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Yu HJ, Ho M, Liu X, Yang J, Chau PH, Fong DYT. Incidence and temporal trends in type 2 diabetes by weight status: A systematic review and meta-analysis of prospective cohort studies. J Glob Health 2023; 13:04088. [PMID: 37651631 PMCID: PMC10471153 DOI: 10.7189/jogh.13.04088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Background Diabetes is more prevalent among overweight/obese individuals, but has become a significant public health challenge among normal weight populations. In this meta-analysis, we aimed to estimate diabetes/prediabetes incidence and its temporal trends by weight status. Methods PubMed, Embase, Web of Science, and Cochrane Library were searched until 8 December 2021. Prospective cohort studies reporting diabetes incidence by baseline body mass index (BMI) categories in adults were included. The median year of data collection was used to assess the temporal trends. Subgroup analyses and meta-regression were also performed. Results We included 94 studies involving 3.4 million adults from 22 countries. The pooled diabetes incidence in underweight, normal-weight, and overweight/obese adults was 4.5 (95% confidence interval (CI) = 2.8-7.3), 2.7 (95% CI = 2.2-3.3), and 10.5 (95% CI = 9.3-11.8) per 1000 person-years, respectively. The diabetes incidence in low- and middle-income countries (LMICs) was higher than in high-income countries among normal-weight (5.8 vs 2.0 per 1000 person-years) or overweight/obese (15.9 vs 8.9 per 1000 person-years) adults. European and American regions had a higher diabetes incidence than the non-Western areas, regardless of weight status. Underweight diabetes incidence decreased significantly from 1995-2000 to 2005-2010. Diabetes incidence in normal-weight populations has increased continuously since 1985 by an estimated 36% every five years. In overweight/obese adults, diabetes incidence increased between 1985-1990 and 1995-2000, stabilised between 2000 and 2010, and spiked suddenly after 2010. Conclusions Diabetes incidence and its temporal trends differed by weight status. The continuous upward trend of diabetes incidence among overweight/obese individuals requires urgent attention, particularly in LMICs. Furthermore, diabetes among normal-weight individuals is becoming a significant public health problem. Registration PROSPERO (CRD42020215957).
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Affiliation(s)
- Hong-jie Yu
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Mandy Ho
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Xiangxiang Liu
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Jundi Yang
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Pui Hing Chau
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
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Yu HJ, Ho M, Liu X, Yang J, Chau PH, Fong DYT. Association of weight status and the risks of diabetes in adults: a systematic review and meta-analysis of prospective cohort studies. Int J Obes (Lond) 2022; 46:1101-1113. [PMID: 35197569 DOI: 10.1038/s41366-022-01096-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/30/2022]
Abstract
Obesity is a known risk factor for type 2 diabetes mellitus (T2DM); however, the associations between underweight and T2DM and between weight status and prediabetes have not been systematically reviewed. We aimed to estimate the relative risks (RRs) of prediabetes/T2DM in underweight/overweight/obesity relative to normal weight. PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to December 8, 2021. Prospective cohort studies with a minimum 12-month follow-up period reporting the association between baseline body mass index (BMI) categories and risk of prediabetes/T2DM in adults were included. Study quality was assessed using the Newcastle-Ottawa Scale. The main analyses of T2DM risk were performed using the ethnic-specific (Asian/non-Asian) BMI classification and additional analyses of prediabetes/T2DM risk by including all eligible studies. Random-effects models with inverse variance weighting were used. Subgroup analyses and meta-regression were conducted to explore the potential effects of pre-specified modifiers. The study protocol was registered with PROSPERO (CRD42020215957). Eighty-four articles involving over 2.69 million participants from 20 countries were included. The pooled RR of prediabetes risk was 1.24 (95% CI: 1.19-1.28, I2 = 9.7%, n = 5 studies) for overweight/obesity vs. normal weight. The pooled RRs of T2DM based on the ethnic-specific BMI categories were 0.93 (95% CI: 0.75-1.15, I2 = 55.5%, n = 12) for underweight, 2.24 (95% CI: 1.95-2.56, I2 = 92.0%, n = 47) for overweight, 4.56 (95% CI: 3.69-5.64, I2 = 96%, n = 43) for obesity, and 22.97 (95% CI: 13.58-38.86, I2 = 92.1%, n = 6) for severe obesity vs. normal weight. Subgroup analyses indicated that underweight is a protective factor against T2DM in non-Asians (RR = 0.68, 95% CI: 0.40-0.99, I2 = 56.1%, n = 6). The magnitude of the RR of T2DM in overweight/obesity decreased with age and varied by region and the assessment methods for weight and T2DM. Overweight/obesity was associated with an increased prediabetes/T2DM risk. Further studies are required to confirm the association between underweight and prediabetes/T2DM, particularly in Asian populations.
