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 Correlates of serum homocysteine in a Sri Lankan population(American Association For Clinical Chemistry, 2010) Chackrewarthy, S.; Wijayasinghe, Y.S.; Gunasekera, D.; Wickremasinghe, R.; Kato, N.Correlates of total serum homocysteine concentration in a Sri Lankan population BACKGROUND: Hyperhomocysteinemia, a possible risk factor for vascular disease occurs at a higher prevalence in South Asian countries. Serum homocysteine concentrations are influenced by genetic, nutritional and lifestyle factors. Correlates of total serum homocysteine concentration (tHcy) are not well characterized in the Sri Lankan population. Such information is important in developing therapeutic and preventative strategies. OBJECTIVE: To investigate the factors potentially associated with fasting levels of serum tHcy in a Sri Lankan population. METHODS: In a cross sectional study, 177 apparently healthy volunteers (91 men and 86 women) aged 38-65 years were selected from residents in an urban health administrative area. Individuals with a history of chronic disease and with any pharmacological treatment were excluded from the study. Information on diet, lifestyle factors and medical history were recorded. Anthropometric indices and blood pressure were measured according standard protocols. Fasting serum levels of tHcy, insulin, creatinine, folate and lipids were estimated using standard protocols. RESULTS: Fasting serum tHcy levels were higher in males than in females (geometric mean +/- SD, 13.75 mumol/l +/- 1.41 Vs. 9.58 mumol/l +/- 1.43, p<0.001) and were positively associated with age (r=0.204, p< 0.01) in both sexes. 32.3% of males and 10.3% of females had mild hyperhomocysteinemia (tHcy>15mumol/l). tHcy levels were significantly higher in smokers than in non-smokers (geometric mean +/- SD, 14.58 mumol/l +/- 1.44 Vs.12.71 mumol/l +/- 1.37, p<0.05) and in alcohol consumers than in non-consumers (geometric mean +/- SD, 14.53 mumol/l +/- 1.43 Vs.12.14 mumol/l +/- 1.32, p< 0.02). In males, tHcy levels were negatively related to serum insulin (r= -0.397, p<0.001) and BMI (r= -0.244, p <0.02) and positively related to serum creatinine (r=0.235, p<0.02). In females, there was a positive relationship between tHcy and systolic blood pressure (r= 0.239, p<0.02) but there was no significant correlation with serum insulin. In both sexes, serum tHcy levels strongly correlated with serum folate (r= -0.412, p<0.001). There were no significant associations between tHcy and serum lipids. Stepwise regression analysis confirmed the associations between tHcy and folate (p<0.001 in both sexes), insulin (p=0.026 in males) and creatinine (p=0.036 in males). CONCLUSION: Low intake of folate, alcohol consumption and smoking were associated with increased tHcy concentrations. Serum insulin and creatinine were independent correlates of tHcy in males, but not in females. Difference in tHcy levels between sexes may partly be attributed to differences in lean muscle mass and to a metabolic link between creatinine synthesis and homocysteine production. Insulin may regulate serum tHcy concentrations by homocysteine remethylation or by increasing homocysteine clearance.Item Incidence, prevalence and demographic and life style risk factors for obesity among urban, adult Sri Lankans: a community cohort follow-up study(Sri Lanka Medical Association, 2017) Niriella, M.A.; de Silva, S.T.; Kasturiratne, A.; Kottachchi, D.; Ranasinghe, R.M.A.G.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.INTRODUCTION & OBJECTIVES: Obesity is a global problem. Data from the South Asian region is limited. METHODS: In a cohort follow-up study we investigated obesity among urban, adult, Sri Lankans (35-64y; selected by age-stratified random sampling from Ragama-MOH area; initial screening 2007; re-evaluation 2014). On both occasions structured interview, anthropometry, liver ultrasound, biochemical and serological tests were performed. Total body fat (TBF) and visceral fat percentage (VFP) were assessed by impedance in 2014. General-obesity (GO) was BMI>25kg/m2. Central-obesity (CO) was waist circumference (WC)>90cm males and WC>80cm females. Multinomial logistic regression was fitted to assess associations. RESULTS: In 2007 (n=2967), 614 (20.7%) were overweight [51.9%-women], 1161(39.1%) had GO [65.9%-women] and 1584(53.4%) had CO [71%-women]. Females (p<0.001), raised-TG (p<0.001), low-HDL (p<0.001), diabetes (p<0.001), hypertension (p<0.001), NAFLD (p<0.001), and low household income (p<0.001) were significantly associated with prevalent GO and CO respectively. Additionally, increased-age (p=0.05), low-educational level (p<0.001) and unhealthy eating (p<0.001) were associated with prevalent CO. Inadequate physical activity was not associated with either. 