Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Influence of baseline inflammatory status on dietary effects of nutrition counseling in women with and without coronary artery disease(Sri Lanka Medical Association, 2012) Thoradeniya, T.; Senenayake, C.; Wickremasinghe, R.; Mendis, S.; Jayasena, S.; Atukorala, S.INTRODUCTION: Inflammatory status influences the biochemical response to diet, suggesting an additional mechanism increasing coronary artery disease (CAD) risk. Aims: To determine the effect of baseline inflammatory status on biochemical response to nutrition counseling to reduce CAD risk. METHODS: A 2x2 factorial experiment having an intervention was conducted among 40-60 year old women with (n=101) and without CAD (n=109). Intervention comprised nutrition counseling. Baseline and post-intervention data on diet, serum high sensitivity CRP (hsCRP), soluble ICAM-1 (sICAM-1), ferritin, folate, plasma total homocysteine (tHcy) concentrations and traditional CAD risk factors were assessed. RESULTS: At baseline tHcy, sICAM-1 and hsCRP concentrations were significantly higher (p<0.05) among women with CAD than in women without CAD. Baseline sICAM-1 [OR=3.19 (95"% CI, 1.65-6.17)] and tHcy concentrations [OR=1.33 (95% CI 1.1-1.61)] were independently associated with CAD after adjusting for other risk factors. Nutrition counseling significantly decreased serum total and LDL cholesterol and increased serum folate (p<0.05) in women without CAD, but not in women with CAD. Among women without CAD, nutrition counseling decreased serum total and LDL cholesterol, and increased serum folate (p<0.05) in the "low" hsCRP group (below median of controls) but not in the "high" hsCRP group (above median). CONCLUSIONS: Nutrition counseling was effective in reducing serum total and LDL cholesterol and increasing serum folate in women without CAD having a "low" baseline inflammatory status. The hindering effect of underlying inflammation, on the biochemical response to dietary modification should be considered in dietary interventions in CAD risk reduction.Item 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.Item 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.Item Effectiveness of a lifestyle modification programme in reducing cardiometabolic risk markers in urban Sri Lankan women with pre- diabetes(Sri Lanka Medical Association, 2015) Waidyatilaka, P.H.I.U.; de Silva, A.; Lanerolle, P.; Wickremasinghe, R.; Atukorala, S.INTRODUCTION AND OBJECTIVES: Prediabetes increases cardlometabolic risk. Our aim was to develop and assess the effectiveness of a lifestyle modification programme in reducing cardiometabolic risk markers in newly diagnosed prediabetic urban Sri Lankan women. METHOD: Women (n=1500) from Colombo Municipal Council area were screened and 130 newly diagnosed prediabetics recruited randomly to intervention and control groups. Participant involvement ensured development of a culturally relevant, four month intervention programme. Control group received initial advice and print material only. Intervention was developed with a goal based strategy of 5% weight loss and 150 minutes of physical activity (PA) per week using a predominantly group based approach with individual sessions.FPG, HbAic, serum lipids and hs-CRP were measured. RESULTS: The final sample was 101 women (intervention n=51, control n=50) with no significant difference in baseline parameters between groups or responders and non-responders. Following intervention, 52.9% achieved the weight loss goal compared to the control group (2%) and37.3% became normoglycaemic, compared to none among controls.In the intervention group, when compared to baseline, there was a significant (p<0.05) reduction in HbAlc (0.2±0.24%), FPG (20.6±11.6 mg/dl), total cholesterol (14.4±26.5 mg/dl) and triglycerides (13.2+30.7 mg/dl) and a significant (p<0.05) increase in HDL-cholesterol (3.2+5.9 mg/dl) post intervention with no significant change in hs-CRP. All differences were significant against the control group. Conclusions: A culturally sensitive intervention programme achieved improvement in markers of glycaemia, lipid profile and weight reduction with reversal of prediabetes in a majority.Item 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.Item Hyperhomocysteinaemia among adolescent girls and young women(Sri Lanka Medical Association, 2007) Thoradeniya, T.; Atukorala, S.; Wickremasinghe, R.INTRODUCTION: Moderately elevated plasma total homocysteine (tHcy) is an independent risk factor for adverse pregnancy outcomes and cardiovascular disease in women. OBJECTIVE: To determine the prevalence of hyperhomocysteinaemia and its association with serum folate and vitamin Bi2 concentrations, BMI and waist circumference (indicators of general nutritional status and cardiovascular risk factors) among adolescent girls and young women. DESIGN, SETTING AND METHODS: A sample of 552 adolescent girls aged 15-18.9 years (n=277) and young women aged 19-30 years (n=275) from Colombo municipality were randomly selected for a study conducted on low folate status and anaemia. A sub-sample with tHcy data was selected for the present study (adolescent girls: n=123; young women: n=136). Serum folate and vitamin B,2 were measured. Anthropometric data were obtained and body mass index (BMI) was calculated. RESULTS: Hyperhomocysteinaemia (tHcy>15 umol/L) was observed among 18.9% of subjects (adolescent girls: 19.5% and young women: 18.4%). Though a high prevalence was noted (43.0%) for low folate status (serum folate <3 ng/ml), none of the subjects studied bad serum vitamin B12 <150 pg/ml. Inverse correlations were noted between tHcy and serum folate (r=-0.151, P=0.018) and vitamin B12 ,r=-0.202, P=0.004) concentrations. Interestingly, positive correlations were noted among tHcy and BMI (r=0.168, P=0.007) and waist circumference (r=0.145, P=0.019). CONCLUSIONS: Our results suggest that hyperhomocysteinaemia could be partly attributable to low folate and vitamin B12 status. The associations noted between tHcy and BMI and waist circumference warrants further investigations in relation to food intake and disease outcomes in this population. ACKNOWLEDGEMENT: Financial support: IAEA, Vienna