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Affiliation(s)
- Hong-Jie Yu
- School of Nursing, the University of Hong Kong, Hong Kong, SAR, China
| | - Mandy Ho
- School of Nursing, the University of Hong Kong, Hong Kong, SAR, China.
| | | | - Jundi Yang
- School of Nursing, the University of Hong Kong, Hong Kong, SAR, China
| | - Pui Hing Chau
- School of Nursing, the University of Hong Kong, Hong Kong, SAR, China
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Fottrell E, Ahmed N, Shaha SK, Jennings H, Kuddus A, Morrison J, Akter K, Nahar B, Nahar T, Haghparast-Bidgoli H, Khan AKA, Costello A, Azad K. Distribution of diabetes, hypertension and non-communicable disease risk factors among adults in rural Bangladesh: a cross-sectional survey. BMJ Glob Health 2018; 3:e000787. [PMID: 30498584 PMCID: PMC6242007 DOI: 10.1136/bmjgh-2018-000787] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 09/14/2018] [Accepted: 09/24/2018] [Indexed: 12/27/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are increasing in low-income settings. We conducted a survey of risk factors, blood pressure and blood glucose in rural Bangladesh and assessed variations by age, sex and wealth. Methods We surveyed a random sample of 12 280 adults aged >30 years in 96 villages in rural Bangladesh. Fieldworkers measured blood glucose and conducted an glucose tolerance test with a repeat blood test 120 min post glucose ingestion. Blood pressure, anthropometric, socioeconomic, lifestyle and behavioural risk factors data were also collected. Data were analysed to describe the prevalence of diabetes, intermediate hyperglycaemia, hypertension and NCD risk factors by age, sex and wealth. Results Women had higher levels of overweight or obesity and lower levels of physical activity and fruit and vegetable consumption than men; 63% of men used tobacco compared with 41.3% of women. Overweight or obesity and abdominal obesity (waist to hip ratio) increased with socioeconomic status (least poor vs most poor: OR (95% CI) 3.21 (2.51 to 4.11) for men and 2.83 (2.28 to 3.52) for women). Tobacco use, passive smoke exposure and salt consumption fell with increasing socioeconomic status in both sexes. Clustering of risk factors showed more than 70% of men and women reported at least three risk factors. Women in the least poor group were 33% more likely to have three or more risk factors compared with women in the most poor group (1.33 (95% CI 1.17 to 1.58)). The combined prevalence of impaired fasting glucose, impaired glucose tolerance and diabetes was 26.1% among men and 34.9% among women, and increased with age. The prevalence of prehypertension and hypertension was 30.7% and 15.9% among men and 27.2% and 22.5% among women, with similar rising prevalence with age. Conclusion NCD risk factors, hyperglycaemia and raised blood pressure are an immediate health threat in rural Bangladesh. Initiatives to improve detection, treatment and prevention strategies are needed.
