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Xiaoyue T, Qichuan Q, Jing G, Pengcuo S, Yu H, Tingxin L. Lipid levels in the Jiarong Tibetan's diet at high altitudes: a cross-sectional survey. Front Nutr 2023; 10:1207710. [PMID: 37435568 PMCID: PMC10330741 DOI: 10.3389/fnut.2023.1207710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Abstract
Despite the ongoing debate on the inconsistent and controversial effects of Tibetan diet on blood lipid levels at high altitude, this cross-sectional study was conducted to analyze the relationship between dietary practices and blood lipid levels among Jiarong Tibetan population. A total of 476 Jiarong Tibetan residents were included, in which basic demographic data, physical activity records, simplified food frequency questionnaire, and biochemical data were collected. Using multivariate logistic regression analysis, the potential associations between the variables were examined, and it was found that fat energy supply ratio increased with the elevation of altitude, while the lipid level showed an inverted U-shaped variation. However, the findings suggested that a diet rich in unsaturated fatty acids might balance the effects of the Tibetan diet on the risk of lipid metabolism disorders. Therefore, it is crucial to concentrate on the fat composition rather than the amount of fat E% intake on the plateau. The results highlighted the importance of investigating the interaction between environment and genes in lipid levels among plateau Tibetan population. However, further large-scale prospective studies are required for better understanding of the complexities involved in dietary practices and their influences on blood lipid levels.
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Affiliation(s)
- Tang Xiaoyue
- Department of Health Management and Physical Examination, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Clinical Nutrition, Yizheng Hospital of Nanjing Drum Tower Hospital Group, Yizheng, Jiangsu, China
| | - Qiao Qichuan
- Department of Health Management and Physical Examination, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Guo Jing
- Physical Examination, Aba Prefecture People’s Hospital, Maerkang, China
| | - Sanlang Pengcuo
- Physical Examination, Aba Prefecture People’s Hospital, Maerkang, China
| | - Huang Yu
- Department of Health Management and Physical Examination, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Li Tingxin
- Department of Health Management and Physical Examination, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
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Nishimura T, Arima H, Koirala S, Ito H, Yamamoto T. Individual variations and sex differences in hemodynamics and percutaneous arterial oxygen saturation (SpO2) in Tibetan highlanders of Tsarang in the Mustang district of Nepal. J Physiol Anthropol 2022; 41:9. [PMID: 35292118 PMCID: PMC8925233 DOI: 10.1186/s40101-022-00282-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/05/2022] [Indexed: 11/12/2022] Open
Abstract
Background Many studies have indicated specific low-hemoglobin (Hb) adaptation to high altitude in the Tibetan population, but studies focusing on physiological variations within this population are limited. This study aimed to investigate the relationships between SpO2 and related factors, including individual variations and sex differences, to assess the generality of high-altitude adaptation in the Tibetan population of Tsarang. Methods The participants were 31 male and 41 female community-dwelling people aged ≥18 years living in Tsarang, in the Mustang district of Nepal. Height, weight, SpO2, Hb concentration, finger temperature, heart rate, and blood pressure were measured. Lifestyle information was obtained by interview. Results Men had significantly higher systolic blood pressure (p = 0.002) and Hb (p < 0.001) than women. There was no significant correlation between SpO2 and other parameters in men. In women, SpO2 was negatively correlated with heart rate (p = 0.036), Hb (p = 0.004), and finger temperature (p = 0.037). In multiple regression analysis, a higher SpO2 was marginally correlated with lower age (β = −0.109, p = 0.086) and higher Hb (β = 0.547, p = 0.053) in men. In women, higher SpO2 was significantly correlated with lower heart rate (β = −0.045, p = 0.036) and Hb (β = −0.341, p = 0.018). Mean hemoglobin (95% confidence interval) was 13.6 g/dl (13.1–14.0 g/dl), which is lower than that found previously in Andeans and almost equal to that in Japanese lowlanders measured using the same device. In some participants of both sexes, hemoglobin was >17.0 g/dl. Conclusion Higher SpO2 was marginally correlated with younger age and higher Hb in men and with lower heart rate and lower Hb in women. Hemoglobin concentration was similar to that found previously in lowlanders, but higher in some individuals. These results indicate individual variation and sex differences in the hemodynamics of high-altitude adaptation in Tibetan highlanders of Tsarang, as well as low-Hb adaptation to high altitude equal to that of other Tibetans.
