High Prevalence of Cardio-Metabolic Risk Factors in a Young Urban Sri-Lankan Population

PLOS ONE, Dec 2019

Background South-Asian's are predisposed to early onset type 2 diabetes (T2DM). The prevalence of cardio-metabolic risk-factors in young Sri-Lankans is unknown. Methodology/Principal Findings To determine by questionnaire and anthropometry the prevalence of first degree family history (FH) of T2DM, physical inactivity, raised waist circumference (WC) and raised body mass index (BMI) in a representative healthy urban population selected by cluster sampling. Those with ≥2 risk-factors were evaluated for metabolic syndrome (MS) and recruited for an intervention trial. Of 23,296 participants screened, 22,507 (53% Female) were eligible [8,497 aged 10–14 yrs, 4,763 aged 15–19 yrs and 9,247 aged 20–40 yrs]. 51% had none of the 4 risk-factors, 26% 1 risk-factor and 23% (5,163) ≥2 risk-factors of whom 4,532 were assessed for MS. Raised BMI was noted in 19.7% aged 10–14 yrs, 15.3% between 15–19 yrs, and between 20–40 yrs, 27.4% of males vs. 21.8% of females p<0.001. Prevalence of raised WC was greater in females for each age group: 42.7% vs. 32.1%; 28.1% vs. 16.1%; 34.5% vs. 25.7% (p<0.05 for all) as was physical inactivity: 39.9% vs. 14.5%; 51.7% vs. 20.0%; 62.7% vs. 41.3% which rose in both sexes with age (p<0.05 for all). FH of T2DM was present in 26.2%. In 4532 (50%<16 yrs) with ≥2 risk-factors, impaired fasting glycaemia/impaired glucose tolerance (pre-diabetes) prevalence was 16%. MS was more prevalent in males [10–16 yrs (13.0% vs. 8.8%), 16–40 yrs (29.5% vs. 20.0%) p<0.001 for both]. Conclusions/Significance There is a high prevalence of modifiable cardio-metabolic risk-factors in young urban Sri-Lankans with significant gender differences. A primary prevention intervention trial is ongoing in this cohort. Clinical Trial Registration Number SLCTR/2008/World Health Organization (WHO) international clinical trial registry platform.

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High Prevalence of Cardio-Metabolic Risk Factors in a Young Urban Sri-Lankan Population

et al. (2012) High Prevalence of Cardio-Metabolic Risk Factors in a Young Urban Sri- Lankan Population. PLoS ONE 7(2): e31309. doi:10.1371/journal.pone.0031309 High Prevalence of Cardio-Metabolic Risk Factors in a Young Urban Sri-Lankan Population Mahen Wijesuriya 0 Martin Gulliford 0 Judith Charlton 0 Laksha Vasantharaja 0 Giancarlo Viberti 0 Luigi 0 Gnudi 0 Janaka Karalliedde 0 Giuseppe Schillaci, University of Perugia, Italy 0 1 Diabetes Association of Sri Lanka, National Diabetes Centre , Colombo , Sri Lanka , 2 Cardiovascular Division, King's College London , London , United Kingdom , 3 Division of Health and Social Care Research, King's College London , London , United Kingdom Background: South-Asian's are predisposed to early onset type 2 diabetes (T2DM). The prevalence of cardio-metabolic riskfactors in young Sri-Lankans is unknown. Methodology/Principal Findings: To determine by questionnaire and anthropometry the prevalence of first degree family history (FH) of T2DM, physical inactivity, raised waist circumference (WC) and raised body mass index (BMI) in a representative healthy urban population selected by cluster sampling. Those with $2 risk-factors were evaluated for metabolic syndrome (MS) and recruited for an intervention trial. Of 23,296 participants screened, 22,507 (53% Female) were eligible [8,497 aged 10-14 yrs, 4,763 aged 15-19 yrs and 9,247 aged 20-40 yrs]. 51% had none of the 4 risk-factors, 26% 1 risk-factor and 23% (5,163) $2 risk-factors of whom 4,532 were assessed for MS. Raised BMI was noted in 19.7% aged 1014 yrs, 15.3% between 15-19 yrs, and between 20-40 yrs, 27.4% of males vs. 21.8% of females p,0.001. Prevalence of raised WC was greater in females for each age group: 42.7% vs. 32.1%; 28.1% vs. 16.1%; 34.5% vs. 25.7% (p,0.05 for all) as was physical inactivity: 39.9% vs. 14.5%; 51.7% vs. 20.0%; 62.7% vs. 41.3% which rose in both sexes with age (p,0.05 for all). FH of T2DM was present in 26.2%. In 4532 (50%,16 yrs) with $2 risk-factors, impaired fasting glycaemia/impaired glucose tolerance (pre-diabetes) prevalence was 16%. MS was more prevalent in males [10-16 yrs (13.0% vs. 8.8%), 16-40 yrs (29.5% vs. 20.0%) p,0.001 for both]. Conclusions/Significance: There is a high prevalence of modifiable cardio-metabolic risk-factors in young urban Sri-Lankans with significant gender differences. A primary prevention intervention trial is ongoing in this cohort. Clinical Trial Registration Number SLCTR/2008/World Health Organization (WHO) international clinical trial registry platform. - Funding: This project is supported by a BRIDGES Grant from the International Diabetes Federation. BRIDGES, an International Diabetes Federation Project, is supported by an educational grant from Lilly Diabetes. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. Type 2 Diabetes Mellitus (T2DM) and associated cardiovascular complications pose a major health care burden worldwide. Recent data indicates that South Asia is one of the major sites of this epidemic of T2DM with a projected 72% increase in the number of subjects with T2DM in the next 20 years [1]. In parallel there is an epidemic of pre-diabetes [impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG)] with prevalence rates between 1015% reported in South Asian adult populations [1]. T2DM and IGT are associated with a significantly increased risk of cardiovascular disease (CVD) with South Asians particularly predisposed to early onset of T2DM and CVD, with almost a third of future T2DM cases predicted to be in those below 45 years [1]. Both CVD and T2DM may share a common pathogenesis and indeed retain many common risk factors/features [1,2]. Sri-Lanka is a middle income country in Asia with a population of approximately 20 million. Nearly 40% of Sri Lankans are aged below 40 years and 25% are aged below 18 years [3]. There has been a rapid urbanisation in recent decades with an estimated 30% of the population now living in urban areas [3]. The most recent national study in subjects aged over 20 years indicated a population prevalence of dysglycaemia (defined as T2DM or IGT or IFG) of 20% which rose to 30% in urban areas [4]. Physical inactivity, raised body mass index (BMI) and central obesity along with urban living were strongly associated with the increased risk of dysglycaemia. In this study only 35% (n = 1530) of subjects were below 40 years of age of whom less 300 were urban dwelling and no subjects aged below 20 years were studied [4]. The DIABRISK-SL research programme is aimed to implement and evaluate a primary prevention intervention to reduce the incidence of T2DM and predictors of cardio-metabolic disease in young at-risk subjects. We employed a high-risk strategy by selecting individuals who were at increased risk of T2DM or CVD. In view of the rela (...truncated)


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Mahen Wijesuriya, Martin Gulliford, Judith Charlton, Laksha Vasantharaja, Giancarlo Viberti, Luigi Gnudi, Janaka Karalliedde. High Prevalence of Cardio-Metabolic Risk Factors in a Young Urban Sri-Lankan Population, PLOS ONE, 2012, 2, DOI: 10.1371/journal.pone.0031309