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Affiliation(s)
- Edward Fottrell
- Institute for Global Health, University College London, London, UK
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Hannah Jennings
- Institute for Global Health, University College London, London, UK
| | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | | | - Badrun Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK.,Maternal, Newborn, Child and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
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Monção CSA, Martins LN, Penteado MPS, Reis RCP, Santos FMM, Lanna CCD, Ribeiro AL, Telles RW. Incidence of cardiovascular risk factors in female patients with systemic lupus erythematosus: a 3-year follow-up cohort. Lupus 2018; 27:1790-1798. [DOI: 10.1177/0961203318790676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objectives To evaluate the incidence and variability of traditional coronary artery disease (CAD) risk factors in a cohort of lupus patients and to investigate if prednisone use predicts an increase in the number of risk factors. Methods A total of 151 women, 37.8 ± 11.1 (mean ± SD) years old at baseline, were reevaluated after a median period of 39 (interquartile range 36.5–42.0) months. The cumulative incidence of traditional risk factors, the incidence rate (with 95% confidence interval) of hypertension, diabetes, dyslipidemia and hypertriglyceridemia, and the frequency of the risk factors’ disappearance were calculated. Metabolic syndrome (MetS) and Framingham risk score (FRS) were computed. Logistic regression was used to investigate if maximum or cumulative prednisone dose used during follow-up predicted an increase in the cardiometabolic risk factors’ number. Results The cumulative incidence of risk factors varied from 39.1% (abdominal obesity) to zero (smoking), and the incidence rate varied from 133.2 (87.8–178.6) per 1000 person-years (dyslipidemia) to 10.4 (1.3–19.5) per 1000 person-years (diabetes). The cumulative incidence for MetS was 18.8%, and 11.7% of 143 patients with low FRS at baseline (T1) were classified in the high-risk category at the end of the study (T2). Dyslipidemia was the most variable risk factor, with 43.5% disappearance at T2. The maximum prednisone dose used during follow-up was borderline ( p = 0.050) for prediction of an increase in the number of cardiometabolic risk factors in an adjusted model for antimalarial use, modified Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and age. Conclusion The authors described high incidence and variability of CAD risk factors in female lupus patients, with higher prednisone dose being borderline for an increase in the number of cardiometabolic risk factors.
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Affiliation(s)
- C S A Monção
- Universidade Federal de Minas Gerais, Faculdade de Medicina Belo Horizonte, Minas Gerais, Brazil
| | - L N Martins
- Universidade Federal de Minas Gerais, Faculdade de Medicina Belo Horizonte, Minas Gerais, Brazil
| | - M P S Penteado
- Universidade Federal de Minas Gerais, Faculdade de Medicina Belo Horizonte, Minas Gerais, Brazil
| | - R C P Reis
- Universidade Federal de Minas Gerais, Faculdade de Medicina Belo Horizonte, Minas Gerais, Brazil
| | - F M M Santos
- Universidade Federal de Minas Gerais, Faculdade de Medicina Belo Horizonte, Minas Gerais, Brazil
| | - C C D Lanna
- Universidade Federal de Minas Gerais, Faculdade de Medicina Belo Horizonte, Minas Gerais, Brazil
| | - A L Ribeiro
- Universidade Federal de Minas Gerais, Faculdade de Medicina Belo Horizonte, Minas Gerais, Brazil
| | - R W Telles
- Universidade Federal de Minas Gerais, Faculdade de Medicina Belo Horizonte, Minas Gerais, Brazil
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Khan MN, Rahman MM, Shariff AA, Rahman MM, Rahman MS, Rahman MA. Maternal undernutrition and excessive body weight and risk of birth and health outcomes. Arch Public Health 2017; 75:12. [PMID: 28174626 PMCID: PMC5291969 DOI: 10.1186/s13690-017-0181-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/20/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Overweight and obesity are increasing in low- and middle-income countries, while underweight remains a significant health problems. However, the association between double burden of nutrition and risk of adverse birth and health outcomes is still unclear in Bangladesh. The aim of this study was to determine the effect of maternal undernutrition and excessive body weight on a range of maternal and child health outcomes. METHODS In this study, we used Bangladesh Demographic and Health Survey (BDHS) 2011 and 2014 data sets to cover the maternal, child and non-communicable diseases related health outcomes. The study considered a range of outcome variables including pregnancy complication, cesarean delivery, diabetes, hypertension, stunting, and wasting, low birth weight, genital discharge, genital sore/ulcer, stillbirth, early neonatal mortality, perinatal mortality, preterm birth and prolonged labor. The key exposure variable was maternal body mass index. Multilevel regression analysis was performed to examine the association between outcomes and exposure variables. RESULTS Maternal overweight and obesity has increased from 10% in 2004 to 24% in 2014, a 240% increase in 10 years. Between 2004 and 2014, maternal undernutrition declined from 33% to 18%, a reduction rate of only 54% in 