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Adhikari C, Dhakal R, Adhikari LM, Parajuli B, Subedi KR, Aryal Y, Thapa AK, Shah K. Need for HTA supported risk factor screening for hypertension and diabetes in Nepal: A systematic scoping review. Front Cardiovasc Med 2022; 9:898225. [PMID: 35979024 PMCID: PMC9376353 DOI: 10.3389/fcvm.2022.898225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Health Technology Assessment (HTA) is a comprehensive and important tool for assessment and decision-making in public health and healthcare practice. It is recommended by the WHO and has been applied in practice in many countries, mostly the developed ones. HTA might be an important tool to achieve universal health coverage (UHC), especially beneficial to low-and-middle-income countries (LMIC). Even though the Package for Essential Non-communicable Diseases (PEN) has already been initiated, there is a clear policy gap in the HTA of any health device, service, or procedure, including the assessment of cardiovascular risk factors (CVRFs) in Nepal. Hence, we carried out the review to document the HTA supported evidence of hypertension and diabetes screening, as CVRFs in Nepal. Materials and methods We searched in PubMed, Cochrane, and Google Scholar, along with some gray literature published in the last 6 years (2016–2021) in a systematic way with a controlled vocabulary using a well-designed and pilot tested search strategy, screened them, and a total of 53 articles and reports that matched the screening criteria were included for the review. We then, extracted the data in a pre-designed MS-Excel format, first in one, and then, from it, in two, with more specific data. Results Of 53 included studies, we reported the prevalence and/or proportion of hypertension and diabetes with various denominators. Furthermore, HTA-related findings such as cost, validity, alternative tool or technology, awareness, and intervention effectiveness have been documented and discussed further, however, not summarized due to their sparingness. Conclusion Overall, the prevalence of DM (4.4–18.8%) and HTN (17.2–70.0%) was reported in most studies, with a few, covering other aspects of HTA of DM/HTN. A national policy for establishing an HTA agency and some immediately implementable actions are highly recommended.
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Affiliation(s)
- Chiranjivi Adhikari
- Department of Public Health, SHAS, Pokhara University, Pokhara, Nepal
- Indian Institute of Public Health Gandhinagar, Gandhinagar, India
- *Correspondence: Chiranjivi Adhikari
| | - Rojana Dhakal
- Department of Nursing, School of Health and Allied Sciences, Pokhara University, Pokhara, Nepal
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Lal Mani Adhikari
- Health Research and Social Development Forum International, Kathmandu, Nepal
| | - Bijaya Parajuli
- Ministry of Health and Population, Gandaki Province, Myagdi Health Office, Myagdi, Nepal
| | - Khem Raj Subedi
- Department of Economics, Far Western University, Tikapur Multiple Campus, Kailali, Nepal
| | | | - Arjun Kumar Thapa
- Department of Economics, School of Humanities and Social Sciences, Pokhara University, Pokhara, Nepal
| | - Komal Shah
- Indian Institute of Public Health Gandhinagar, Gandhinagar, India
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Prevalence of hypertension and its relationship with altitude in highland areas: a systematic review and meta-analysis. Hypertens Res 2022; 45:1225-1239. [PMID: 35705740 DOI: 10.1038/s41440-022-00955-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 02/05/2023]
Abstract
This systematic review and meta-analysis synthesized the pooled prevalence of hypertension at high altitudes and explored its correlation with altitude using studies published in Chinese and English from database inception to February 2021. A systematic literature search was conducted among bibliographic databases (PubMed, Embase, and Web of Science) and three Chinese databases (CNKI, VIP, and Wanfang data) to identify eligible studies. A random-effects model was used to calculate the overall pooled prevalence of hypertension. The I2 statistic was used to assess heterogeneity across studies. Random-effects meta-regression was conducted to investigate covariates that may have influenced between-study heterogeneity. The pooled prevalence of hypertension among the general population in high-altitude areas was 33.0% (95% CI: 29.0-38.0%), with high between-study heterogeneity (I2 = 99.4%, P < 0.01). Subgroup analyses showed the pooled prevalence of hypertension in Tibetan individuals was significantly higher than that in non-Tibetan individuals living in the Himalayas and Pamir Mountains (41% vs. 18%). A trend toward an increase in the prevalence of hypertension was found with every 100-m increase in elevation (coefficient: 0.012, 95% CI: -0.001 to 0.025, P = 0.069) only in Tibetan individuals. In addition, in these individuals, we found an increase in mean diastolic BP with each 100-m increase in altitude (coefficient: 0.763, 95% CI: 0.122-1.403, P = 0.025). Our meta-analysis suggests that the pooled prevalence of hypertension among the general population in high-altitude areas is 33.0%. Subjects of Tibetan ethnicity were more prone to developing hypertension at high altitudes. However, a very weak relationship between altitude and the prevalence of hypertension was found only in Tibetan individuals.
