Browsing by Author "Somasundaram, N."

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Contribution of physical activity and sedentary behaviour to glycaemic status in urban women
(Sri Lanka Medical Assosiation, 2012) Waidyatilaka, P.H.I.U.; de Silva, A.; Lanerolle, P.; Wickremasinghe, R.; Somasundaram, N.; Atukorala, S.
INTRODUCTION: Physical activity plays a significant role in the development of Type 2 diabetes mellitus and the role of sedentary behaviour is gaining importance. This association may exist even in persons meeting exercise guidelines. AIMS: To assess percentage fat mass (FM%), waist circumference (WC), physical activity (PA) and sedentary behaviour (sitting time) in relation to glycaemic status in urban women. METHODS: Newly diagnosed diabetic and non diabetic urban women (30-45 years) were recruited in a community based cross sectional study following screening using fasting blood sugar (n-425). HbAlc was used to categorise "worn en as normoglycaemic (n=182) or dysglycaemic (n=243). PA and sitting time were assessed by the International Physical Activity Questionnaire (IPAQ). WC was measured and FM% was determined by Bio-impedance analysis. Means were used to describe variables and Spearman correlation coefficients and multiple linear regression analysis were used to test for associations. Results: Mean age of women was 37.7+4.0 years. Compared with normoglycemics, dysglycaemics had significantly higher WC(70.7±7.1 vs 80.7±7.5cm), FM% (32.0±5.6 vs 37.0±4.7%), and sitting time (144±66 vs 311±120 minutes/day)(p<0.001 for each variable). PA (7252±2935 vs 2769±1762METminutes/week) was significantly lower (p<0.001) in dysglycemics. WC(rs=0.575, p<0.001), sitting time (rs=0.712, p<0.001) were significantly correlated with HbAlc. PA (rs=- 0.719, p<0.001) was negatively correlated with HbAlc. WC and sitting time were significantly associated with glycaemic status (F=69.3, p<0.001) after adjusting for PA. CONCLUSIONS: WC, sitting time and PA are significantly associated with glycaemic status. Independent of PA, WC and sedentary behaviour are associated with dysglycaemia.
High prevalence of overweight/obesity in urban Sri Lanka: findings from the Colombo urban study.
(Hindawi Limited, 2019) Somasundaram, N.; Ranathunga, I.; Gunawardana, K.; Ahamed, M.; Ediriweera, D.; Antonypillai, C.N.; Kalupahana, N.
BACKGROUND:South Asian countries face a double burden of malnutrition characterized by high prevalence of underweight, overweight, and obesity. Understanding the distribution of this public health problem is important to tailor targeted interventions for communities. The objective of the current study was to find out the prevalence of obesity in urban Sri Lanka and to identify sociodemographic factors associated with it. METHODS:Adult males and females residing in an urban government division of the Colombo District in Sri Lanka were included in this study (Colombo Urban Study). Stratified simple random sampling was used to select a sample of 463 from the total population. Sociodemographic data using an interviewer-administered questionnaire, anthropometric measurements, and serum samples were obtained for investigations. RESULTS: When the global BMI cutoffs were applied, the community prevalences of underweight, normal weight, overweight, and obesity were 7.7%, 39.6%, 37.0%, and 15.8%, respectively. When the Asian BMI cutoffs were applied, the respective prevalences were 7.7%, 26.8%, 34.3%, and 31.2%. The community prevalence for abdominal obesity was 58.1% when using Asian cutoffs. Females had a higher prevalence of both obesity and abdominal obesity. There was an ethnic difference in obesity rates with Moors having the highest rates (65.5%) followed by Sinhalese (52.3%) and Tamils (40.2%). The highest obesity prevalence was observed in the most educated group. Multiple regression analysis showed that high BMI was associated with female gender and family history of hypertension. Serum LDL negatively associated with BMI while the strength of this relationship was impacted by serum HBA1c levels. Finally, serum triglyceride level showed positive association with BMI, and the effect was more marked in Moors compared to Sinhalese. CONCLUSION:Two-thirds of adults in the studied urban population were overweight or obese. This highlights the urgent need for interventions to curb this epidemic. The gender, ethnic differences in obesity, its associations with educational status, and the interactions with metabolic comorbidities indicate that these interventions may need to be targeted towards different groups in the population.
Knowledge, attitudes and practices regarding type 2 diabetes mellitus, nutrition and lifestyle in urban Sri Lankan women
(Sri Lanka Medical Association, 2013) Waidyatilaka, P.H.I.U.; de Silva, A.; Atukorala, S.; Somasundaram, N.; Lanerolle, P.; Wickramasinghe, R.