10 years. Compared to normal-weight women, overweight and obese women were more likely to have experienced pregnancy complication, cesarean delivery, diabetes, and hypertension. Underweight women were 1.3 times more likely to have children with stunting and 1.6 times more likely to experience wasting compared to normal weight women. Maternal BMI was not significantly associated with increased risk of genital sore or ulcer, genital discharge, menstrual irregularities, or low birth weight though in certain cases risk was higher. CONCLUSIONS High maternal overweight and obesity were observed to have significant adverse effects on health outcomes, while underweight was a risk factor for newborn health. The findings show that weight management is necessary to prevent adverse birth and health outcomes in Bangladesh. TRIAL REGISTRATION Data related to health was collected by following the guidelines of ICF international and Bangladesh Medical Research Council. The registration number of data collection is 132989.0.000 and the data-request was registered on March 11, 2015.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Science and Human Resource Development, University of Rajshahi, 6205 Rajshahi, Bangladesh
| | - Md Mizanur Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, 6205 Rajshahi, Bangladesh
- Department of Global Health Policy, University of Tokyo, Tokyo, Japan
| | - Asma Ahmad Shariff
- Centre for Foundation Studies in Science, University of Malaya, Malaya, Malaysia
| | - Md Mostafizur Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, 6205 Rajshahi, Bangladesh
| | - Md Shafiur Rahman
- Department of Global Health Policy, University of Tokyo, Tokyo, Japan
| | - Md Aminur Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, 6205 Rajshahi, Bangladesh
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Fottrell E, Jennings H, Kuddus A, Ahmed N, Morrison J, Akter K, Shaha SK, Nahar B, Nahar T, Haghparast-Bidgoli H, Khan AKA, Costello A, Azad K. The effect of community groups and mobile phone messages on the prevention and control of diabetes in rural Bangladesh: study protocol for a three-arm cluster randomised controlled trial. Trials 2016; 17:600. [PMID: 27993166 PMCID: PMC5170893 DOI: 10.1186/s13063-016-1738-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/03/2016] [Indexed: 12/14/2022] Open
Abstract
Background Increasing rates of type 2 diabetes mellitus place a substantial burden on health care services, communities, families and individuals living with the disease or at risk of developing it. Estimates of the combined prevalence of intermediate hyperglycaemia and diabetes in Bangladesh vary, and can be as high as 30% of the adult population. Despite such high prevalence, awareness and control of diabetes and its risk factors are limited. Prevention and control of diabetes and its complications demand increased awareness and action of individuals and communities, with positive influences on behaviours and lifestyle choices. In this study, we will test the effect of two different interventions on diabetes occurrence and its risk factors in rural Bangladesh. Methods/design A three-arm cluster randomised controlled trial of mobile health (mHealth) and participatory community group interventions will be conducted in four rural upazillas in Faridpur District, Bangladesh. Ninety-six clusters (villages) will be randomised to receive either the mHealth intervention or the participatory community group intervention, or be assigned to the control arm. In the mHealth arm, enrolled individuals will receive twice-weekly voice messages sent to their mobile phone about prevention and control of diabetes. In the participatory community group arm, facilitators will initiate a series of monthly group meetings for men and women, progressing through a Participatory Learning and Action cycle whereby group members and communities identify, prioritise and tackle problems associated with diabetes and the risk of developing diabetes. Both interventions will run for 18 months. The primary outcomes of the combined prevalence of intermediate hyperglycaemia and diabetes and the cumulative 2-year incidence of diabetes among individuals identified as having intermediate hyperglycaemia at baseline will be evaluated through baseline and endline sample surveys of permanent residents aged 30 years or older in each of the study clusters. Data on blood glucose level, blood pressure, body mass index and hip-to-waist ratio will be gathered through physical measurements by trained fieldworkers. Demographic and socioeconomic data, as well as data on knowledge of diabetes, chronic disease risk factor prevalence and quality of life, will be gathered through interviews with sampled respondents. Discussion This study will increase our understanding of diabetes and other non-communicable disease burdens and risk factors in rural Bangladesh. By documenting and evaluating the delivery, impact and cost-effectiveness of participatory community groups and mobile phone voice messaging, study findings will provide evidence on how population-level strategies of community mobilisation and mHealth can be implemented to prevent and control noncommunicable diseases and risk factors in this population. Trial registration ISRCTN41083256. Registered on 30 Mar 2016 (Retrospectively Registered). Trial acronym D-Magic: Diabetes Mellitus – Action through Groups or mobile Information for better Control.
