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)