Prevalence of obesity and its associated risk of diabetes in a rural Bangladeshi Population

Background: People in the developing countries are increasingly vulnerable to the worldwide epidemic of obesity. It is a common modifiable risk factor for all the cardiometabolic diseases including type 2 diabetes (T2DM). Population-based data on the prevalence of obesity in rural Bangladeshi adults based on newly proposed cut off points for Asian population have scarce until recently. Objective: To assess the prevalence of general and central obesity in a rural Bangladeshi population and their association with T2DM. Methods: This study data have retrieved from Chandra Rural Diabetes Study, a population-based cross-sectional study which was conducted in a rural community called Chandra, 40 km. north of Bangladesh s capital, Dhaka in 2009. The survey was carried out in two phases. The first phase consisted of household census of the total population residing in the study locations. Based on the census results, a list of all men and women aged 20 years and above was selected in the second phase. Required numbers of individuals were selected following a random procedure. Ten villages were randomly selected from five areas. The total population of these villages was approximately 20,000 aged ≥20 years. For this study, 3000 individuals were randomly selected and among them 2376 (79.2%) participated. Structured questionnaires including socio-demographic parameters, anthropometric measurements, blood pressure (BP), and blood glucose values were recorded. Age adjusted data for anthropometric indices and diabetes risks were assessed and their relationships were examined. Newly proposed cut off points for Asian population had been used to define general obesity defined by body mass index (BMI) and central obesity defined by both waist circumference (WC) and waist hip ratio (WHR). Results: The age standardized prevalence of overweight (BMI 23-<25 kg/m2) and obesity (BMI ≥25 kg/m2) were 17.7 (95% confidence interval (CI): 16.1, 19.2%) and 26.2% (95% CI: 24.4, 27.9%), respectively. The age standardized prevalence of central obesity based on WC (M ≥90 & F ≥80 cm) and WHR (M ≥0.90 & F ≥0.80) were 39.8% (95% CI: 37.9, 41.7%) and 71.6% (95% CI: 69.8, 73.4%) respectively. Among the study population 88% had both high BMI (≥25 Kg/m2) and high WC (M ≥90 & F ≥80 cm) and on the other hand, 92.7% had both high BMI (≥25 Kg/m2) and high WHR (M ≥0.90 & F ≥0.80). The result shows that prevalence of central obesity was more in female than male. Study shows middle age, medium and high socioeconomic status (SES), illiterate, primary and secondary education levels, physical inactivity, high consumption of carbohydrate, protein and fat, were some significant risk indicators for general and central obesity. The adjusted odd ratio (OR) was highest for BMI ≥25 (OR: 2.12, P<0.001) for predicting T2DM compared to BMI ≥23 (OR: 1.26, P = 0.228), BMI ≥27.5 (OR: 1.93, P = 0.0.002) and BMI ≥30 (OR: 1.78, P = 0.098). Study also indicates that WHR predicted better T2DM risk than WC and BMI for both men and women. ROC analysis showed the optimal cut-off points for T2DM detection were at a BMI of 21.2 kg/m2 in men and 21.8 kg/m2 in women, WC 82 cm in men and women and WHR 0.93 and 0.87, respectively. Conclusions: It is apparent that obesity is increasing even in poor rural population. In rural Bangladeshi population, the prevalence of both general and central obesity was high among both sexes with the use of newly proposed cut off points for Asian population. Women presented with more central obesity than men. Gender, diet, physical activity, education level, socioeconomic condition, and smoking were associated with the prevalence of obesity. Compared with BMI, measures of central obesity, WHR and WC showed a better association with the risk of T2DM for both gender. Longitudinal follow-up studies are needed to confirm the risk indicators for obesity found in this study

Prevalence of obesity in a rural Asian Indian (Bangladeshi) population and its determinants