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Affiliation(s)
- Edward Fottrell
- Institute for Global Health, University College London, London, UK.
| | - Hannah Jennings
- Institute for Global Health, University College London, London, UK
| | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | | | | | - Badrun Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK.,World Health Organisation, Geneva, Switzerland
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
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Papier K, Jordan S, D‘Este C, Bain C, Peungson J, Banwell C, Yiengprugsawan V, Seubsman SA, Sleigh A. Incidence and risk factors for type 2 diabetes mellitus in transitional Thailand: results from the Thai cohort study. BMJ Open 2016; 6:e014102. [PMID: 27974373 PMCID: PMC5168599 DOI: 10.1136/bmjopen-2016-014102] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is increasingly prevalent in countries undergoing rapid development, including Thailand. We assessed T2DM incidence over an 8-year period in a nationwide cohort of Thai adults. METHODS Thai Cohort Study participants were surveyed in 2005, 2009 and 2013. The analysed cohort members were aged (15-88), did not have diabetes in 2005 and were followed up by questionnaire in 2013 (n=39 507). T2DM was ascertained using self-report, which has been validated using physician interviews. We calculated the 8-year cumulative incidence of T2DM. Multivariable logistic regression assessed associations between potential risk factors and T2DM incidence. RESULTS 8-year cumulative incidence of T2DM (2005 to 2013) was 177 per 10 000 (95% CI 164 to 190). Crude and age-standardised cumulative incidences of T2DM by sex were 249 per 10 000 (95% CI 226 to 272) and 222 per 10 000 (95% CI 219 to 225) for men; and 119 per 10 000 (95% CI 105 to 133) and 96 per 10 000 (95% CI 94 to 98) for women, respectively. T2DM increased significantly for both sexes with increasing age and body mass index (BMI) (p trend <0.001 for both). Residence in an urban area as a child associated with T2DM among men and women (OR=1.4, 95% CI 1.1 to 1.7 and OR=1.4, 95% CI 1.01 to 1.79); this was no longer statistically significant after adjusting for BMI. Among men, smoking (OR=1.7, 95% CI 1.3 to 2.2) and alcohol intake (OR=1.8, 95% CI 1.1 to 3.0) were associated with T2DM. CONCLUSIONS This study found that the sociodemographic and lifestyle changes that have accompanied Thailand's economic development are associated with T2DM risk in a large cohort of Thai adults. Our findings highlight the need to address these transitions to prevent a further increase in the national incidence of T2DM, particularly among Thai men.
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Affiliation(s)
- Keren Papier
- National Centre for Epidemiology and Population Health (NCEPH) and Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Susan Jordan
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Catherine D‘Este
- National Centre for Epidemiology and Population Health (NCEPH) and Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia
| | - Chris Bain
- National Centre for Epidemiology and Population Health (NCEPH) and Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Janya Peungson
- Thai Health-Risk Transition Study, School of Human Ecology, Sukhothai Thammathirat Open University, Nonthaburi, Thailand
| | - Cathy Banwell
- National Centre for Epidemiology and Population Health (NCEPH) and Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia
| | - Vasoontara Yiengprugsawan
- National Centre for Epidemiology and Population Health (NCEPH) and Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia
- Health and Wellbeing and Department of Global Health, Centre for Research on Ageing, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sam-ang Seubsman
- Thai Health-Risk Transition Study, School of Human Ecology, Sukhothai Thammathirat Open University, Nonthaburi, Thailand
| | - Adrian Sleigh
- National Centre for Epidemiology and Population Health (NCEPH) and Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia
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Bhowmik B, Akhter A, Ali L, Ahmed T, Pathan F, Mahtab H, Khan AKA, Hussain A. Simple risk score to detect rural Asian Indian (Bangladeshi) adults at high risk for type 2 diabetes. J Diabetes Investig 2015; 6:670-7. [PMID: 26543541 PMCID: PMC4627544 DOI: 10.1111/jdi.12344] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 01/27/2015] [Accepted: 02/22/2015] [Indexed: 01/29/2023] Open
Abstract
AIMS/INTRODUCTION To develop and evaluate a simple, non-invasive, diabetes risk score for detecting individuals at high risk for type 2 diabetes in rural Bangladesh. MATERIALS AND METHODS Data from 2,293 randomly selected individuals aged ≥20 years from a cross-sectional study in a rural community of Bangladesh (2009 Chandra Rural Study) was used for model development. The validity of the model was assessed in another rural cross-sectional study (2009 Thakurgaon Rural Study). The logistic regression model used included age, sex, body mass index, waist-to-hip ratio and hypertension status to predict individuals who were at high risk for type 2 diabetes. RESULTS On applying the developed model to both cohorts, the area under the receiver operating characteristic curve was 0.70 (95% confidence interval 0.68-0.72) for the Chandra cohort and 0.71 (95% confidence interval 0.68-0.74) for the Thakurgaon cohort. The risk score of >9 was shown to have the optimal cut-point to detect diabetes. This score had a sensitivity of 62.4 and 75.7%, and specificity of 67.4 and 61.6% in the two cohorts, respectively. This risk score was shown to have improved sensitivity and specificity to detect type 2 diabetes cases compared with the Thai, Indian, Omani, UK, Dutch, Portuguese and Pakistani diabetes risk scores. CONCLUSIONS This simple, non-invasive risk score can be used to detect individuals at high risk for type 2 diabetes in rural Bangladesh. Subjects with a score of 9 or above (out of 15) should undergo an oral glucose tolerance test for definitive diagnosis of diabetes.
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Affiliation(s)
| | - Afroza Akhter
- Department of Epidemiology & Biostatistics, Bangladesh Institute of Health Sciences (BIHS)Mirpur, Bangladesh
| | - Liaquat Ali
- Department of Biochemistry & Cell Biology, BUHSMirpur, Bangladesh
| | - Tofail Ahmed
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM)Dhaka, Bangladesh
| | - Faruque Pathan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM)Dhaka, Bangladesh
| | - Hajera Mahtab
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM)Dhaka, Bangladesh
| | - Abul Kalam Azad Khan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM)Dhaka, Bangladesh
| | - Akhtar Hussain
- Department of International Health, University of OsloOslo, Norway
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9
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Siddiquee T, Bhowmik B, Karmaker RK, Chowdhury A, Mahtab H, Azad Khan AK, Hussain A. Association of general and central obesity with diabetes and prediabetes in rural Bangladeshi population. Diabetes Metab Syndr 2015; 9:247-251. [PMID: 25795165 DOI: 10.1016/j.dsx.2015.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Recent data shown that both general and central obesity indices are significantly associated with diabetes (T2DM) and prediabetes (impaired glucose tolerance [IGT] and impaired fasting glucose [IFG]). Data regarding association of obesity with T2DM and prediabetes in rural Bangladeshi population is scarce. This study aims to observe the association of general and central obesity with diabetes (T2DM) and prediabetes in rural Bangladeshi population. MATERIALS AND METHODS A total of 2293 rural Bangladeshi adults aged ≥20 years were randomly selected in a population-based, cross-sectional survey which was conducted in 2009. The association of general (defined by body mass index [BMI]) and central obesity (defined by waist circumference [WC] and waist hip ratio [WHR]) with T2DM and prediabetes was assessed by using receiver operating characteristic curve analysis and logistic regression. RESULTS Subjects with T2DM, IGT and IFG had a higher rate of general and central obesity than normal subjects. WHR was more closely associated with T2DM than WC and BMI. However, all three obesity indices were significantly associated with IGT and IFG. CONCLUSIONS In rural Bangladeshi population, both general and central obesity showed good association with T2DM and prediabetes.
