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 OP59 Ultra-processed food consumption in South Asia: quantification of regional variation in intakes and the assessment of their sociodemographic correlates. Findings from the South Asia Biobank in four South Asian countrie(BMJ, 2024) Bhagtani, D.; Adams, J.; Imamura, F.; Lahiri, A.; Irfan, K.; Jha, V.; Kasturiratne, A.; Katulanda, P.; Mridha, M.; Anjana, R.M.BACKGROUND Escalation of ultra-processed foods (UPFs) sales has been recorded in low-to-middle-income countries, including in South Asia. However, individual consumption levels and sociodemographic characteristics influencing UPF consumption remain largely unknown in South Asia. We aimed to quantify UPF consumption and investigate its sociodemographic correlates in South Asia.METHODS We analysed data from 60,714 participants in the South Asia Biobank that recruited adults in Bangladesh, Pakistan, Sri Lanka, North India, and South India. Dietary assessment was conducted using interviewer-led 24h dietary recalls with a South Asia-specific digital tool. Foods were classified by the degree of industrial processing using the NOVA classification. Adjusted two-part multivariable regression models examined associations between sociodemographic factors and any UPF consumption and quantity of UPF consumption in consumers.RESULTS In Bangladesh, Sri Lanka and North India, approximately 75% of the participants reported consuming any UPFs in the previous 24h while in South India and Pakistan this was 40%. Median contribution of UPFs to total energy among UPF consumers ranged between 17% in Pakistan, 15% in North India, and 13% in Bangladesh, Sri Lanka, and South India. Biscuits were a common source of UPF across all regions. Other commonly consumed UPFs among consumers included sweetened beverages in Pakistan, packaged salty snacks in South India, and breakfast cereals in Bangladesh. Diverse associations between sociodemographic factors and any UPF consumption were seen across regions. Younger age was associated with any UPF consumption in Pakistan and Sri Lanka whereas in Bangladesh and North India, older age was. In all regions except Bangladesh, female sex was associated with any UPF consumption. Higher education was associated with UPF consumption in Bangladesh (odds ratio 2.01; 95% confidence interval 1.71 to 2.35), Pakistan (1.69; 1.55 to 1.85), and North India (1.40; 1.13 to 1.73). Paid employment was not associated with UPF consumption in any region. Among UPF consumers, in all regions, UPF consumption was lower in married or cohabitating than in single people. In Bangladesh and Sri Lanka UPF consumption was higher in rural residents, while in Pakistan, consumption was higher in urban participants.CONCLUSION Younger age, female sex, higher education, employment, and income exhibited associations with UPF, but this varied across South Asia. This heterogeneity should be considered when developing regionally specific interventions to support dietary public health. Our findings of regional consumption of specific UPFs, such as biscuits, breakfast cereals, sweetened beverages, and salty snacks, provide valuable insights for targeted interventions.Item Prevalence, predictors and outcome of chronic kidney disease in a cohort of aging urban, adult Sri Lankans(Sri Lanka Medical Association, 2021) de Silva, S.T.; Ediriweera, D.D.; Niriella, M.A.; Kasturiratne, A.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.Introduction and Objectives Chronic kidney disease (CKD) affects 700 million people worldwide. In 2017, deaths due to CKD accounted for 4.6% of mortality globally. Prevalence of CKD is increasing worldwide, with increasing diabetes and hypertension in aging populations. Our objective was to determine prevalence of CKD in an urban, adult cohort, since such data is scarce in Sri Lanka. Methods The study population was selected by stratified random sampling from Ragama MOH area initially in 2007 (aged 35-64 years) and re-assessed in 2014. On both occasions, participants were assessed by structured interview, anthropometric measurements and biochemical tests. CKD was assessed in 2014. