Browsing by Author "Jha, S."

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Data resource profile: understanding the patterns and determinants of health in South Asians-the South Asia Biobank
(Oxford University Press., 2021) Song, P.; Gupta, A.; Goon, I.Y.; Hasan, M.; Mahmood, S.; Pradeepa, R.; Siddiqui, S.; Frost, G.S.; Kusuma, D.; Miraldo, M.; Sassi, F.; Wareham, N.J.; Ahmed, S.; Anjana, R.M.; Brage, S.; Forouhi, N.G.; Jha, S.; Kasturiratne, A.; Katulanda, P.; Khawaja, K.I.; Loh, M.; Mridha, M.K.; Wickremasinghe, A.R.; Kooner, J.S.; Chambers, J.C.
No abstract available
Effects of a lifestyle intervention programme after 1 year of follow-up among South Asians at high risk of type 2 diabetes: a cluster randomised controlled trial
(BMJ Publishing Group Ltd, 2021) Muilwijk, M.; Loh, M.; Siddiqui, S.; Mahmood, S.; Palaniswamy, S.; Shahzad, K.; Athauda, L.K.; Jayawardena, R.; Batool, T.; Burney, S.; Glover, M.; Bamunuarachchi, V.; Panda, M.; Madawanarachchi, M.; Rai, B.; Sattar, I.; Silva, W.; Waghdhare, S.; Jarvelin, M.R.; Rannan-Eliya, R.P.; Wijemunige, N.; Gage, H.M.; Valabhji, J.; Frost, G.S.; Wickremasinghe, R.; Kasturiratne, A.; Khawaja, K.I.; Ahmad, S.; Valkengoed, I.G.V.; Katulanda, P.; Jha, S.; Kooner, J.S.; Chambers, J.C.
Introduction South Asians are at high risk of type 2 diabetes (T2D). We assessed whether intensive family-based lifestyle intervention leads to significant weight loss, improved glycaemia and blood pressure in adults at elevated risk for T2D.Methods This cluster randomised controlled trial (iHealth-T2D) was conducted at 120 locations across India, Pakistan, Sri Lanka and the UK. We included 3684 South Asian men and women, aged 40–70 years, without T2D but with raised haemoglobin A1c (HbA1c) and/or waist circumference. Participants were randomly allocated either to the family-based lifestyle intervention or control group by location clusters. Participants in the intervention received 9 visits and 13 telephone contacts by community health workers over 1-year period, and the control group received usual care. Reductions in weight (aim >7% reduction), waist circumference (aim ≥5 cm reduction), blood pressure and HbA1C at 12 months of follow-up were assessed. Our linear mixed-effects regression analysis was based on intention-to-treat principle and adjusted for age, sex and baseline values. Results There were 1846 participants in the control and 1838 in the intervention group. Between baseline and 12 months, mean weight of participants in the intervention group reduced by 1.8 kg compared with 0.4 kg in the control group (adjusted mean difference −1.10 kg (95% CI −1.70 to −1.06), p<0.001). The adjusted mean difference for waist circumference was −1.9 cm (95% CI −2.5; to 1.3), p<0.001). No overall difference was observed for blood pressure or HbA1c. People who attended multiple intervention sessions had a dose-dependent effect on waist circumference, blood pressure and HbA1c, but not on weight. Conclusion An intensive family-based lifestyle intervention adopting low-resource strategies led to effective reduction in weight and waist circumference at 12 months, which has potential long-term benefits for preventing T2D. A higher number of attended sessions increased the effect on waist circumference, blood pressure and HbA1c.