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Diabetes Prevalence and Associated Risk Factors among Women in a Rural District of Nepal Using HbA1c as a Diagnostic Tool: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127011. [PMID: 35742264 PMCID: PMC9223207 DOI: 10.3390/ijerph19127011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/30/2022] [Accepted: 06/04/2022] [Indexed: 11/17/2022]
Abstract
Given the scarcity of data on diabetes prevalence and associated risk factors among women in rural Nepal, we aimed to examine this, using glycated hemoglobin (HbA1c) as a diagnostic tool. A cross-sectional survey addressing reproductive health and non-communicable diseases was conducted in 2012–2013 among non-pregnant, married women in Bolde, a rural district of Nepal. HbA1c ≥ 6.5% (48 mmol/mol) was used as diagnostic criterion for diabetes, a cut-off of 7.0% (53 mmol/mol) was used to increase the specificity. HbA1c was measured in 757 women (17–86 years). The prevalence of diabetes and prediabetes was 13.5% and 38.5%, respectively. When using 7.0% as a cut-off, the prevalence of diabetes was 5.8%. Aging, intake of instant noodles and milk and vegetarian food (ns) were associated with increased risk for diabetes. Waist circumference was higher among women with diabetes, although not significant. The women were uneducated (87.6%), and only 12% had heard about diabetes. In conclusion, we observed a higher prevalence of diabetes and prediabetes than anticipated among rural, Nepalese women. The increased risk was mainly attributed to dietary factors. In contrast to most previous studies in Nepal, we used HbA1c as diagnostic criterion.
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Arima H, Koirala S, Nema K, Nakano M, Ito H, Poudel KM, Pandey K, Pandey BD, Yamamoto T. High prevalence of rheumatoid arthritis and its risk factors among Tibetan highlanders living in Tsarang, Mustang district of Nepal. J Physiol Anthropol 2022; 41:12. [PMID: 35366946 PMCID: PMC8976395 DOI: 10.1186/s40101-022-00283-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background In Tsarang (at 3560 m), which is located in Mustang, 62.7% of the residents answered that they had a subjective medical history of arthritis, and 41.1% of the residents answered that their families had a subjective medical history of arthritis on a survey conducted in 2017. The expression of hypoxia-inducible factor (HIF) and its effects are deeply involved in hypoxic adaptation in Tibetan highlanders. At the same time, HIF is also related to the onset of rheumatoid arthritis. Therefore, the adaptive mechanism acquired by Tibetan highlanders may promote the development of rheumatoid arthritis. The prevalence of rheumatoid arthritis is estimated to be approximately 0.5–1.0% worldwide. The objective of this study was to estimate the prevalence of rheumatoid arthritis in Tsarang residents using existing diagnostic criteria and to explore its risk factors. Methods An epidemiological survey was conducted in Tsarang in 2019. Data obtained from anthropometry and questionnaires were statistically analyzed. Biochemical measurements using blood samples were also performed, and the results were used to assess arthritis status. Residents’ joint status was scored, and arthritis was assessed based on the clinical disease activity index and ACR/EULAR 2010 criteria. Results Twenty-seven males and 50 females participated in this survey. In Tsarang, ACR/EULAR 2010 classified 4.3% of males and 7.1% of females as having rheumatoid arthritis, indicating a very high estimated prevalence. We also performed a multivariate analysis to explore its risk factors, and two factors, older age (standardized parameter estimate = 4.84E−01, 95% CI = [9.19E−02, 8.76E−01], p = 0.0170) and a history of living in urban areas (standardized parameter estimate = − 5.49E−01, 95% CI = [− 9.21E−01, 1.77E−01], p = 0.0050), significantly contributed to the higher ACR/EULAR 2010 score in females. In addition, three factors, having no spouse (standardized parameter estimate = 3.17E−01, 95% CI = [5.74E−02, 5.77E−01], p = 0.0179), having a smoking habit (standardized parameter estimate = 2.88E−01, 95% CI = [1.71E−02, 5.59E−01], p = 0.0377), and a history of living in urban areas (standardized parameter estimate = − 3.69E−01, 95% CI = [− 6.83E−01, − 5.60E−02], p = 0.0219), resulted in significantly higher clinical disease activity index scores in females. Furthermore, smoking habits were found to significantly increase blood hyaluronic acid in both males (standardized