Protein and amino acid intakes in a rural area of Bangladesh

Protein Energy Wasting in a Cohort of Maintenance Hemodialysis Patients in Dhaka, Bangladesh

Malnutrition is associated with high rates of mortality among patients with end stage kidney disease (ESKD). There is a paucity of data from Bangladesh, where around 35,000−40,000 people reach ESKD annually. We assessed protein-energy wasting (PEW) amongst 133 patients at a single hemodialysis setting in Dhaka. Patients were 49% male, age 50 ± 13 years, 62% were on twice-weekly hemodialysis. Anthropometric, biochemical, and laboratory evaluations revealed: BMI 24.1 ± 5.2 kg/m2, mid-arm muscle circumference (MAMC) 21.6 ± 3.6 cm, and serum albumin 3.7 ± 0.6 g/dL. Based on published criteria, 18% patients had PEW and for these patients, BMI (19.8 ± 2.4 vs. 25.2 ± 5.2 kg/m2), MAMC (19.4 ± 2.4 vs. 22.2 ± 3.8 cm), serum albumin (3.5 ± 0.7 vs. 3.8 ± 0.5 g/dL), and total cholesterol (135 ± 34 vs. 159 ± 40 mg/dL), were significantly lower as compared to non-PEW patients, while hand grip strength was similar (19.5 ± 7.6 vs. 19.7 ± 7.3 kg). Inflammatory C-reactive protein levels tended to be higher in the PEW group (20.0 ± 34.8 vs. 10.0 ± 13.9 p = 0.065). Lipoprotein analyses revealed PEW patients had significantly lower low density lipoprotein cholesterol (71 ± 29 vs. 88 ± 31 mg/dL, p < 0.05) and plasma triglyceride (132 ± 51 vs. 189 ± 103 mg/dL, p < 0.05), while high density lipoprotein cholesterol was similar. Nutritional assessments using a single 24 h recall were possible from 115 of the patients, but only 66 of these were acceptable reporters. Amongst these, while no major differences were noted between PEW and non-PEW patients, the majority of patients did not meet dietary recommendations for energy, protein, fiber, and several micronutrients (in some cases intakes were 60−90% below recommendations). Malnutrition Inflammation Scores were significantly higher in PEW patients (7.6 ± 3.1 vs. 5.3 ± 2.7 p < 0.004). No discernible differences were apparent in measured parameters between patients on twice- vs. thrice-weekly dialysis. Data from a larger cohort are needed prior to establishing patient-management guidelines for PEW in this population.

Exploring the impact of soil and water salinity on dietary behavior and health risk of coastal communities in Bangladesh

The purpose of this study was to evaluate the impact of soil and water salinity on dietary behavior and health risk in the coastal people of Bangladesh. This study was conducted among 240 respondents in rural coastal sub-districts in Khulna and Patuakhali of Bangladesh using a simple random sampling technique. To evaluate the association between health risk and salinity exposure categories, a multinomial logit regression analysis was conducted and statistical significance was declared at p ≤ 0.05. A significantly higher amount of salinity (NaCl) level was found in radish, potato, bean, bitter gourd, rice, shallow tube-well, and pond water from Patuakhali than Khulna. Males and those aged 36-50 years (RRR:1.89, SE:0.58) and 51-65 years (RRR:4.51, SE:1.81) were associated with hypertension compared with the females (RRR:0.57, SE:0.18) and age group 20-35 years. Consumption of shallow tube-well water (RRR:3.12, SE:1.46), salt content rice (RRR:1.36, SE:0.50), salt content vegetables (RRR:1.09, SE:0.09), salt content fish (RRR:2.77, SE:0.47), and intake of table salt (RRR:1.05, SE:0.03) were significantly associated with risk factors of hypertension (p < 0.01). A sustainable policy for salt reduction through dietary interventions along with the promotion of low saline foods and drinking water must be a priority with special emphasis on coastal areas.

The effect of drinking water salinity on blood pressure in young adults of coastal Bangladesh

More than 35 million people in coastal Bangladesh are vulnerable to increasing freshwater salinization. This will continue to affect more people and to a greater extent as climate change projections are realised in this area in the future. However the evidence for health effects of consuming high salinity water is limited. This research examined the association between drinking water salinity and blood pressure in young adults in coastal Bangladesh. We conducted a cross-sectional study during May-June 2014 in a rural coastal sub-district of Bangladesh. Data on blood pressure (BP) and salinity of potable water sources was collected from 253 participants aged 19-25 years. A linear regression method was used to examine the association between water salinity exposure categories and systolic BP (SBP) and diastolic BP (DBP) level. Sixty five percent of the study population were exposed to highly saline drinking water above the Bangladesh standard (600 mg/L and above). Multivariable linear regression analyses identified that compared to the low water salinity exposure category (<600 mg/L), those in the high water salinity category (>600 mg/L), had statistically significantly higher SBP (B 3.46, 95% CI 0.75, 6.17; p = 0.01) and DBP (B 2.77, 95% CI 0.31, 5.24; p = 0.03). Our research shows that elevated salinity in drinking water is associated with higher BP in young coastal populations. Blood pressure is an important risk factor of hypertension and cardiovascular diseases. Given the extent of salinization of freshwater in many low-lying countries including in Bangladesh, and the likely exacerbation related to climate change-induced sea level rise, implementation of preventative strategies through dietary interventions along with promotion of low saline drinking water must be a priority in these settings.