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI formula. CKD was defined as eGFR<60ml/min/1.72m2, using KDIGO/KDOQI classification. The cohort was further followed up in 2017 when all-cause and cardiovascular (CV) mortality and CV morbidity were also assessed. Results Of 2985 individuals recruited in 2007, 2148(71.6%) attended follow-up in 2014. 2032/2148 (94.6%) had CKD data [57.0% women, mean age 52.3(SD 7.7) years]. Age adjusted prevalence of CKD was 3.03(1.98–4.11) per 100 population in 2014; 41/61(67.2%) were in CKD Stage-3A, 14/61(23%) in Stage-3B, 6/61(9.8%) in Stage-4 and none in end-stage. Independent predictors of CKD in 2014 were older age (p<0.001), male gender (P<0.05) and presence of diabetes (p<0.001) and hypertension (p<0,001) in 2007. CKD was not associated with all-cause mortality, CV mortality or morbidity (p>0.05) in 2017.Conclusion Diabetes and hypertension were associated with CKD. Most with CKD were in Stage 3, where early recognition and better control of co-morbidities retard progression of CKD.Item The effect of a community-based health promotion intervention to improve utilization of healthy lifestyle centers in Sri Lanka(College of Community Physicians of Sri Lanka, 2021) Herath, H.M.T.P.; Perera, K.M.N.; Kasturiratne, A.Background: Healthy lifestyle centers (HLCs) report underutilization by the target population. There is a dearth of evidence on improving HLC utilization through the Health Promotion (HP) approach. This study aims to evaluate of the effectiveness of a HP intervention in improving the utilization of HLCs.Methods: A quasi-experimental study was conducted in six grama niladari divisions from the catchment area of two selected HLCs, one each in Gampaha (intervention) and Kalutara (comparison) districts. Community support groups (CSGs) were developed and empowered as the intervention. Contributory factors for the underutilization were addressed with the CSG.The pre and post intervention assessments were done in a random sample of 498 (aged 35-65 years) from each group. Primary outcome was improvement in the attendance of the HLC and secondary outcomes were changes in contributory factors. Data collected using an interviewer-administered questionnaire and secondary data from the HLCs were used. Results: Utilization of the HLC improved significantly among the sample from the intervention group (Post 35.3% [95% CI: 30.9 - 39.8]; Pre 5.85% [95% CI: 3.74 - 7.95], P < 0.001). The comparison group showed no significant change (Post 3.49% [95% CI: 1.80 -5.17] - Pre 3.25% [95% CI: 1.62 - 4.87], p = 1.00). There was a significant improvement in mean HLC attendance in the intervention group (Mean difference= 91.83, P < 0.05) compared to the comparison group (Mean difference = 2.66, P > 0.05). Conclusions: The utilization of the HLCs can be improved by a HP intervention through developing and empowering CSGs.Item Predictors of mortality in a cohort of adult Sri Lankans(Sri Lanka Medical Association., 2019) Kasturiratne, A.; Beddage, T.; de Silva, S.T.; Niriella, M.A.; Pathmeswaran, A.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.INTRODUCTION & OBJECTIVES: There is limited knowledge on early predictors of mortality among Sri Lankans. We investigated predictors of mortality in the Ragama Health Study cohort 10 years after recruitment. METHODS: The study population (35-64-year-olds selected by age-stratified random sampling from the Ragama Medical Officer of Health area) was initially screened in 2007 for socio-demographic, lifestyle, anthropometric and clinical risk factors with informed written consent. Their vital status was assessed in 2017 and the causes of death of the deceased were retrieved from death certificates available with the next-of-kin or declaration of death records from the hospital where the death occurred. RESULTS: Of the 2986 enrolled in 2007, 169 [Males: 107 (63.3%)] had died over the 10-year period, giving an overall mortality rate of 5.7% (95% CI: 5.0 % - 6.4%). The number of deaths due to cardiovascular and cancer related causes were 73/169 and 31/169, respectively. On multivariate analysis using Cox's proportional hazards model, advancing age, male sex, lower educational level, unsafe alcohol consumption and the presence of metabolic syndrome at baseline were independent predictors of all-cause mortality. Advancing