AIMS: Data on population specific patterns of knowledge, attitudes and practices (KAP) is essential for the design of effective intervention strategies. The aim of this study was to assess KAP regarding type 2 diabetes mellitus (T2DM), nutrition and lifestyle in Sri Lankan urban women who were unaware of their glycaemic status. Methods: 2800 apparently healthy urban women (30 - 45 years) were screened for dysglycaemia and 345 normoglcaemics and 272 dysglycaemics were selected from Coiombo Municipal Council area by random cluster sampling for a cross sectional study. An interviewer administered questionnaire was used to obtain KAP, demographic information and family history. Chi square test and Student's t- tests were used for categorical variables and for group comparison respectively. RESULTS: KAP on T2DM, nutrition and healthy lifestyle were poor. Knowledge on pre-diabetes and prevention of T2DM was also poor. However majority wanted to improve their knowledge. Women with a family history had better knowledge (p< 0.001) and attitudes (p< 0.05), but lower practice scores (p< 0.05) compared to women without a family history of T2DM. A significant (p< 0.001) proportion of women with a family history of T2DM found it difficult to resist eating foods high in fat and sugar. CONCLUSIONS: Overall KAP was poor, especially about pre-diabetes and prevention. Willingness to learn can be used positively to direct future interventions. Poor practices despite better knowledge and attitudes among women with a family history of T2DM indicate a need for targeted intervention.
Lifestyle patterns and dysglycaemic risk in urban Sri Lankan women
(Cambridge University Press, 2014) Waidyatilaka, I.; de Silva, A.; de Lanerolle-Dias, M.; Wickremasinghe, R.; Atukorala, S.; Somasundaram, N.; Lanerolle, P.
Specific dietary patterns are associated with the risk of chronic disease. An in-depth understanding more reflective of lifestyle would be possible when assessing the synergistic effects of both diet and physical activity in pattern analysis. In the present study, we examined the biochemical markers of dysglycaemia and cardiometabolic risk in relation to lifestyle patterns using principal component analysis (PCA). Urban women (n 2800) aged 30-45 years were screened for dysglycaemia using cluster sampling from the Colombo Municipal Council area. All the 272 dysglycaemic women detected through screening and 345 randomly selected normoglycaemic women were enrolled. The International Physical Activity Questionnaire and a quantitative FFQ were used to assess physical activity and diet, respectively. Anthropometric measurements, bioelectrical impedance analysis and biochemical estimations were carried out. Lifestyle patterns were identified based on dietary and physical activity data using exploratory factor analysis. PCA was used for the extraction of factors. A total of three lifestyle patterns were identified. Women who were predominantly physically inactive and consumed snacks and dairy products had the greatest cardiometabolic risk, with a higher likelihood of having unfavourable obesity indices (increased waist circumference, fat mass percentage and BMI and decreased fat-free mass percentage), glycaemic indices (increased glycosylated Hb (HbA1c) and fasting blood sugar concentrations) and lipid profile (increased total cholesterol/TAG and decreased HDL-cholesterol concentrations) and increased high-sensitivity C-reactive protein concentrations. For the first time, we report lifestyle patterns and demonstrate the synergistic effects of physical activity/inactivity and diet and their relative association with cardiometabolic risk in urban women. Lifestyle pattern analysis greatly increases our understanding of high-risk behaviours occurring within real-life complexities. © The Authors 2014
Measures of body fat in diabetic and non-diabetic females
(Sri Lanka Medical Association, 2011) Waidyatilaka, P.H.I.U.; de Silva, A.; Lanerolle, P.; Wickremasinghe, R.; Somasundaram, N.; Atukorala, S.
INTRODUCTION AND OBJECTIVES: Increased body fat (BF) predisposes to obesity linked co-morbidities, including diabetes. Data on body fat percentage in Sri Lankan adult populations are limited. Aim of this study was to assess %BF, waist circumference (WC) and body mass index (BMI) in adult diabetic, pre-diabetic and normoglycaemic females. METHODS: Free living females (n=25) aged 30-45 years, without any known illness, and 19 females of similar age, social class and employment, recently diagnosed with DM and yet untreated, were recruited from primary health care centers in Colombo Municipality for a community based cross sectional study. Weight, height and WC were measured using standard protocols and BMI calculated. Bio-impedance analysis was used to determine % BF. HbAlc was estimated and women grouped into diabetic (HbAlc >6.5 %), pre-diabetic (HbAlc 5.7-6.4 %) or normoglycemic categories. Results: Mean age of women was 36.6±4.1 years. In the group without known illness, 9 were pre-diabetic and 16 were normoglycaemic. No significant differences were observed between diabetic, pre-diabetic and normoglycaemic women in age or weight. There was no significant difference in BMI between diabetic (25.3±3.3kg/m), pre-diabetic (26.8±2.5 kg/m2) or normoglycaemic (24.4±3.7 kg/m2) women. However, %BF was significantly higher (p < 0.01) among diabetic (37.3± 6.1} and pre-diabetic (33.9±5.5) than in normoglycaemic women (28.6±9.9). WC was also significantly higher (p < 0.01) among diabetic (83.5±7.9 cm.) and pre-diabetics (84.5±6.8) than normoglycaemic women (76.2±6.4 cm). CONCLUSIONS: In this population, although there was no difference in BMI, pre-diabetic and diabetic women had a higher %BF and WC than normogiycaemics. Funded by IAEA.