parameter estimate = 6.03E−01, 95% CI = [3.06E−01, 9.01E−01], p = 0.0020) and females (standardized parameter estimate = 4.87E−01, 95% CI = [5.63E−02, 9.18E−01], p = 0.0291). Conclusions In this study, we evaluated the symptoms of arthritis and estimated the prevalence of rheumatoid arthritis using classification criteria for Tibetan highlanders who have adapted to the hypoxic environment and fostered their own culture. The high prevalence of rheumatoid arthritis among Tsarang residents suggests that the hypoxic adaptation mechanism involving HIF in Tibetan highlanders may promote the onset or exacerbation of rheumatoid arthritis. The high prevalence of rheumatoid arthritis among Tibetan highlanders may be related not only to the environmental factors analyzed in this study but also to hypoxic adaptation genes. Further investigation is needed to clarify the genetic factors involved.
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Affiliation(s)
- Hiroaki Arima
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Sweta Koirala
- Nepal Development Society, Bharatpur-5, Chitwan, Nepal
| | - Kotaro Nema
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,School of Medical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan
| | - Masayuki Nakano
- Department of Nutrition, Faculty of Health Sciences, Kochi Gakuen University, 292-26 Asahitenjin-cho, Kochi, Japan
| | - Hiromu Ito
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Kapil Madi Poudel
- Institute of Medicine, Tribhuvan University, Maharajgung, 44600, Nepal
| | - Kishor Pandey
- Central Department of Zoology, Tribhuvan University, Kirtipur, Nepal
| | - Basu Dev Pandey
- Department of Molecular Epidemiology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan
| | - Taro Yamamoto
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan. .,Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan. .,Leading Program, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan.
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Xiao Z, Sun X, Zhaxi D, Zhang F, Ji Y, Cheng T, Li X, Xu X. Distinct Nutrient Intake Style in Inhabitants of Ultra-High-Altitude Areas in North of Tibet, China: A Cross-Sectional Study Based on Newly Developed Tibetan Food Frequency Questionnaires. Front Nutr 2021; 8:743896. [PMID: 35004798 PMCID: PMC8733569 DOI: 10.3389/fnut.2021.743896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022] Open
Abstract
Dietary pattern is quite distinct among the inhabitants of high-altitude areas because of environmental and geographical uniqueness; hence, it is important to investigate this data as accurately as possible. However, very few data are related to these populations up to now. Based on the food frequency questionnaire (FFQ) used in the Chinese population, a revised Tibetan edition was developed with respect to the lifestyle in high-altitude areas. After assessment of validity and reproducibility, a nutrition intake survey was conducted among 1,071 randomly sampled Tibetan people. In addition, the Bland-Altman approach was used to compare the agreement between the two dietary tools. For the reproducibility analysis, intraclass correlation coefficients (ICC) were calculated to examine the agreement of food groups and nutrients from the two FFQs (FFQ1 and FFQ2). Nutrient intake was calculated using food composition tables. For the validity analysis, Pearson's correlation of food groups intakes varied from 0.22 to 0.91 (unadjusted). The correlations of nutrients ranged from 0.24 to 0.76 (unadjusted). In the analysis of reliability, the ICC of food groups varied from 0.27 to 0.70 (unadjusted). The ICC of nutrient intakes ranged from 0.22 to 0.87 (unadjusted). The results of nutritional analysis showed that ~25% of foods consumed frequently were traditional Tibetan foods. However, traditional Han foods were frequently consumed. In addition, the energy, iron, and protein intakes for male or female subjects were close to the Chinese Dietary Nutrient Reference Intake (Chinese DRIs); however, fat and sodium intakes were significantly higher than the Chinese DRIs. Interestingly, lower intakes of other types of nutrition, such as vitamin C were detected in people living in high-altitude areas. Our data indicated that excess consumption of fat and sodium and insufficient intake of vitamin C were common among Tibetan people, as compared with the most Chinese people living in the plateau areas. More investigations are needed to reveal the association between the food intake style and high-altitude endemic diseases.