age, male sex, unsafe alcohol consumption and the presence of metabolic syndrome at baseline were independent predictors of cardiovascular mortality, while advancing age and unsafe alcohol consumption were the only independent predictors of cancer-related mortality. CONCLUSION: Unsafe alcohol consumption and the presence of metabolic syndrome were important modifiable risks for mortality in this population. Addressing these risks in early adulthood will help to improve longevity.Item Incidence and predictors of Diabetes Mellitus: A 7- year community cohort follow-up of urban, adult Sri Lankans(Sri Lanka Medical Association., 2019) de Silva, S.T.; Ediriweera, D.; Beddage, T.; Kasturiratne, A.; Niriella, M.A.; de Silva, A.P.; Dassanayake, A.S.; Pathmeswaran, A.; Kato, N.; Wickremasinghe, A.R.INTRODUCTION & OBJECTIVES: There is limited data on incidence of type 2 diabetes mellitus (T2DM) from South Asia. We investigated incidence and predictors ofT2DM in an urban, adult population after seven-years of follow-up. METHODS: The study population (42-71 year-olds in 2014, selected by age-stratified random sampling from the Ragama MOH area) was initially screened in 2007 and re-evaluated in 2014 with informed written consent. On both occasions they were assessed by structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests. RESULTS: Of the 2986 enrolled in 2007, 737 had established T2DM giving a baseline prevalence of 24.7% (95% CI: 23.1%-26.2%). 2148/2984 (71.6%) of the original cohort attended follow-up [1237 (57.5%) women; median (IQR) 60 (54-66) years]. 1650 participants who did not have T2DM in 2007 presented for follow up; 436 (27.6%) of them had developed new T2DM by 2014, giving an annual incidence of 3.9% (95% CI: 3.0%-4.9%). Of 525 participants with pre-diabetes (HbA1c 5.7-6.4%) in 2007, 364 attended follow up and 201/364 (55.1%) had developed T2DM by 2014, giving an annual conversion rate of pre-diabetes to T2DM of 7.9%. On logistic regression, pre-diabetes (OR:4.4;95%CI:3.3%-6.0%), central obesity (OR: 1.8;95%CI: 1.3%-2.4%), dyslipidemia (OR: l.5;95%CI: 1.1 %-2.1 %) and non-alcoholic fatty liver disease (NAFLD) (OR:1.5;95%CI: 1.1 %-2.1%) showed significant association with incident T2DM. CONCLUSION: In this urban cohort, the annual incidence of T2DM was 3.9% and the annual conversion rate of pre-diabetes to T2DM was 7.9%. Our findings emphasize the need for targeted and intensive lifestyle interventions for individuals with high metabolic risk to prevent T2DM.Item Extra-curricular activities and self-esteem of school children in the Colombo District(Sri Lanka Medical Association, 2018) Welhenge, C.U.; Wickramanayake, D.S.; Wickramasekara, M.H.M.; Wijayarathne, W.A.L.T.; Wijeratne, N.G.; Zangmo, L.; Kasturiratne, A.INTRODUCTION AND OBJECTIVES: Self-esteem has a positive effect on the optimal performance of a person. Association between engaging in extra-curricular activities in school and the self-esteem of adolescents has not been described in Sri Lanka. The study aimed to describe the association between engaging in extra-curricular activities in school and the level of self-esteem among school children in two national schools in the Colombo District. METHODS: A descriptive cross sectional study was conducted in two schools among 422 adolescents between 13- 15 years of age. A questionnaire including the Coopersmith self-esteem inventory was used to collect the data after informed consent. Self esteem was scored using the Coopersmith self esteem inventory score. R studio was used to describe the level of self-esteem and its associations. RESULTS: A significant difference in the self-esteem score between students engaged in more than one sport [Mean= 78.38; 95% CI: 75.41-81.36] and students not engaged in any sport [Mean=72.2; 95% CI: 69.38-75.02] was observed. A similar difference was observed between students engaged in physically intense sports [Mean =76.15; 95% CI: 74.26-78.04] and students not engaged in any sport [Mean= 72.2; 95% CI: 69.38-75.02]. No significant difference in self-esteem was observed between, students engaged in sports with a high physical exertion and low physical exertion. Students engaged in more than one extra-curricular activity had a non• significant