Seasonal dietary intakes and socioeconomic status among women in the Terai of Nepal

Despite widespread nutritional deficiencies, investigations of usual diet in rural South Asia remain sparse. The present study characterizes year-round and seasonal dietary patterns of women in the Terai of Nepal by sociodemographic status, using a novel, weekly single-visit and usual food frequency questionnaire that links recall to the agricultural season. The study was conducted across seasons in 2006-2008 among 15,899 women of reproductive age in Sarlahi district. Intakes were tabulated for all foods, overall and by socioeconomic status (SES), and in and out of season, as appropriate. Foods consumed regularly [median (interquartile range) weekly frequency] were rice [13 (7-13)], potatoes [10 (5-13)], legumes [6 (2-9)], and vegetable oil [13 (13-13)]. Animal products were infrequently consumed [1 (0-2) time per week] as were fruits and vegetables, most with a median weekly intake frequency of 0. Higher SES was associated with more frequent consumption of most food-groups, including in-season fruits and vegetables. Diets of women in the Terai of Nepal lack diversity and, likely, nutrient adequacy, which may pose health risks.

A population-based prospective study of energy-providing nutrients in relation to all-cause cancer mortality and cancers of digestive organs mortality

The effect of dietary composition on mortality in low-income countries is largely unknown. We evaluated whether percentages of dietary energy derived from protein, fat and carbohydrates were associated with all-cause and cancer mortalities in a Bangladeshi population. Data from a prospective population-based cohort study of 17,244 men and women were used. Percentages of dietary energy derived from protein, fat and carbohydrates, assessed using a validated food-frequency questionnaire at baseline, were analyzed in relation to mortality over an average of 9 years (155,126 person-years) of follow-up. Cox proportional hazards regression models were used to estimate hazard ratios for all cause, all cancer and cancers of the digestive organs mortalities. Percentage of dietary energy from protein appeared to be significantly associated with cancer mortality. Fully adjusted hazard ratios for cancer mortality in increasing tertiles of percentage of dietary energy from protein were 1.0 (reference), 1.21 (0.73, 2.00) and 1.84 (1.08, 3.15) (p for trend = 0.023). These associations were much stronger for deaths from cancers of the digestive organs with fully adjusted hazard ratios in increasing tertiles of percentage of dietary energy from protein being 1.0 (reference), 2.25 (0.91, 5.59) and 4.85 (1.88, 12.51) (p for trend = 0.001). No significant associations in relation to cancer-related mortality were observed for percentage of dietary energy from fat. Novel findings from this prospective study show protein is an important risk factor or proxy to an important risk factor for cancer mortality especially from digestive organ cancers in Bangladesh.

Betel quid chewing in rural Bangladesh: prevalence, predictors and relationship to blood pressure

BACKGROUND

Betel quid is chewed by 600 million people worldwide and it has been linked to obesity and cardiovascular disease. The purpose of our study was to examine the prevalence and predictors of betel quid chewing in a rural area of Bangladesh, and determine its effects on body mass index (BMI) and blood pressure.

METHODS

In this population-based prospective study, we analysed data on 19 934 Bangladeshi adults. Linear and multivariate logistic regression was used to determine the socio-demographic predictors of betel quid chewing and the effect of betel quid on change in BMI and on systolic and diastolic blood pressure, pulse pressure, arterial pressure, overweight or obesity, and hypertension.

RESULTS

At baseline, betel quid was chewed by 33.2% of the cohort (35.5% of men, 31.6% of women). In a subsample in which we collected methods of use, 17.5% chewed it without tobacco and 82.5% chewed it with tobacco. In multivariate analysis, betel quid chewing was associated with female sex, older age, tobacco smoking and lower socio-economic status, as measured by fewer years of formal education and not owning land. Betel quid was chewed more times per day among women and older persons. At follow-up, persons who chewed betel quid without tobacco had higher systolic blood pressure, diastolic blood pressure and arterial pressure in comparison with never users. After controlling for other explanatory variables, chewing betel quid without tobacco was associated with general hypertension [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.04-2.10] and systolic hypertension (OR 1.55, 95% CI 1.01-2.37). We did not observe associations of betel quid chewing with BMI or overweight.

CONCLUSIONS

Betel quid chewing is likely contributing to high blood pressure in Bangladesh, particularly among women.