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Affiliation(s)
- Zhen Xiao
- Institute of High Altitude Medicine, People's Hospital of Naqu Affiliated to Dalian Medical University, Naqu, China
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xianzhi Sun
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Duoji Zhaxi
- Institute of High Altitude Medicine, People's Hospital of Naqu Affiliated to Dalian Medical University, Naqu, China
| | - Fan Zhang
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Yuchen Ji
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Tingting Cheng
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Xiaofeng Li
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Xiaoguang Xu
- Institute of High Altitude Medicine, People's Hospital of Naqu Affiliated to Dalian Medical University, Naqu, China
- Department of Neurosurgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Shrestha DB, Budhathoki P, Sedhai YR, Marahatta A, Lamichhane S, Nepal S, Adhikari A, Poudel A, Nepal S, Atreya A. Type 2 Diabetes Mellitus in Nepal from 2000 to 2020: A systematic review and meta-analysis. F1000Res 2021; 10:543. [PMID: 34621512 PMCID: PMC8459622 DOI: 10.12688/f1000research.53970.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/20/2022] Open
Abstract
Aims: To evaluate the prevalence and risk factors of type 2 diabetes mellitus (T2DM) from 2000-2020 in various parts of Nepal. Methods: PubMed, Embase, Scopus, and Google Scholar were searched using the appropriate keywords. All Nepalese studies mentioning the prevalence of T2DM and/or details such as risk factors were included. Studies were screened using Covidence. Two reviewers independently selected studies based on the inclusion criteria. Meta-analysis was conducted using Comprehensive Meta-Analysis Software v.3. Results: A total of 15 studies met the inclusion criteria. The prevalence of T2DM, pre-diabetes, and impaired glucose tolerance in Nepal in the last two decades was 10% (CI, 7.1%- 13.9%), 19.4% (CI, 11.2%- 31.3%), and 11.0% (CI, 4.3%- 25.4%) respectively. The prevalence of T2DM in the year 2010-15 was 7.75% (CI, 3.67-15.61), and it increased to 11.24% between 2015-2020 (CI, 7.89-15.77). There were 2.19 times higher odds of having T2DM if the body mass index was ≥24.9 kg/m 2. Analysis showed normal waist circumference, normal blood pressure, and no history of T2DM in a family has 64.1%, 62.1%, and 67.3% lower odds of having T2DM, respectively. Conclusion: The prevalence of T2DM, pre-diabetes, and impaired glucose tolerance in Nepal was estimated to be 10%, 19.4%, and 11% respectively.
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Affiliation(s)
| | - Pravash Budhathoki
- Department of Emergency Medicine, Dr. Iwamura Memorial Hospital, Bhaktapur, 44800, Nepal
| | - Yub Raj Sedhai
- Department of Internal Medicine, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, 23298, USA
| | - Achyut Marahatta
- Chitwan Medical College Teaching Hospital, Chitwan, 44200, Nepal
| | - Samit Lamichhane
- Chitwan Medical College Teaching Hospital, Chitwan, 44200, Nepal
| | - Sarbin Nepal
- Chitwan Medical College Teaching Hospital, Chitwan, 44200, Nepal
| | - Anurag Adhikari
- Department of Emergency Medicine, Nepal National Hospital, Kathmandu, Bagmati, 44600, Nepal
| | - Ayusha Poudel
- Department of Emergency Medicine, Alka Hospital, Lalitpur, Bagmati, 44600, Nepal
| | - Samata Nepal
- Department of Community Medicine, Lumbini Medical College, Palpa, Lumbini, 32500, Nepal
| | - Alok Atreya
- Department of Forensic Medicine, Lumbini Medical College, Palpa, Lumbini, 32500, Nepal
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Shrestha DB, Budhathoki P, Sedhai YR, Marahatta A, Lamichhane S, Nepal S, Adhikari A, Poudel A, Nepal S, Atreya A. Type 2 Diabetes Mellitus in Nepal from 2000 to 2020: A systematic review and meta-analysis. F1000Res 2021; 10:543. [PMID: 34621512 PMCID: PMC8459622 DOI: 10.12688/f1000research.53970.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 04/19/2024] Open
Abstract