increase in self-esteem [Mean= 78.97; 95% CI: 75.46-82.49] compared with students not engaged in extracurricular activities [Mean= 72.40; 95% CI: 70.18-74.61]. CONCLUSION: Since extra-curricular activities have a positive effect on the self esteem of Sri Lankan adolescents, they should be promoted in schoolsItem Prevalence of chronic kidney disease and associations among hypertensive patients in North Western Sri Lanka: A cross sectional study(Sri Lanka Medical Association, 2018) Luke,W.A.N.V; Ediriweera, D.S.; de Silva, C.K.; Perera, K.M.N.; Ranasinha, C.D.; Kasturiratne, A.; de Silva, H.A.INTRODUCTION AND OBJECTIVES: Chronic kidney disease is a major non communicable disease in Sri Lanka with a rising prevalence. We studied the prevalence and associations of chronic kidney disease among patients with hypertension in a rural Sri Lankan population. METHODS: A community-based study was conducted in selected Grama Niladhari divisions in ten Medical Officer of Health areas in the Puttalam district. Adults with hypertension were investigated with serum creatinine, urine albumin creatinine ratio and eGFR. Socio-demographic and anthropometric data was obtained as well. RESULTS: Total of798 hypertensive patients (546 females and 252 males) were included in the study. 383 (48.7%, 95% CI: 45.2% - 54.0%) had proteinuria .486 (61.I %, 95% CI: 57.7% - 64.5%) of them had stage III or advanced CKD among which 241 had proteinuria. 618 (78.7%, 95% CI: 75.9% - 81.6%) showed either eGFR<60ml/min/l.73m2 or proteinuria. Advancing age (p<0.01), female gender (p<0.01) and raised LDL levels (p=0.01) were significantly associated with CKD.CONCLUSION: Prevalence of CKD is high in this rural hypertensive adult cohort. A significant proportion had non protienuric CKD. It may be justifiable to assess renal functions of all patients with hypertension to establish an early diagnosis of CKD to prevent complications. Considering the very high prevalence, community screening for CKD can be recommended in this populationItem Prevalence and patterns of dyslipidaemia among hypertensive patients in North Western Sri Lanka: A cross sectional study(Sri Lanka Medical Association, 2018) Luke, W.A.N.V.; Ediriweera, N.S.; de Silva, C.K.; Perera, K.M.N.; Ranasinha, C.D.; Kasturiratne, A.; de Silva, H.A.INTRODUCTION AND OBJECTIVES: Dyslipidaemia and hypertension are major risk factors for cardiovascular disease. Data on prevalence and patterns of dyslipidaemia in rural settings of Sri Lanka are limited. We conducted a study to determine the prevalence of dyslipidaemia among hypertensive adults over 40 years of age in the Puttalam district. METHODS: A community-based study was conducted in selected Grama Niladhari divisions in ten Medical Officer of Health areas in the Puttalam district. Socio-demographic data were obtained from adult hypertensive and basic investigations were carried out. RESULTS: Total of 798 hypertensive patients (546 females and 252 males) were included in the study. Median (Interquartile range) levels of total cholesterol, HDL, LDL and TG of the patients were 205 (173 - 238), 55 (48 - 63), 125 (96 - 155), 109 (85 - 143) respectively. Elevated levels of total cholesterol, LDL, TG and non HDL were reported in 192 (24. %), 371(46.4%), 173 (21.6%) and 527 (66%) respectively and low HDL was observed among 40 (5%) patients. High non HDL cholesterol was associated with female gender (P=0.03) and advancing age showed a negative association (P<0.01). CONCLUSION: Prevalence of dyslipidaemia is high in this hypertensive adult cohort. Suboptimal level of modifiable risk factor control is observed in this population which should be addressed to further reduce cardiovascular morbidity and mortalityItem Evaluating temporal patterns of snakebite in Sri Lanka: The potential for higher snakebite burdens with climate change(Sri Lanka Medical Association, 2018) Ediriweera, D.S.; Diggle, P.J.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Jayamanne, S.F.; Isbister, J.K.; Dawson, A.; Lalloo, D.G.