A.S.)
| | - Saad Ahmed Sami
- Department of Pharmacy, Faculty of Biological Sciences, University of Chittagong, Chittagong 4331, Bangladesh; (A.R.); (T.A.E.); (S.A.S.)
| | - Saikat Mitra
- Department of Pharmacy, Faculty of Pharmacy, University of Dhaka, Dhaka 1000, Bangladesh;
| | - Iqbal Hossain Nafiz
- Department of Biochemistry and Molecular Biology, Faculty of Biological Sciences, University of Chittagong, Chittagong 4331, Bangladesh; (I.H.N.); (A.D.)
| | - Ayan Das
- Department of Biochemistry and Molecular Biology, Faculty of Biological Sciences, University of Chittagong, Chittagong 4331, Bangladesh; (I.H.N.); (A.D.)
| | - Abu Montakim Tareq
- Department of Pharmacy, International Islamic University Chittagong, Chittagong 4318, Bangladesh;
| | - Firzan Nainu
- Faculty of Pharmacy, Hasanuddin University, Tamalanrea, Kota Makassar, Sulawesi Selatan 90245, Indonesia;
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly 243122, Uttar Pradesh, India;
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong 4381, Bangladesh
- Correspondence: (T.B.E.); (J.S.-G.); Tel.: +880-1819-942214 (T.B.E.); +34-988-387-000 (J.S.G.)
| | - Jesus Simal-Gandara
- Nutrition and Bromatology Group, Department of Analytical and Food Chemistry, Faculty of Food Science and Technology, University of Vigo–Ourense Campus, E32004 Ourense, Spain
- Correspondence: (T.B.E.); (J.S.-G.); Tel.: +880-1819-942214 (T.B.E.); +34-988-387-000 (J.S.G.)
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dos Santos JRR, Dias CM, Filho AC. Machine learning and national health data to improve evidence: Finding segmentation in individuals without private insurance. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Islam SMS, Ahmed S, Uddin R, Siddiqui MU, Malekahmadi M, Al Mamun A, Alizadehsani R, Khosravi A, Nahavandi S. Cardiovascular diseases risk prediction in patients with diabetes: Posthoc analysis from a matched case-control study in Bangladesh. J Diabetes Metab Disord 2021; 20:417-425. [PMID: 34222069 DOI: 10.1007/s40200-021-00761-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/01/2021] [Indexed: 01/14/2023]
Abstract
Purpose This study aimed to investigate the estimated 10-year predicted risk of developing cardiovascular diseases (CVD) among participants with and without diabetes in Bangladesh. Methods We performed posthoc analysis from a matched case-control study conducted among 1262 participants. A total of 631 participants with diabetes (case) were recruited from a tertiary hospital, and 631 age, sex and residence matched participants (control) were recruited from the community in Dhaka, Bangladesh. Socioeconomic anthropometric, clinical and CVD risk factor data were collected from the participants. The 10-year estimated CVD risk was calculated using the Framingham Risk Score, which has reasonable validity in South Asians. Results The mean (SD) age of the participants were 51 (10) years. Total 52.3% of cases and 17.2% of controls were at high risk for CVD. The 10-year risk of CVD increased by age and was higher among males in both groups. Among the control group, high CVD risk was more prevalent among higher education and income groups. More than 85% of the tobacco smokers and 70% of chewing tobacco users in the case group were at high risk of CVD. Prevalence of high CVD risk among non-smokers cases was 8.6%. About 35% of hypertensive participants in the control group were at high risk of CVD. Conclusion Bangladeshi patients with diabetes showed a significant burden of CVD risk at a relatively younger age. Strategies for reducing tobacco use and improving BP control in people with diabetes is needed for lowering future CVD risks.
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Affiliation(s)
- Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220 Australia.,Cardiovascular Division, The George Institute for Global Health, Newtown, Australia.,Sydney Medical School, University of Sydney, Camperdown, Australia
| | - Shyfuddin Ahmed
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL USA.,International Centre for Diarrhoeal Diseases, Bangladesh, Dhaka, Bangladesh
| | - Riaz Uddin
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220 Australia
| | - Muhammad U Siddiqui
- Marshfield Clinic Health System, Rice Lake, WI USA.,George Washington University, Washington, D.C. USA
| | - Mahsa Malekahmadi
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Nutrition Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdullah Al Mamun
- Department of Computer Science and Engineering, United International University, Dhaka, Bangladesh
| | - Roohallah Alizadehsani
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, VIC Australia
| | - Abbas Khosravi
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, VIC Australia
| | - Saeid Nahavandi
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, VIC Australia
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