Aims: To evaluate the prevalence and risk factors of type 2 diabetes mellitus (T2DM) from 2000-2020 in various parts of Nepal. Methods: PubMed, Embase, Scopus, and Google Scholar were searched using the appropriate keywords. All Nepalese studies mentioning the prevalence of T2DM and/or details such as risk factors were included. Studies were screened using Covidence. Two reviewers independently selected studies based on the inclusion criteria. Meta-analysis was conducted using Comprehensive Meta-Analysis Software v.3. Results: A total of 15 studies met the inclusion criteria. The prevalence of T2DM, pre-diabetes, and impaired glucose tolerance in Nepal in the last two decades was 10% (CI, 7.1%- 13.9%), 19.4% (CI, 11.2%- 31.3%), and 11.0% (CI, 4.3%- 25.4%) respectively. The prevalence of T2DM in the year 2010-15 was 7.75% (CI, 3.67-15.61), and it increased to 11.24% between 2015-2020 (CI, 7.89-15.77). There were 2.19 times higher odds of having T2DM if the body mass index was ≥24.9 kg/m 2. Analysis showed normal waist circumference, normal blood pressure, and no history of T2DM in a family has 64.1%, 62.1%, and 67.3% lower odds of having T2DM, respectively. Conclusion: The prevalence of T2DM, pre-diabetes, and impaired glucose tolerance in Nepal was estimated to be 10%, 19.4%, and 11% respectively.
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Affiliation(s)
| | - Pravash Budhathoki
- Department of Emergency Medicine, Dr. Iwamura Memorial Hospital, Bhaktapur, 44800, Nepal
| | - Yub Raj Sedhai
- Department of Internal Medicine, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, 23298, USA
| | - Achyut Marahatta
- Chitwan Medical College Teaching Hospital, Chitwan, 44200, Nepal
| | - Samit Lamichhane
- Chitwan Medical College Teaching Hospital, Chitwan, 44200, Nepal
| | - Sarbin Nepal
- Chitwan Medical College Teaching Hospital, Chitwan, 44200, Nepal
| | - Anurag Adhikari
- Department of Emergency Medicine, Nepal National Hospital, Kathmandu, Bagmati, 44600, Nepal
| | - Ayusha Poudel
- Department of Emergency Medicine, Alka Hospital, Lalitpur, Bagmati, 44600, Nepal
| | - Samata Nepal
- Department of Community Medicine, Lumbini Medical College, Palpa, Lumbini, 32500, Nepal
| | - Alok Atreya
- Department of Forensic Medicine, Lumbini Medical College, Palpa, Lumbini, 32500, Nepal
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Mehata S, Shrestha N, Ghimire S, Atkins E, Karki DK, Mishra SR. Association of altitude and urbanization with hypertension and obesity: analysis of the Nepal Demographic and Health Survey 2016. Int Health 2021; 13:151-160. [PMID: 32623453 PMCID: PMC7902681 DOI: 10.1093/inthealth/ihaa034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/14/2020] [Accepted: 06/09/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nepal's Himalayan range attracts mountaineers, climbers and tourists from all across the globe. Limited recent evidence suggests that exposure to hypoxia at a higher altitude may be a risk factor for hypertension and a protective factor for obesity. The existing urban-rural disparities in Nepal in health and economic resources may be anticipated in the burden of hypertension and obesity, two rapidly growing public health issues, but they remain largely unstudied. Therefore this study aims to assess the association of altitude and urbanization with hypertension and overweight/obesity in Nepal. METHODS Data on 10 473 participants from a nationally representative survey, the 2016 Nepal Demographic and Health Survey (NDHS), was used. The NDHS assessed/measured blood pressure, height, weight, urbanization and the altitude of participants' households by following standard procedures. Logistic and linear regression models were used to study the association of altitude (per 100 m increases) and urbanization with hypertension and obesity, or their continuous measurements (i.e. systolic and diastolic blood pressure [SBP and DBP, respectively] and body mass index [BMI]). RESULTS The prevalence of hypertension, overweight and obesity was 25.6%, 19.6% and 4.8%, respectively. After controlling for covariates, residents of metropolitan cities had a 30% higher prevalence of overweight/obesity (adjusted prevalence ratio 1.30 [95% confidence interval {CI} 1.11 to 1.52]) than their rural counterparts. For altitude, there was a marginally increased odds of hypertension and overweight/obesity with elevation. Consistently, DBP (β = 0.18 [95% CI 0.09 to 0.27]) and BMI increased with altitude (β = 0.11 [95% CI 0.08 to 0.13]). CONCLUSION Urbanization was positively associated with BMI, while altitude showed a marginally positive association with hypertension and overweight/obesity. Given the role of obesity and hypertension in the aetiology of other chronic diseases and subsequently associated mortality and health care costs, residents in urban areas and at higher altitudes may benefit from weight control interventions and BP monitoring, respectively.