Epigenome-wide association of DNA methylation markers in peripheral blood from Indian Asians and Europeans with incident type 2 diabetes: a nested case-control study
(The Lancet, Diabetes & Endocrinology, 2015) Chambers, J.C.; Loh, M.; Lehne, B.; Drong, A.; Kriebel, J.; Motta, V.; Wahl, S.; Elliott., H.R; Rota, F.; Scott, W.R.; Zhang, W.; Tan, S.T.; Campanella, G.; Chadeau-Hyam, M.; Yengo, L.; Richmond, R.C.; Adamowicz-Brice, M.; Afzal, U.; Bozaoglu, K.; Mok, Z.Y.; Ng, H.K.; Pattou, F.; Prokisch, H.; Rozario, M.A.; Tarantini, L.; Abbott, J.; Ala-Korpela, M.; Albetti, B.; Ammerpohl, O.; Bertazzi, P.A.; Blancher, C.; Caiazzo, R.; Danesh, J.; Gaunt, T.R.; de Lusignan, S.; Gieger, C.; Illig, T.; Jha, S.; Jones, S.; Jowett, J.; Kangas, A.J.; Kasturiratne, A.; Kato, N.; Kotea, N.; Kowlessur, S.; Pitkäniemi, J.; Punjabi, P.; Saleheen, D.; Schafmayer, C.; Soininen, P.; Tai, E.S.; Thorand, B.; Tuomilehto, J.; Wickremasinghe, A.R.; Kyrtopoulos, S.A.; Aitman, T.J.; Herder, C.; Hampe, J.; Cauchi, S.; Relton, C.L.; Froguel, P.; Soong, R.; Vineis, P.; Jarvelin, M.R.; Scott, J.; Grallert, H.; Bollati, V.; Elliott, P.; McCarthy, M.I.; Kooner, J.S. J
BACKGROUND: Indian Asians, who make up a quarter of the world's population, are at high risk of developing type 2 diabetes. We investigated whether DNA methylation is associated with future type 2 diabetes incidence in Indian Asians and whether differences in methylation patterns between Indian Asians and Europeans are associated with, and could be used to predict, differences in the magnitude of risk of developing type 2 diabetes. METHODS: We did a nested case-control study of DNA methylation in Indian Asians and Europeans with incident type 2 diabetes who were identified from the 8-year follow-up of 25 372 participants in the London Life Sciences Prospective Population (LOLIPOP) study. Patients were recruited between May 1, 2002, and Sept 12, 2008. We did epigenome-wide association analysis using samples from Indian Asians with incident type 2 diabetes and age-matched and sex-matched Indian Asian controls, followed by replication testing of top-ranking signals in Europeans. For both discovery and replication, DNA methylation was measured in the baseline blood sample, which was collected before the onset of type 2 diabetes. Epigenome-wide significance was set at p<1 × 10(-7). We compared methylation levels between Indian Asian and European controls without type 2 diabetes at baseline to estimate the potential contribution of DNA methylation to increased risk of future type 2 diabetes incidence among Indian Asians. FINDINGS: 1608 (11•9%) of 13 535 Indian Asians and 306 (4•3%) of 7066 Europeans developed type 2 diabetes over a mean of 8•5 years (SD 1•8) of follow-up. The age-adjusted and sex-adjusted incidence of type 2 diabetes was 3•1 times (95% CI 2•8-3•6; p<0•0001) higher among Indian Asians than among Europeans, and remained 2•5 times (2•1-2•9; p<0•0001) higher after adjustment for adiposity, physical activity, family history of type 2 diabetes, and baseline glycemic measures. The mean absolute difference in methylation level between type 2 diabetes cases and controls ranged from 0•5% (SD 0•1) to 1•1% (0•2). Methylation markers at five loci were associated with future type 2 diabetes incidence; the relative risk per 1% increase in methylation was 1•09 (95% CI 1•07-1•11; p=1•3 × 10(-17)) for ABCG1, 0•94 (0•92-0•95; p=4•2 × 10(-11)) for PHOSPHO1, 0•94 (0•92-0•96; p=1•4 × 10(-9)) for SOCS3, 1•07 (1•04-1•09; p=2•1 × 10(-10)) for SREBF1, and 0•92 (0•90-0•94; p=1•2 × 10(-17)) for TXNIP. A methylation score combining results for the five loci was associated with future type 2 diabetes incidence (relative risk quartile 4 vs quartile 1 3•51, 95% CI 2•79-4•42; p=1•3 × 10(-26)), and was independent of established risk factors. Methylation score was higher among Indian Asians than Europeans (p=1 × 10(-34)). INTERPRETATION: DNA methylation might provide new insights into the pathways underlying type 2 diabetes and offer new opportunities for risk stratification and prevention of type 2 diabetes among Indian Asians. FUNDING: The European Union, the UK National Institute for Health Research, the Welcome Trust, the UK Medical Research Council, Action on Hearing Loss, the UK Biotechnology and Biological Sciences Research Council, the Oak Foundation, the Economic and Social Research Council, Helmholtz Zentrum Munchen, the German Research Center for Environmental Health, the German Federal Ministry of Education and Research, the German Center for Diabetes Research, the Munich Center for Health Sciences, the Ministry of Science and Research of the State of North Rhine-Westphalia, and the German Federal Ministry of Health. Copyright © 2015 Elsevier Ltd. All rights reserved.