Background Obesity has reached epidemic proportions worldwide including Bangladesh. To assess the prevalence and associated factors of general and central obesity in a rural Bangladeshi population based on newly proposed cut off level for Asian population. Methods 2293 subjects aged ≥20 years from rural Bangladesh were randomly recruited to participate in a population-based, cross sectional survey, conducted in 2009. Both socio-demographic and anthropometric measurements were recorded. Age adjusted data for anthropometric indices were examined. Results The age standardized prevalence of overweight (BMI 23-24.9 kg/m2) and obesity (BMI ≥25 kg/m2) were 17.7 (95 % confidence interval (CI): 16.1, 19.2 %) and 26.2 % (95 % CI: 24.4, 27.9 %), respectively. The age standardized prevalence of central obesity based on WC (M ≥90 & F ≥80 cm) and WHR (M ≥0.90 & F ≥0.80) were 39.8 % (95 % CI: 37.9, 41.7 %) and 71.6 % (95 % CI: 69.8, 73.4 %) respectively. The result shows that prevalence of central obesity was more in female than male. Study shows middle age, medium and high socioeconomic status (SES), low education levels, physical inactivity, high consumption of carbohydrate, protein and fat, were significant risk indicators for general and central obesity. Smoking was shown as protective factor for both general and central obesity. Conclusions In rural Bangladeshi population, the prevalence of both general and central obesity was high among both sexes with the use of newly proposed cut off points for Asian population. Gender, diet, physical activity, education levels and SES were associated with the increase prevalence of obesity

Diabetes risk score for identifying cardiometabolic risk factors in adult Bangladeshi population

Context: Simple non-invasive tools to identify high-risk individuals would facilitate screening of cardiometabolic diseases as well as diabetes. Aims: (1) To estimate variations in Bangladesh diabetes risk score (BDRS) according to stages of glucose intolerance, (2) to examine the usefulness of BDRS for identifying metabolic syndrome (MS), dyslipidaemia and 10-year risk of coronary artery disease (CAD) in people with normal glucose tolerance (NGT). Subjects and Methods: Data were taken from a randomised cross-sectional study of 2293 patients in a rural community of Bangladesh in 2009, based on questionnaire interviews, anthropometric measurements, fasting blood samples and oral glucose tolerance test. The BDRS includes age, sex, body mass index, waist-hip ratio and hypertension (HTN). Spearman correlation and logistic regression were done to assess the relationship between BDRS and cardiometabolic risk factors. Results: The mean BDRS increased significantly with higher glucose intolerance (P for trend < 0.001). Among NGT group, the prevalence of cardiometabolic risk factors increased progressively from low-to-medium-to-high-risk score groups; HTN: 7.8%, 12.3% and 19.8% (P for trend: <0.001), dyslipidaemia: 16.3%, 25.3% and 27.4% (P for trend: <0.001), MS: 10.2%, 22.4% and 30.9% (P for trend: <0.001) and CAD risk: 3.6%, 9.0% and 13.8% (P for trend: <0.001), respectively. BDRS was significantly associated with MS (odds ratio [OR]: 1.92, P < 0.001); dyslipidaemia (OR: 1.30, P = 0.018); and CAD risk (OR: 1.93, P < 0.001). Conclusions: BDRS can be used for identifying MS, dyslipidaemia and CAD risk even among people with NGT

Cardiovascular Risk, Obesity, and Sociodemographic Indicators in a Brazilian Population

Background and Aims: Cardiovascular diseases (CVDs) are the leading cause of death globally and in Brazil. Evidence suggests that the risk of CVDs differs by race/ethnicity. Scarce information exists about the association between CVD risk, obesity indicators and sociodemographic characteristics in the Brazilian population. Objectives: We aimed to assess the CVD risk following the Framingham risk score in relation to the population's sociodemographic profile. Further, we examined the association between anthropometric markers and risk of CVDs. Methods: A total of 701 subjects aged ≥20 years from North-eastern Brazil were recruited randomly to participate in a population-based, cross-sectional survey. Age-adjusted data for CVD risk, sociodemographic characteristics, and anthropometric indices were assessed, and their relationships examined. Results: High CVD risk (Framingham risk score ≥10%) was observed in 18.9% of the population. Males (31.9 vs. 12.5%) and older subjects (age ≥45 years: 68.9% vs. age &amp;lt;45 years: 4.2%) had significantly higher risk of CVDs, whereas those employed in manual labor showed lower risk (7.6 vs. 21.7%). Central obesity measures like waist-to-hip ratio and waist-to-height ratio were more strongly associated with predicted CVD risk than body mass index. Conclusions: Our population had a high risk of CVDs using the Framingham risk score. Cost-effective strategies for screening, prevention and treatment of CVDs may likely reduce disease burden and health expenditure in Brazil. Central obesity measures were strongly associated with predicted CVD risk and might be useful in the clinical assessment of patients. Follow-up studies are warranted to validate our findings