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Affiliation(s)
- Tasnima Siddiquee
- Department of International Health, University of Oslo, P.O. Box 1130 Blindern, 0318 Oslo, Norway
| | - Bishwajit Bhowmik
- Department of International Health, University of Oslo, P.O. Box 1130 Blindern, 0318 Oslo, Norway.
| | - Rajat Kanti Karmaker
- Mother and Child Health Project, Diabetic Association of Bangladesh, Dhaka 1200, Bangladesh
| | - Abhijit Chowdhury
- Mother and Child Health Project, Diabetic Association of Bangladesh, Dhaka 1200, Bangladesh
| | - Hajera Mahtab
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka 1200, Bangladesh
| | - A K Azad Khan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka 1200, Bangladesh
| | - Akhtar Hussain
- Department of International Health, University of Oslo, P.O. Box 1130 Blindern, 0318 Oslo, Norway
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Bhowmik B, Munir SB, Ahmed KR, Siddiquee T, Diep LM, Wright E, Hassan Z, Debnath PR, Mahtab H, Azad Khan A, Hussain A. Anthropometric indices of obesity and type 2 diabetes in Bangladeshi population: Chandra Rural Diabetes Study (CRDS). Obes Res Clin Pract 2014; 8:e201-98. [DOI: 10.1016/j.orcp.2013.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 03/19/2013] [Accepted: 06/04/2013] [Indexed: 01/08/2023]
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Bhowmik B, Afsana F, My Diep L, Binte Munir S, Wright E, Mahmood S, Khan AKA, Hussain A. Response: increasing prevalence of type 2 diabetes in a rural bangladeshi population: a population based study for 10 years (diabetes metab j 2013;37:46-53). Diabetes Metab J 2013; 37:153-4. [PMID: 23641358 PMCID: PMC3638228 DOI: 10.4093/dmj.2013.37.2.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Bishwajit Bhowmik
- Department of Community Medicine, Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Faria Afsana
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Lien My Diep
- Department of Community Medicine, Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
- Unit for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Sanjida Binte Munir
- Executive Diabetes Care Centre, NHN, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Erica Wright
- ACT Diabetes Service, Division of Medicine, Canberra Hospital, Canberra, Australia
| | - Sharif Mahmood
- Institutes of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - A. K. Azad Khan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Akhtar Hussain
- Department of Community Medicine, Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
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Bhowmik B, Munir SB, Diep LM, Siddiquee T, Habib SH, Samad MA, Azad Khan AK, Hussain A. Anthropometric indicators of obesity for identifying cardiometabolic risk factors in a rural Bangladeshi population. J Diabetes Investig 2013; 4:361-8. [PMID: 24843680 PMCID: PMC4020230 DOI: 10.1111/jdi.12053] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 12/07/2012] [Accepted: 12/10/2012] [Indexed: 12/21/2022] Open
Abstract
Aims/Introduction The aim of the present study was to evaluate the predictive ability of body mass index (BMI), waist circumference (WC), waist‐to‐hip ratio (WHR), waist‐to‐height ratio (WHtR) and body fat percentages (BF%) for the presence of cardiometabolic risk factors, namely type 2 diabetes (DM), hypertension (HTN), dyslipidemia and metabolic syndrome (MS). Materials and Methods A total of 2293 subjects aged ≥20 years from rural Bangladesh were randomly selected in a population‐based, cross‐sectional survey. The association of anthropometric indicators with cardiometabolic risk conditions was assessed by using receiver operating characteristic curve analysis and adjusted odds ratios (ORs) for DM, HTN, dyslipidemia and MS. Results Area under the curve cut‐off values showed that the association of WHR, BF% and WC was higher than that for other indices for DM, HTN and MS, respectively, for both sexes, and WHtR for men and WHR for women for dyslipidemia. The ORs were highest for WHR for DM and WC for MS for both sexes, and WHtR for men and WC for women for HTN and dyslipidemia, respectively. The optimal cut‐off values for obesity for the present study in men and women showed BMIs of 22 and 22.8 kg/m2, WHRs of 0.93 and 0.87, WHtRs of 0.52 and 0.54, BF% of 21.4 and 32.4%, and WCs of 82 and 81 cm, except for MS, which were 90 for men and 80 for women. Conclusions Compared with BMI, measures of central obesity, particularly WHR, WC, WHtR and BF%, showed a better association with obesity‐related cardiometabolic risk factors for both sexes.