Epigenome-wide association study of body mass index, and the adverse outcomes of adiposity
(Nature Publishing Group, 2017) Whal, S.; Drong, A.; Lehne, B.; Loh, M.; Scott, W.R.; Kunze, S.; Tsai, P.C.; Ried, J.S.; Zhang, W.; Yang, Y.; Tan, S.; Fiorito, G.; Franke, L.; Guarrera, S.; Kasela, S.; Kriebel, J.; Richmond, R.C.; Adamo, M.; Afzal, U.; Ala-Korpela, M.; Albeetti, B.; Ammerpohl, O.; Apperley, J.F.; Beekman, M.; Bertazzi, P.A.; Black, S.L.; Blancher, C.; Bonder, M.J.; Brosch, M.; Carstensen-Kirberg, M.; de Craen, A.J.; de Lusignan, S.; Dehghan, A.; Elkalaawy, M.; Fischer, K.; Franco, O.H.; Gaunt, T.R.; Hampe, J.; Hashemi, M.; Isaacs, A.; Jenkinson, A.; Jha, S.; Kato, N.; Krogh, V.; Laffan, M.; Meisinger, C.; Meitinger, T.; Mok, Z.Y.; Motta, V.; Ng, H.K.; Nikolakopoulou, Z.; Nteliopoulos, G.; Panico, S.; Pervjakova, N.; Prokisch, H.; Rathmann, W.; Roden, M.; Rota, F.; Rozario, M.A.; Sandling, J.K.; Schafmayer, C.; Schramm, K.; Siebert, R.; Slagboom, P.E.; Soininen, P.; Stolk, L.; Strauch, K.; Tai, E.S.; Tarantini, L.; Thorand, B.; Tigchelaar, E.F.; Tumino, R.; Uitterlinden, A.G.; van Duijn, C.; van Meurs, J.B.; Vineis, P.; Wickremasinghe, A.R.; Wijmenga, C.; Yang, T.P.; Yuan, W.; Zhernakova, A.; Batterham, R.L.; Smith, G.D.; Deloukas, P.; Heijmans, B.T.; Herder, C.; Hofman, A.; Lindgren, C.M.; Milani, L.; van der Harst, P.; Peters, A.; Illig, T.; Relton, C.L.; Waldenberger, M.; Järvelin, M.R.; Bollati, V.; Soong, R.; Spector, T.D.; Scott, J.; McCarthy, M.I.; Elliott, P.; Bell, J.T.; Matullo, G.; Gieger, C.; Kooner, J.S.; Grallert, H.; Chambers, J.C.
Approximately 1.5 billion people worldwide are overweight or affected by obesity, and are at risk of developing type 2 diabetes, cardiovascular disease and related metabolic and inflammatory disturbances. Although the mechanisms linking adiposity to associated clinical conditions are poorly understood, recent studies suggest that adiposity may influence DNA methylation, a key regulator of gene expression and molecular phenotype. Here we use epigenome-wide association to show that body mass index (BMI; a key measure of adiposity) is associated with widespread changes in DNA methylation (187 genetic loci with P < 1 × 10-7, range P = 9.2 × 10-8 to 6.0 × 10-46; n = 10,261 samples). Genetic association analyses demonstrate that the alterations in DNA methylation are predominantly the consequence of adiposity, rather than the cause. We find that methylation loci are enriched for functional genomic features in multiple tissues (P < 0.05), and show that sentinel methylation markers identify gene expression signatures at 38 loci (P < 9.0 × 10-6, range P = 5.5 × 10-6 to 6.1 × 10-35, n = 1,785 samples). The methylation loci identify genes involved in lipid and lipoprotein metabolism, substrate transport and inflammatory pathways. Finally, we show that the disturbances in DNA methylation predict future development of type 2 diabetes (relative risk per 1 standard deviation increase in methylation risk score: 2.3 (2.07-2.56); P = 1.1 × 10-54). Our results provide new insights into the biologic pathways influenced by adiposity, and may enable development of new strategies for prediction and prevention of type 2 diabetes and other adverse clinical consequences of obesity.