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Affiliation(s)
- Suresh Mehata
- Ministry of Population and Health, Nepal Government, Kathmandu
| | - Nipun Shrestha
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia
| | - Saruna Ghimire
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA.,Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Emily Atkins
- George Institute for Global Health, University of New South Wales Sydney, Newtown, NSW, Australia
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Nishimura T, Ugarte J, Ohnishi M, Nishihara M, Alvarez G, Yasukochi Y, Fukuda H, Arima K, Watanuki S, Mendoza V, Aoyagi K. Individual variations and sex differences in hemodynamics with percutaneous arterial oxygen saturation (SpO 2) in young Andean highlanders in Bolivia. J Physiol Anthropol 2020; 39:31. [PMID: 33028423 PMCID: PMC7542971 DOI: 10.1186/s40101-020-00240-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Many studies have reported specific adaptations to high altitude, but few studies have focused on physiological variations in high-altitude adaptation in Andean highlanders. This study aimed to investigate the relationships between SpO2 and related factors, including individual variations and sex differences, in Andean highlanders. Methods The participants were community-dwelling people in La Paz, Bolivia, aged 20 years and over (age range 20–34 years). A total of 50 men and 50 women participated in this study. Height, weight, SpO2, hemoglobin concentration, finger temperature, heart rate, and blood pressure were measured. Information about lifestyle was also obtained by interview. Results There were individual variations of SpO2 both in men (mean 89.9%, range 84.0–95.0%) and women (mean 91.0%, range 84.0–96.0%). On Student’s t test, men had significantly lower heart rate (p = 0.046) and SpO2 (p = 0.030) than women. On the other hand, men had significantly higher SBP (p < 0.001), hemoglobin (p < 0.001), and finger temperature (p = 0.004). In men, multiple stepwise regression analysis showed that a higher SpO2 was correlated with a lower heart rate (β = − 0.089, p = 0.007) and a higher finger temperature (β = 0.308, p = 0.030) (r2 for model = 0.18). In women, a higher SpO2 was significantly correlated with a higher finger temperature (β = 0.391, p = 0.015) (r2 for model = 0.12). A higher SpO2 was related to a higher finger temperature (β = 0.286, p = 0.014) and a lower heart rate (β = − 0.052, p = 0.029) in all participants (r2 for model = 0.21). Residual analysis showed that individual SpO2 values were randomly plotted. Conclusion Random plots of SpO2 on residual analysis indicated that these variations were random error, such as biological variation. A higher SpO2 was related to a lower heart rate and finger temperature in men, but a higher SpO2 was related to finger temperature in women. These results suggest that there are individual variations and sex differences in the hemodynamic responses of high-altitude adaptation in Andean highlanders.
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Affiliation(s)
- Takayuki Nishimura
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Department of Human Science, Kyushu University, 4-9-1 Shiobaru, Minami-ku, Fukuoka, 815-8540, Japan
| | - Juan Ugarte
- Faculty of Dentistry, Universidad Mayor de San Andres, Av. Saavedra 2244, La Paz, Bolivia
| | - Mayumi Ohnishi
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Mika Nishihara
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Guillermo Alvarez
- Faculty of Dentistry, Universidad Mayor de San Andres, Av. Saavedra 2244, La Paz, Bolivia
| | - Yoshiki Yasukochi
- Department of Human Functional Genomics, Advanced Science Research Promotion Center, Organization for the Promotion of Regional Innovation, Mie University, 1577 Kurima-machiya, Tsu, Mie, 514-8507, Japan
| | - Hideki Fukuda
- National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan
| | - Kazuhiko Arima
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Shigeki Watanuki
- Department of Human Science, Kyushu University, 4-9-1 Shiobaru, Minami-ku, Fukuoka, 815-8540, Japan
| | - Victor Mendoza
- Faculty of Dentistry, Universidad Mayor de San Andres, Av. Saavedra 2244, La Paz, Bolivia
| | - Kiyoshi Aoyagi
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
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