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Affiliation(s)
- Bishwajit Bhowmik
- Department of Community Medicine Institute of Health and Society University of Oslo Oslo Norway
| | - Sanjida B Munir
- Unit of Biostatistics and Epidemiology Oslo University Hospital Oslo Norway
| | - Lien M Diep
- Department of Community Medicine Institute of Health and Society University of Oslo Oslo Norway ; Executive Diabetes Care Center NHN Diabetic Association of Bangladesh Dhaka Bangladesh
| | - Tasnima Siddiquee
- Diabetes Prevention Intervention Project Diabetic Association of Bangladesh Dhaka Bangladesh
| | | | - Mohammad A Samad
- National Health Care Network Diabetic Association of Bangladesh Dhaka Bangladesh
| | - Abul Kalam Azad Khan
- Endocrinology Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders (BIRDEM) Dhaka Bangladesh
| | - Akhtar Hussain
- Department of Community Medicine Institute of Health and Society University of Oslo Oslo Norway
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Hadaegh F, Jahangiri Noudeh Y, Tohidi M, Vatankhah N, Khalili D, Mohebi R, Azizi F. Change in general and central adiposity measures in prediction of incident dysglycemia; Tehran Lipid and Glucose Study. Prev Med 2012; 55:608-12. [PMID: 23046898 DOI: 10.1016/j.ypmed.2012.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 09/28/2012] [Accepted: 09/29/2012] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To examine the change in general and central adiposity measures as a predictor of incident dysglycemia during a 6-year follow-up. SUBJECTS A total of 4029 (2333 women and 1696 men) non-dysglycemic Iranians aged ≥ 20 years, underwent standard fasting and 2-h post-challenge plasma glucose tests at baseline and follow-up. RESULTS During follow-up, 458 new cases of dysglycemia occurred. In multivariable models including baseline values of each anthropometric measure, odds ratios (ORs) for dysglycemia incidence corresponding to a 1-SD increase in changes of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and hip circumference (HC), were 1.32, 1.56, 1.39, 1.51 and 1.39 for men and 1.59, 1.50, 1.37, 1.47, and 1.38, for women, respectively (all P<0.05). After controlling for weight change and WC change among men and women, respectively, HC change did not remain as a predictor. Using the paired homogeneity test, there was no superiority for changes in central obesity measures compared to changes in BMI to predict dysglycemia. CONCLUSION The association between HC changes and incident dysglycemia was dependent upon changes in central and general adiposity measures, where the former did not have higher predictability than the latter in prediction of dysglycemia.
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Affiliation(s)
- Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Frank LK, Heraclides A, Danquah I, Bedu-Addo G, Mockenhaupt FP, Schulze MB. Measures of general and central obesity and risk of type 2 diabetes in a Ghanaian population. Trop Med Int Health 2012. [PMID: 23190041 DOI: 10.1111/tmi.12024] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The epidemic of obesity and type 2 diabetes is evident in sub-Saharan Africa (SSA). However, their associations have hardly been examined in this region. METHODS A hospital-based case-control study in urban Ghana consisting of 1221 adults (542 cases and 679 controls) investigated the role of anthropometric parameters for diabetes. Logistic regression was used for analysis. The discriminative power and population-specific cut-off points for diabetes were identified by receiver operating characteristic curves. RESULTS The strongest association with diabetes was observed for waist-to-hip ratio: age-adjusted odds ratios per 1 standard deviation difference were 1.95 (95% confidence interval [CI]: 1.64-2.31) in women and 1.40 [1.01-1.94] in men. Also, among women, the odds of diabetes increased with higher waist circumference (1.35 [1.17-1.57]) and waist-to-height ratio (1.29 [1.12-1.50]). Among men, this was not discernible. Rather, hip circumference was inversely related (0.69 [0.50-0.95]). Body mass index was neither associated with diabetes in women (1.01 [0.88-1.15]) nor in men (0.74 [0.52-1.04]). Among both genders, waist-to-hip ratio showed the best discriminative ability for diabetes in this population and the optimal cut-off points were ≥ 0.88 in women and ≥ 0.90 in men. Recommended cut-off points for body mass index and waist circumference had a poor predictive ability. CONCLUSION Our findings suggest that measures of central rather than general obesity relate to type 2 diabetes in SSA. It remains to be verified from larger population-based epidemiological studies whether anthropometric targets of obesity prevention in SSA differ from those in developed countries.
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Affiliation(s)
- Laura K Frank
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
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