Food environment and diabetes mellitus in South Asia: A geospatial analysis of health outcome data
(Public Library of Science,San Francisco, 2022) Kusuma, D.; Atanasova, P.; Pineda, E.; Anjana, R.M.; de Silva, L.; Hanif, A.A.; Hasan, M.; Hossain, M.M.; Indrawansa, S.; Jayamanne, D.; Jha, S.; Kasturiratne, A.; Katulanda, P.; Khawaja, K.I.; Kumarendran, B.; Mridha, M.K.; Rajakaruna, V.; Chambers, J.C.; Frost, G.; Sassi, F.; Miraldo, M.
Background: The global epidemic of type 2 diabetes mellitus (T2DM) renders its prevention a major public health priority. A key risk factor of diabetes is obesity and poor diets. Food environments have been found to influence people's diets and obesity, positing they may play a role in the prevalence of diabetes. Yet, there is scant evidence on the role they may play in the context of low- and middle-income countries (LMICs). We examined the associations of food environments on T2DM among adults and its heterogeneity by income and sex. Methods and findings: We linked individual health outcome data of 12,167 individuals from a network of health surveillance sites (the South Asia Biobank) to the density and proximity of food outlets geolocated around their homes from environment mapping survey data collected between 2018 and 2020 in Bangladesh and Sri Lanka. Density was defined as share of food outlets within 300 m from study participant's home, and proximity was defined as having at least 1 outlet within 100 m from home. The outcome variables include fasting blood glucose level, high blood glucose, and self-reported diagnosed diabetes. Control variables included demographics, socioeconomic status (SES), health status, healthcare utilization, and physical activities. Data were analyzed in ArcMap 10.3 and STATA 15.1. A higher share of fast-food restaurants (FFR) was associated with a 9.21 mg/dl blood glucose increase (95% CI: 0.17, 18.24; p < 0.05). Having at least 1 FFR in the proximity was associated with 2.14 mg/dl blood glucose increase (CI: 0.55, 3.72; p < 0.01). A 1% increase in the share of FFR near an individual's home was associated with 8% increase in the probability of being clinically diagnosed as a diabetic (average marginal effects (AMEs): 0.08; CI: 0.02, 0.14; p < 0.05). Having at least 1 FFR near home was associated with 16% (odds ratio [OR]: 1.16; CI: 1.01, 1.33; p < 0.05) and 19% (OR: 1.19; CI: 1.03, 1.38; p < 0.05) increases in the odds of higher blood glucose levels and diagnosed diabetes, respectively. The positive association between FFR density and blood glucose level was stronger among women than men, but the association between FFR proximity and blood glucose level was stronger among men as well as among those with higher incomes. One of the study's key limitations is that we measured exposure to food environments around residency geolocation; however, participants may source their meals elsewhere. Conclusions: Our results suggest that the exposure to fast-food outlets may have a detrimental impact on the risk of T2DM, especially among females and higher-income earners. Policies should target changes in the food environments to promote better diets and prevent T2DM.
Food environments and obesity: A geospatial analysis of the South Asia Biobank, income and sex inequalities
(Elsevier Ltd, 2022) Atanasova, P.; Kusuma, D.; Pineda, E.; Anjana, R.M.; de Silva, L.; Hanif, A.A.M.; Hasan, M.; Hossain, M.M.; Indrawansa, S.; Jayamanne, D.; Jha, S.; Kasturiratne, A.; Katulanda, P.; Khawaja, K.I.; Kumarendran, B.; Mrida, M.K.; Rajakaruna, V.; Chambers, J.C.; Frost, G.; Sassi, F.; Miraldo, M.