Prevalence of Metabolic Syndrome by different definitions, and its association with type 2 diabetes, pre-diabetes, and cardiovascular disease risk in Brazil

Background and aims Metabolic Syndrome (MS) is increasing in developing countries. Different definitions of MS lead to discrepancies in prevalence estimates and applicability. We assessed the prevalence of MS as defined by the International Diabetes Federation (IDF), modified National Cholesterol Education Program Adult Treatment Plan III (Modified NCEP) and Joint Interim Statement (JIS); compared the diagnostic performance and association of these definitions of MS with pre-diabetes, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) risk. Methods A total of 714 randomly selected subjects from Northeastern Brazil were investigated in a cross-sectional study. Sociodemographic, anthropometric, and clinical data were recorded. Diagnostic test performance measures assessed the ability of the different MS definitions to identify those with pre-diabetes, T2DM and increased CVD risk. Results The adjusted prevalence of MS was 36.1% applying the JIS criteria, 35.1% the IDF and 29.5% Modified NCEP. Women were more affected by MS according to all definitions. MS was significantly associated with pre-diabetes, T2DM and CVD risk following the three definitions. However, the JIS and IDF definitions showed higher sensitivity than the Modified NCEP to identify pre-diabetes, T2DM and CVD risk. The odds ratios for those conditions were not significantly different when comparing the definitions. Conclusions MS is highly prevalent in Brazil, particularly among those with pre-diabetes, T2DM, and high CVD risk. The IDF and JIS criteria may be better suited in the Brazilian population to identify pre-diabetes, T2DM and CVD risk. This may also signify the importance of the assessment of MS in clinical practice

Prevalence of Type 2 Diabetes and Impaired Glucose Regulation with Associated Cardiometabolic Risk Factors and Depression in an Urbanizing Rural Community in Bangladesh: A Population-Based Cross-Sectional Study

BackgroundTo determine the prevalence of type 2 diabetes (T2DM) and impaired glucose regulation (impaired fasting glucose [IFG] and impaired glucose tolerance [IGT]) in an urbanizing rural population of Bangladesh and associated cardiometabolic risk indicators and depression.MethodsA total of 2,293 subjects aged ≥20 years in an urbanizing rural Bangladeshi community were investigated. Socio-demographic and anthropometric details, blood pressure, fasting plasma glucose (FPG), 2 hours after 75 g plasma glucose (2hPG), glycosylated hemoglobin, fasting serum insulin and lipid profiles were studied. Presence of depressive symptoms using Montogomery-Asberg Depression Rating Scale was also assessed.ResultsThe prevalence of IFG, IGT, IFG+IGT, and T2DM were 3.4%, 4.0%, 1.2%, and 7.9%, respectively. The prevalence of T2DM and impaired glucose regulation differed between males and females, but, both increased with age in both sexes. FPG and 2hPG had positive correlation. Employing logistic regression, it was found that increased age, waist to hip ratio, systolic blood pressure, total cholesterol, triglycerides, and depression were independent risk indicators for diabetes. Both insulin resistance and β-cell deficiency were significantly related for causation of diabetes. Among the study population, 26.2% had general obesity, 39.8% central obesity, 15.5% hypertension, 28.7% dyslipidemia, 17.6% family history of diabetes, and 15.3% had depression. Physical inactivity and smoking habits were significantly higher in male.ConclusionRising prevalence of diabetes and impaired glucose regulation in this urbanizing rural population exist as a significant but hidden public health problem. Depression and other cardiometabolic risk indicators including obesity, hypertension, and dyslipdemia were also prevalent in this population