2137 (72%) attended follow-up in 2014. Of those who were initially non-obese who attended follow-up, 189/1270 (14.9%) [64% women] had developed GO (annual-incidence 2.13%) and 206/947 (21.9%) [56.3% women] had developed CO (annual incidence 3.12%) after 7 years. TBF and VFP significantly correlated with incident GO and CO (p<0.001). Female gender (OR-1.78, p<0.001; 2.81, p<0.001) and NAFLD (OR-2.93, p<0.001; OR-2.27, p<0.001) independently predicted incident GO and CO respectively. CONCLUSION: The prevalence and incidence of GO and CO were high in this cohort. Both incident GO and CO were strongly associated with female gender and NAFLD.Item Lean non-alcoholic fatty liver disease (Lean-NAFLD): characteristics and risk factors from a community cohort follow up study(Sri Lanka Medical Association, 2016) Niriella, M.A.; de Silva, S.T.; Kasturiratne, A.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Piyaratna, T.A.C.L.; Vithiya, K.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is usually associated with obesity. However, some NAFLD patients are lean. We assessed the characteristics and risk factors for lean-NAFLD. METHOD: In a community cohort follow up study (initial screening-2007, re-evaluation-2014), NAFLD was established on USS criteria and exclusion of alcohol overuse and secondary causes. Lean (BMI <23 kg/m2) and non-lean (BMI ≥23 kg/m2) NAFLD were compared. The two groups were compared for differences in gender, diabetes, hypertension, hypertriglyceridemia, low-HDL, weight and waist circumference (WC) at baseline. They were also compared for differences in development of incident diabetes, hypertension, hypertriglyceridemia, low-HDL, and change in weight and WC. RESULTS: 678 (69.6%) individuals with NAFLD detected in 2007 presented for follow up in 2014. 78(11.5%) [males-32(41%); mean-age 53.7(SD-7.1) years] were lean and 600(88.5%) [males-191(31.8%); mean-age 52.3(SD-7.5) years] were non-lean. Hypertension (p=0.007) and a smaller WC (<90cm for males, <80cm for females) (p<0.001) were associated with lean-NAFLD. After 7 years, change in BMI was less (p=0.022) among lean-NAFLD. There were no differences in change in WC or incident metabolic co-morbidities. Of those who did not have NAFLD in 2007, 746 developed incident NAFLD in 2014; lean-NAFLD 193/746 (25.9%) [males-100(51.8%); mean age 59.6(SD-7.5)], non-lean-NAFLD 553/746 (74.1%) [males-201(36.3%); mean age 58.2(SD-7.7)]. On logistic regression analysis, presence of diabetes (p=0.002, OR 2.1) and raised WC (p=0.003, OR 1.7) were associated with incident lean-NAFLD. CONCLUSIONS: Among individuals with NAFLD, lean-NAFLD is associated with hypertension and smaller WC. In the community, diabetes and bigger WC predict incident lean-NAFLD.Item Incidence and risk factors for non-alcoholic fatty liver disease in an urban, adult Sri Lankan population – a community cohort follow-up study(Sri Lanka Medical Association, 2016) Niriella, M.A.; Kasturiratne, A.; de Silva, S.T.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Piyarathna, T.A.C.L.; Vithiya, K.; Dassanayake, A.S.; de Silva, A.P.INTRODUCTION: In 2007, we reported a 33% prevalence of non-alcoholic fatty liver disease (NAFLD) and its association with PNPLA3(rs738409) gene polymorphism in an urban, adult Sri Lankan population. OBJECTIVES: This study investigated incidence and risk factors for NAFLD after seven years follow-up. METHOD: The study population (42-71-year-olds, selected by age-stratified random sampling from the Ragama MOH area) was screened initially in 2007 and re-evaluated in 2014. On both occasions they were assessed by structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests. NAFLD was diagnosed on established ultrasound criteria, safe alcohol consumption and absence of hepatitis B/C markers. Non-NAFLD controls did not have any ultrasound criteria for NAFLD. An updated case-control genetic association study for 10 selected genetic variants and incident NAFLD was also performed. RESULTS: 2155/2985 (72.2%) of the original cohort attended follow-up [1244-women, 911-men; mean-age 59.2(SD, 7.7) years]. 