Introduction: In low-middle income countries (LMICs) the role of food environments on obesity has been understudied. We address this gap by 1) examining the effect of food environments on adults' body size (BMI, waist circumference) and obesity; 2) measuring the heterogeneity of such effects by income and sex.Methods: This cross-sectional study analysed South Asia Biobank surveillance and environment mapping data for 12,167 adults collected between 2018 and 2020 from 33 surveillance sites in Bangladesh and Sri Lanka. Individual-level data (demographic, socio-economic, and health characteristics) were combined with exposure to healthy and unhealthy food environments measured with geolocations of food outlets (obtained through ground-truth surveys) within 300 m buffer zones around participants' homes. Multivariate regression models were used to assess association of exposure to healthy and unhealthy food environments on waist circumference, BMI, and probability of obesity for the total sample and stratified by sex and income.Findings: The presence of a higher share of supermarkets in the neighbourhood was associated with a reduction in body size (BMI, β = - 3∙23; p < 0∙0001, and waist circumference, β = -5∙99; p = 0∙0212) and obesity (Average Marginal Effect (AME): -0∙18; p = 0∙0009). High share of fast-food restaurants in the neighbourhood was not significantly associated with body size, but it significantly increased the probability of obesity measured by BMI (AME: 0∙09; p = 0∙0234) and waist circumference (AME: 0∙21; p = 0∙0021). These effects were stronger among females and low-income individuals.Interpretation: The results suggest the availability of fast-food outlets influences obesity, especially among female and lower-income groups. The availability of supermarkets is associated with reduced body size and obesity, but their effects do not outweigh the role of fast-food outlets. Policies should target food environments to promote better diets and reduce obesity.
The iHealth-T2D study, prevention of type 2 diabetes amongst South Asians with central obesity and prediabetes: study protocol for a randomised controlled trial
(BioMed Central, London, 2021) Kasturiratne, A.; Khawaja, K.I.; Ahmad, S.; Siddiqui, S.; Shahzad, K.; Athauda, L.K.; Jayawardena, R.; Mahmood, S.; Muilwijk, M.; Batool, T.; Burney, S.; Glover, M.; Palaniswamy, S.; Bamunuarachchi, V.; Panda, M.; Madawanarachchi, S.; Rai, B.; Sattar, I.; Silva, W.; Waghdhare, S.; Jarvelin, M.R.; Rannan-Eliya, R.P.; Gage, H.M.; van Valkengoed, I.G.M.; Valabhji, J.; Frost, G.S.; Loh, M.; Wickremasinghe, A.R.; Kooner, J.S.; Katulanda, P.; Jha, S.; Chambers, J.C.
Background: People from South Asia are at increased risk of type 2 diabetes (T2D). There is an urgent need to develop approaches for the prevention of T2D in South Asians that are cost-effective, generalisable and scalable across settings.Hypothesis: Compared to usual care, the risk of T2D can be reduced amongst South Asians with central obesity or raised HbA1c, through a 12-month lifestyle modification programme delivered by community health workers.Design: Cluster randomised clinical trial (1:1 allocation to intervention or usual care), carried out in India, Pakistan, Sri Lanka and the UK, with 30 sites per country (120 sites total). Target recruitment 3600 (30 participants per site) with annual follow-up for 3 years.Entry criteria: South Asian, men or women, age 40-70 years with (i) central obesity (waist circumference ≥ 100 cm in India and Pakistan; ≥90 cm in Sri Lanka) and/or (ii) prediabetes (HbA1c 6.0-6.4% inclusive).Exclusion criteria: known type 1 or 2 diabetes, normal or underweight (body mass index < 22 kg/m2); pregnant or planning pregnancy; unstable residence or planning to leave the area; and serious illness.Endpoints: The primary endpoint is new-onset T2D at 3 years, defined as (i) HbA1c ≥ 6.5% or (ii) physician diagnosis and on treatment for T2D. Secondary endpoints at 1 and 3 years are the following: (i) physical measures: waist circumference, weight and blood pressure; (ii) lifestyle measures: smoking status, alcohol intake, physical activity and dietary intake; (iii) biochemical measures: fasting glucose, insulin and lipids (total and HDL cholesterol, triglycerides); and (iv) treatment compliance. Intervention: Lifestyle intervention (60 sites) or usual care (60 sites). Lifestyle intervention was delivered by a trained community health worker over 12 months (5 one-one sessions, 4 group sessions, 13 telephone sessions) with the goal of the participants achieving a 7% reduction in body mass index and a 10-cm reduction in waist circumference through (i) improved diet and (ii) increased physical activity. Usual care comprised a single 30-min session of lifestyle modification advice from the community health worker. Results: We screened 33,212 people for inclusion into the study. We identified 10,930 people who met study entry criteria, amongst whom 3682 agreed to take part in the intervention. Study participants are 49.2% female and aged 52.8 (SD 8.2) years. Clinical characteristics are well balanced between intervention and usual care sites. More than 90% of follow-up visits are scheduled to be complete in December 2020. Based on the follow-up to end 2019, the observed incidence of T2D in the study population is in line with expectations (6.1% per annum). Conclusion: The iHealth-T2D study will advance understanding of strategies for the prevention of diabetes amongst South Asians, use approaches for screening and intervention that are adapted for low-resource settings. Our study will thus inform the implementation of strategies for improving the health and well-being of this major global ethnic group.