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: Snakebite is a neglected tropical disease that has been overlooked by healthcare decision makers in many countries. Previous studies have reported seasonal variation in hospital admission rates due to snakebites in endemic countries including Sri Lanka, but seasonal patterns have not been investigated in detail. METHODS: A national community-based survey was conducted during the period of August 2012 to June 2013. The survey used a multistage cluster design, sampled 165,665 individuals living in 44,136 households and recorded all recalled snakebite events that had occurred during the preceding year Log-linear models were fitted to describe the expected number of snakebites occurring in each month taking into account seasonal trends and weather conditions, and addressing the effects of variation in survey effort during the study and due to recall bias amongst survey respondents RESULTS: Snakebite events showed a clear seasonal variation. Typically, snakebite incidence was highest during November to December followed by March to May and August, but this varied between years due to variations in relative humidity, which is also a risk-factor. Low relative humidity levels was associated with high snakebite incidence. If current climate change projections are correct, this could lead to an increase in the annual snakebite of burden of 35,086 (95% CI: 4 202 a€" 69,232) during the next 25 to 50 years. CONCLUSION: Snakebite in Sri Lanka shows seasonal variation Additionally, more snakebites can be expected during periods of lower than expected humidity. Global climate change is likely to increase the incidence of snakebite in Sri Lanka.Item Incidence and predictors of metabolic syndrome among urban, adult Sri Lankans: a community cohort, 7-year follow-up study(European Association for the Study of Diabetes, 2017) de Silva, S.T.; Niriella, M.A.; Kasturiratne, A.; Kottahachchi, D.; Ranawaka, U.K.; Dassanayake, A.; de Silva, A.P.; Pathmeswaran, P.; Wickremasinghe, R.; Kato, N.; de Silva, H.J.BACKGROUND AND AIMS In 2007, we reported a 38.9% prevalence of metabolic syndrome (MetS) in an urban, adult population. Published data on incident MetS from South Asia is lacking. This study investigated the incidence and risk factors for MetS after a 7-year follow-up of the initial cohort. MATERIALS AND METHODS: The study population (selected by age-stratified random sampling from the Ragama MOH area) was screened in 2007 (aged 35-64 years) and re-evaluated in 2014 (aged 42-71 years). On both occasions, structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests were performed. MetS was diagnosed on established International Diabetes Federation (IDF 2012) criteria. Total body fat (TBF) and visceral fat percentage (VFP) were measured in 2014, using impedance. Abnormal TBF was defined as >32% for females and >25% for males. Abnormal VFP was defined as >10% for both sexes. Non-alcoholic fatty liver disease (NAFLD) was diagnosed on established ultrasound criteria, safe alcohol consumption (Asian standards: <14 units/week for men, <7 units/week for women) and absence of hepatitis B and C markers. RESULTS: 2137/2967 (72.0%) of the initial cohort attended follow-up [1229 (57.5%) women; mean-age 52.4 (SD-7.7) years]. 1000/2137 [548 (54.8%) women; mean age 57.5 years (SD-7.74)] had MetS (prevalence-46.8%). Out of 1246 individuals who initially did not have MetS in 2007, 318 [225 (70.8%) women; mean age 57.5 (SD 7.7) years] had developed incident MetS after 7 years (annual incidence-2.13%). Comparison of incident MetS with those with no MetS in 2014 is shown in Table 1. On logistic regression, female sex (OR 3.6, p<0.001), central obesity [OR 4.58, p<0.001], BMI >23kg/m2 [OR 4.84, p<0.001], increase in weight 2%-5% [OR 2.02, p<0.001], increase in weight >5% [OR 5.3, p<0.001), increase in waist circumference (WC) 5-10-cm [OR 3.68, p<0.001], increase in WC >10cm [OR 10.34, p<0.001] and NAFLD (OR 2.44, p<0.001) in 2007 were independently predictive of incident MetS in 2014. Abnormal VFP [OR 4.23, p<0.001] and abnormal TBF [OR 5.25, p<0.001] were also associated with incident MetS. CONCLUSION: In this prospective community study, the annual incidence of MetS was 2.13%. Female gender, increase in weight and WC from baseline and the presence of NAFLD predicted the development of incident MetS. Obesity at baseline was the only defining individual component of MetS that predicted future MetS.