1322 [839 women; mean-age 58.9 (SD, 7.6) years] had NAFLD. Out of 795 [466 women] who initially did not have NAFLD, 365 [226 women, mean-age 58.6(SD,7.9) years] had developed NAFLD after 7 years (annual incidence-6.6%). Increased waist circumference [p=0.001], BMI>23kg/m2 [p<0.001] and raised plasma triglycerides [p<0.05] independently predicted incident NAFLD. The updated genetic association study (1310 cases, 427 controls) showed borderline association with NAFLD at 2/10 candidate loci: PPP1R3B(rs4240624), PNPLA3(rs738409) (one-tailed p=0.044 and 0.033, respectively). CONCLUSIONS: In this community cohort follow-up study, the annual incidence of NAFLD was 6.6%. Incident NAFLD was associated with features of metabolic syndrome, and showed tendency of association with PNPLA3 and PPP1R3B gene polymorphisms.Item Intracerebral haemorrhage - risk factors, subtypes and mortality(Sri Lanka Medical Association, 1998) Gunatilake, S.; Premawardhena, A.INTRODUCTION : No data are available regarding intracerebral haemorrhage among Sri Lankans. In a hospital based study in Colombo we identified 49 consecutive patients with intra cerebral haemorrhage and they were studied to determine the risk factors, site and size of haemorrhage, clinical severity and mortality. METHODS : Consecutive patients with intracerebral haemorrhage admitted to two private hospitals were included in the study. They were assessed prospectively during the hospital stay using a protocol. Diagnosis of intracerebral haemorrhage was made by CT scanning. Abstracts/SLMA Sessions 1998 RESULTS : Of the 49, 43 had intracerebral haemorrhage and 6 had subarachnoid haemorrhage. 31were males and 18 were females. Age ranged from 34 to 92 years. Distribution of the intra cerebral haemorrhage was as follows. Basal ganglia 30. lobar 5, massive supratentorial 04, celebellar 01, unknown 3. Of the basal ganglia haemorrhage 20 were putaminal, 8 were thalamic, 2 were caudate. 9 had in addition intra ventricular haemorrhage. 19(44%) patients were known hypertensives and 9 had diabetes mellitus. Of the patients with intracerebral haemorrhage, 06 were unconscious. 20 were drowsy and 17 were alert on admission. Of the subarachnoid haemorrhages 1 was unconsious and 5 were drowsy. In- hospital mortality for intracerebral haemorrhage was 30% and for sub-arachnoid haemorrhage was 83%. CONCLUSIONS : Intra cerebral haemorrhage is a important cause of morbidity and mortality in hospitalised patients. 30% mortality is low when compared to other countries. Hypertension is an important risk factor and measures should be taken to improve detection and treatment of hypertension.Item Incidence and risk factors for Non-Alcoholic Fatty Liver Disease in an urban, adult Sri Lankan population – a community cohort follow-up study(Sage Publishing, 2015) Niriella, M.; Kasturiratne, A.; de Silva, S.; Perera, R.; Subasinghe, C.; Kodisinghe, K.; Priyantha, C.; Rishikeshavan, V.; Dassanayake, A.; de Silva, A.; Pathmeswaran, A.; Kato, N.; de Silva, H.J.INTRODUCTION: We previously reported a community prevalence of 33% for NAFLD in an urban, adult Sri Lankan population. We also found a significant association between patatin-like phospholipase domain containing 3 (PNPLA3) gene rs738409 polymorphism, and susceptibility to NAFLD in the same population, after testing 10 selected single nucleotide polymorphisms (SNPs) in a case control study. AIMS & METHODS: The aim of this study was to assess the incidence and risk factors for NAFLD in this population after seven years of follow-up. The study population consisted of 42-71-year-old adults, originally selected by age stratified random sampling from electoral lists from Ragama, Sri Lanka. The target population was screened initially in 2007 and subsequently invited back for re-evaluation in 2014. On both occasions they were assessed using a structured interview, clinical and anthropometric measurements, liver ultrasound, and biochemical and serological tests. NAFLD was diagnosed on established ultrasound criteria for fatty liver (two out of three criteria: increased echogenecity of the liver compared to kidney and spleen, obliteration of the vascular architecture of the liver and deep attenuation of the ultrasonic signal), safe alcohol consumption (Asian standards: 514 units/week for men, 57 units/week for females) and absence of hepatitis B and C markers. Non-NAFLD controls were defined as subjects who did not have any of the ultrasound criteria for NAFLD. We also performed an updated case-control study to investigate associations of selected genetic variants with incident NAFLD [SNPs: PNPLA3 (rs738409), LYPLAL1 (rs12137855), GCKR (rs780094), PPP1R3B (rs4240624) and NCAN (rs2228603), APOC3 (rs2854117 and rs2854116), ADIPOR2 (rs767870) and STAT3 (rs6503695 and rs9891119)]. RESULTS: Of the 2985 original study participants, 2155 (72.2%) (1244 women and 911 men; mean age 59.2 years [SD, 7.7]) participated in the follow-up assessment. 