The iHealth-T2D study: a cluster randomised trial for the prevention of type 2 diabetes amongst South Asians with central obesity and prediabetes-a statistical analysis plan
(BioMed Central, London, 2022) Muilwijk, M.; Loh, M.; Mahmood, S.; Palaniswamy, S.; Siddiqui, S.; Silva, W.; Frost, G.S.; Gage, H.M.; Jarvelin, M.R.; Rannan-Eliya, R.P.; Ahmad, S.; Jha, S.; Kasturiratne, A.; Katulanda, P.; Khawaja, K.I.; Kooner, J.S.; Wickremasinghe, A.R.; van Valkengoed, I.G.M.; Chambers, J.C.
Background: South Asians are at high risk of type 2 diabetes (T2D). Lifestyle modification is effective at preventing T2D amongst South Asians, but the approaches to screening and intervention are limited by high costs, poor scalability and thus low impact on T2D burden. An intensive family-based lifestyle modification programme for the prevention of T2D was developed. The aim of the iHealth-T2D trial is to compare the effectiveness of this programme with usual care. Methods: The iHealth-T2D trial is designed as a cluster randomised controlled trial (RCT) conducted at 120 sites across India, Pakistan, Sri Lanka and the UK. A total of 3682 South Asian men and women with age between 40 and 70 years without T2D but at elevated risk for T2D [defined by central obesity (waist circumference ≥ 95 cm in Sri Lanka or ≥ 100 cm in India, Pakistan and the UK) and/or prediabetes (HbA1c ≥ 6.0%)] were included in the trial. Here, we describe in detail the statistical analysis plan (SAP), which was finalised before outcomes were available to the investigators. The primary outcome will be evaluated after 3 years of follow-up after enrolment to the study and is defined as T2D incidence in the intervention arm compared to usual care. Secondary outcomes are evaluated both after 1 and 3 years of follow-up and include biochemical measurements, anthropometric measurements, behavioural components and treatment compliance. Discussion: The iHealth-T2D trial will provide evidence of whether an intensive family-based lifestyle modification programme for South Asians who are at high risk for T2D is effective in the prevention of T2D. The data from the trial will be analysed according to this pre-specified SAP. Ethics and dissemination: The trial was approved by the international review board of each participating study site. Study findings will be disseminated through peer-reviewed publications and in conference presentations.
Low uptake of COVID-19 prevention behaviours and high socioeconomic impact of lockdown measures in South Asia: Evidence from a large-scale multi-country surveillance programme
(Elsevier Science, 2021) Kusuma, D.; Pradeepa, R.; Khawaja, K.I.; Hasan, M.; Siddiqui, S.; Mahmood, S.; Ali Shah, S.M.; de Silva, C.K.; de Silva, L.; Gamage, M.; Loomba, M.; Rajakaruna, V.P.; Hanif, A.A.; Kamalesh, R.B.; Kumarendran, B.; Loh, M.; Misra, A.; Tassawar, A.; Tyagi, A.; Waghdhare, S.; Burney, S.; Ahmad, S.; Mohan, V.; Sarker, M.; Goon, I.Y.; Kasturiratne, A.; Kooner, J.S.; Katulanda, P.; Jha, S.; Anjana, R.M.; Mridha, M.K.; Sassi, F.; Chambers, J.C.; NIHR Global Health Research Unit for diabetes and cardiovascular disease in South Asia.