Screening of cushings syndrome in patients with poorly controlled type 2 diabetes with hypertension and obesity
(2018) Karuppiah, D.; Cooray, M.S.A.; Somasundaram, N.; Ediriweera, D.S.
INTRODUCTION: Cushing’s syndrome (CS) may be unrecognized in patients with diabetes. There is no consensus on routine screening for CS in patients with type 2 diabetes (T2DM). Aim of the study was to evaluate the prevalence of unsuspected CS in out-patients with diabetes. METHODS: Cross sectional prospective study was conducted at diabetes clinic in National Hospital of Sri Lanka among patients with diabetes who were attending for out-patient visit from January-2016 to January- 2017. Total of 287 patients were investigated with over-night dexamethasone- suppression test (ODST) as a screening test. Patients who fail to suppress serum cortisol less than 50nmol/l were further tested by Low-dose-dexamethasone-suppression test (LDDST). A third step midnight cortisol measurement was performed in patients who were failed to suppress cortisol less than 50nmol/l on LDDST. Fourth step imaging studies with pituitary MRI, abdominal-CT or CT-scan of chest abdomen and pelvis depending on the ACTH levels were performed. RESULTS: Out of 287, 46.18% (133) patients failed to suppress cortisol to less than 50nmol/l on ODST. Among these 133, 23(11.49% of total) patients failed to suppress cortisol less than 50nmol/l on LDDST. Nine out of 23 patients had cortisol more than 140nmol/l on midnight cortisol test, confirming true CS. Further investigations with imaging revealed one with pituitary adenoma, one with adrenal adenoma and 6 had normal imaging. CONCLUSION: Considering the prevalence of definitive CS of 3.18% among poorly controlled T2DM patients with hypertension and obesity suggest that CS is not rare as previously thought. But in our Asian population with T2DM and high prevalence of co-morbidities, taking overnight dexamethasone suppression test alone as a screening test would not be a suitable test to screen CS.
Sedentary behaviour and physical activity in South Asian women: time to review current recommendations?
(Public Library of Science, 2013) Waidyatilaka, I.; Lanerolle, P.; Wickremasinghe, R.; Atukorala, S.; Somasundaram, N.; de Silva, A.
OBJECTIVE: Our aims were to describe activity and sedentary behaviours in urban Asian women, with dysglycaemia (diagnosed at recruitment), and without dysglycaemia and examine the relative contribution of these parameters to their glycaemic status. METHODS: 2800 urban women (30-45 years) were selected by random cluster sampling and screened for dysglycaemia for a final sample of 272 newly diagnosed, drug naive dysglycaemic and 345 normoglycaemic women. Physical activity and sedentary behaviours were assessed by the International Physical Activity Questionnaire (IPAQ). Demographic data, diet and anthropometry were recorded. Logistic regression analysis assessed contribution of all parameters to dysglycaemia and exposure attributable fractions were calculated. RESULTS: The mean energy expenditure on walking (2648.5±1023.7 MET-min/week) and on moderate and vigorous physical activity(4342.3±1768.1 MET-min/week) for normoglycemic women and dysglycaemic women (walking;1046.4±728.4 MET-min/week, moderate and vigorous physical activity; 1086.7±1184.4 MET-min/week) was above the recommended amount of physical activity per week. 94.3% ofwomen spent >1000 MET-minutes/week on activity. Mean sitting and TV time for normoglycaemic and dysglycaemic women were 154.3±62.8, 38.4±31.9, 312.6±116.7 and 140.2±56.5 minutes per day respectively. Physical activity and sedentary behaviour contributed to dysglycaemia after adjustment for family history, diet, systolic blood pressure and Body Mass Index. Exposure attributable fractions for dysglycaemia were; lower physical activity: 78%, higher waist circumference: 94%, and TV viewing time: 85%.CONCLUSIONS: Urban South Asian women are at risk of dysglycaemia at lower levels of sedentary behaviour and greater physical activitythan western populations, indicating the need for re-visiting current physical activity guidelines for South Asians