BACKGROUND: South Asia has become a major epicentre of the COVID-19 pandemic. Understanding South Asians' awareness, attitudes and experiences of early measures for the prevention of COVID-19 is key to improving the effectiveness and mitigating the social and economic impacts of pandemic responses at a critical time for the Region. METHODS: We assessed the knowledge, behaviours, health and socio-economic circumstances of 29,809 adult men and women, at 93 locations across four South Asian countries. Data were collected during the national lockdowns implemented from March to July 2020, and compared with data collected prior to the pandemic as part of an ongoing prospective surveillance initiative. RESULTS: Participants were 61% female, mean age 45.1 years. Almost half had one or more chronic disease, including diabetes (16%), hypertension (23%) or obesity (16%). Knowledge of the primary COVID-19 symptoms and transmission routes was high, but access to hygiene and personal protection resources was low (running water 63%, hand sanitisers 53%, paper tissues 48%). Key preventive measures were not widely adopted. Knowledge, access to, and uptake of COVID-19 prevention measures were low amongst people from disadvantaged socio-economic groups. Fifteen percent of people receiving treatment for chronic diseases reported loss of access to long-term medications; 40% reported symptoms suggestive of anxiety or depression. The prevalence of unemployment rose from 9.3% to 39.4% (P < 0.001), and household income fell by 52% (P < 0.001) during the lockdown. Younger people and those from less affluent socio-economic groups were most severely impacted. Sedentary time increased by 32% and inadequate fruit and vegetable intake increased by 10% (P < 0.001 for both), while tobacco and alcohol consumption dropped by 41% and 80%, respectively (P < 0.001), during the lockdown. CONCLUSIONS: Our results identified important knowledge, access and uptake barriers to the prevention of COVID-19 in South Asia, and demonstrated major adverse impacts of the pandemic on chronic disease treatment, mental health, health-related behaviours, employment and household finances. We found important sociodemographic differences for impact, suggesting a widening of existing inequalities. Our findings underscore the need for immediate large-scale action to close gaps in knowledge and access to essential resources for prevention, along with measures to safeguard economic production and mitigate socio-economic impacts on the young and the poor. KEYWORDS: COVID-19; Preventative measures; Socioeconomic impact; South Asia; Surveillance system.
Policy implementation and recommended actions to create healthy food environments using the healthy food environment policy index (Food-EPI): a comparative analysis in South Asia
(Elsevier Ltd, 2024) Pineda, E.; Atanasova, P.; Wellappuli, N.T.; Kusuma, D.; Herath, H.; Segal, A.B.; Vandevijvere, S.; Anjana, R.M.; Shamim, A.A.; Afzal, S.; Akter, F.; Aziz, F.; Gupta, A.; Hanif, A.A.; Hasan, M.; Jayatissa, R.; Jha, S.; Jha, V.; Katulanda, P.; Khawaja, K.I.; Kumarendran, B.; Loomba, M.; Mahmood, S.; Mridha, M.K.; Pradeepa, R.; Aarthi, G.R.; Tyagi, A.; Kasturiratne, A.; Sassi, F.; Miraldo, M.
BACKGROUND The increasing prevalence of diet-related non-communicable diseases (NCDs) in South Asia is concerning, with type 2 diabetes projected to rise to 68%, compared to the global increase of 44%. Encouraging healthy diets requires stronger policies for healthier food environments.METHODS This study reviewed and assessed food environment policies in Bangladesh, India, Pakistan, and Sri Lanka from 2020 to 2022 using the Healthy Food Environment Policy Index (Food-EPI) and compared them with global best practices. Seven policy domains and six infrastructure support domains were considered, employing 47 good practice indicators to prevent NCDs. Stakeholders from government and non-governmental sectors in South Asia (n = 148) were invited to assess policy and infrastructure support implementation using the Delphi method.FINDINGS Implementation of food environment policies and infrastructure support in these countries was predominantly weak. Labelling, monitoring, and leadership policies received a moderate rating, with a focus on food safety, hygiene, and quality rather than obesity prevention. Key policy gaps prioritized for attention included front-of-pack labelling, healthy food subsidies, unhealthy food taxation, restrictions on unhealthy food promotion, and improvements in school nutrition standards to combat NCDs.INTERPRETATION Urgent action is required to expand food policies beyond hygiene and food security measures. Comprehensive strategies targeting NCD prevention are crucial to combat the escalating burden of NCDs in the region.
Reference equations for evaluation of spirometry function tests in South Asia, and amongst south asians living in other countries
(European Respiratory Society, 2022) Leong, W.Y.; Gupta, A.; Hasan, M.; Mahmood, S.; Siddiqui, S.; Ahmed, S.; Goon, I.Y.; Loh, M.; Mina, T.H.; Lam, B.; Yew, Y.W.; Ngeow, J.; Lee, J.; Lee, E.S.; Riboli, E.; Elliott, P.; Tan, G.P.; Chotirmall, S.H.; Wickremasinghe, A.R.; Kooner, J.S.; Khawaja, K.I.; Katulanda, P.; Mridha, M.K.; Jha, S.; Ranjit, M.A.; Pradeepa, G.; Kasturiratne, A.; Chambers, J.C.
Background: There is little data to accurate interpretation of spirometry data in South Asia, a major global region with high reported burden for chronic respiratory disease. Method: We measured lung function in 7,453 healthy men and women aged over 18 years, from Bangladesh, North India, South India, Pakistan and Sri Lanka, as part of the South Asia Biobank study. We first assessed the accuracy of existing equations for predicting normal forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC ratio. We then used our data to derive (N=5589) and internally validate (N=1864) new prediction equations amongst South Asians, with further external validation amongst 339 healthy South Asians living in Singapore. Results: GLI2012 and NHANESIII consistently overestimated expiratory volumes (best fit GLI-African American, mean [sd] z-score (n=7453): FEV1 -0.94 [1.05]; FVC -0.91 [1.10]). Age, height and weight were strong predictors of lung function in our participants (p<0.001), and sex specific reference equations using these three variables were highly accurate in both internal validation (z-scores: FEV1 0.03 [0.99]; FVC 0.04 [0.97]; FEV1/FVC -0.03 [0.99]) and external validation (z-scores: FEV1 0.31 [0.99]; FVC 0.24 [0.97]; FEV1/FVC 0.16 [0.91]). Further adjustment for study regions improves the model fit, with highest accuracy for estimation of region specific lung function in South Asia. Conclusion: We present improved equations for predicting lung function in South Asians. These offer the opportunity to enhance diagnosis and management of acute and chronic lung diseases in this major global population.
The Role of Orthography in Dyslexia
(Department of Linguistics, University of Kelaniya, Sri Lanka, 2016) Pandey, K.K.; Jha, S.
The objective of the paper is to obtain a comprehensive understanding of the syllabic and alpha-syllabic writing system and the role of grapheme to phoneme conversion among dyslexic children. Researches in the area of learning disabilities have established that dyslexia is a developmental reading disorder that manifests itself in the problems relating to word recognition and the comprehension of written language. With the average or the above average intelligence, both reading and spelling errors can indicate the sign of dyslexia. There are biological as well as environmental factors linked to dyslexia, the primary characteristics of difficulties are associated with reading and writing. Hindi (Hindi and its sub-group) is spoken as a first language in India by about 41.03% of the total population (census, 2001) but most of the Hindi speakers also learn English. This means that they grow up learning one orthographically shallow or transparent language (language- Hindi, script- Devanagari) and another orthographically deep or opaque language (language – English, script – Roman). There are various studies on bilingual/biliterates with respect to English and more regular scripts like, Spanish, German etc., or English and non-alphabetic script like Chinese. However, there are very few researches on writing difficulties with respect to alpha-syllabary scripts such as Indic scripts and English. The first part of the paper traces the language based research and theories of dyslexia which characterise it basically as a linguistic processing problem. The second part of the paper traces the provisions granted by the central and the state governments of India for dyslexic children.