1322 [mean age 58.9 years (SD, 7.6), 483 (53.0%) men and 839 (67.4%) women] had NAFLD. Out of 795 [466 (58.6%) women] participants who did not have NAFLD in the original study, 365 [226 (61.9%) women, mean age 58.6 years (SD, 7.9)] had developed NAFLD after 7 years, giving an annual incidence rate 6.6%. On multivariate analysis, increased waist circumference [OR 1.96(1.30 – 2.97), p=0.001], BMI4 23 kg/m2 [OR 2.93(1.99 – 4.30), p50.001] and raised plasma triglycerides (TG) [OR 1.49(1.03 – 2.13), p=0.03] were independently predictive of incident NAFLD in this cohort, while raised BP and reduced HDL, were not. In the updated association study involving 1310 cases and 427 controls, we found borderline association with NAFLD at two of the 10 candidate loci: rs4240624 at PPP1R3B and rs738409 at PNPLA3 (one-tailed P=0.044 and 0.033, respectively). CONCLUSION: In this community cohort follow-up study in an urban, adult population in Sri Lanka, the annual incidence of NAFLD was 6.6%. Incident NAFLD was associated with features of the metabolic syndrome, and showed tendency of association at PNPLA3 and PPP1R3B gene polymorphisms. Disclosure of Interest: None declaredItem Prevalence of functional constipation in infants and toddlers in Sri Lanka.(Lippincott Williams & Wilkins, 2015) Walter, H.A.; Hovenkamp, A.; Rajindrajith, S.; Devanarayana, N.M.; Rajapakshe, N.N.; Benninga, M.A.OBJECTIVE: To determine the prevalence of functional constipation (FC) in toddlers in Sri Lanka and to identify risk factors associated with the development of FC, such as demographic features, social and economic factors. METHODS: Children between 7 months and 5 years of age were selected from 14 well baby and vaccination clinics in the Gampaha District, Sri Lanka. Data were collected using a self-administered questionnaire. The questionnaire contained questions regarding the child's bowel habits, socio-demographic characteristics as well as physical and verbal violence against mother and/or child. Functional constipation was diagnosed according to ROMEIII criteria. RESULTS: A total of 1151 toddlers were included in the analysis, (female n = 588 [50,8%], mean age 21,7 months, standard deviation [SD] 12,5 months). A total of, 92 children (8,0%) fulfilled the Rome III criteria for FC. The prevalence of constipation was significantly and independently associated with first birth order (9,6% vs. 6,5% p = 0,026), underweight [<2SD] (15,0% vs. 7,1%, p = 0,004) and living in an urban residence (9,5% vs. 5,8%, p = 0,023). Odds ratios [OR] and 95% confidence intervals [CI] are were respectively 1,61 (CI; 1,02-2,53), 2,53 (CI; 1,45-4,41), 1,70 (CI; 1,08-2,69). Toddlers being overweight, being subject to violence or with mothers subject to violence illustrated higher prevalence of FC, but p-values were >0,05. No association was found with gender, age, parental age, parental education level, shortage in income and quality of relationship between parents. CONCLUSIONS: Functional constipation is a significant health problem in toddlers in Sri Lanka, concerning 8 percent of its population between 7 months and 5 years old. Toddlers being first born, underweight and living in an urban area show a significant higher risk for FC.Item Infant dyschezia in Sri lankan children: epidemiology and risk factors(Lippincott Williams & Wilkins, 2015) Hovenkamp, A.; Walter, H. A.; Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.OBJECTIVES: Little is known regarding functional gastrointestinal diseases in infants, especially in developing countries. Our aim was to assess the prevalence of infant dyschezia in relation to bowel habits and sociodemographic factors in a representative community sample in Sri Lanka. METHODS: A multicenter cross-sectional study was conducted among mothers of 0 -7-month-old infants, attending 14 growth monitoring and immunization clinics in Gampaha District, Sri Lanka. A self-administered questionnaire was used to determine gastrointestinal symptoms, the infant's bowel habits and sociodemographic characteristics for a total of 1004 infants. The questionnaire was translated to the native language (Sinhala) and pretested. Infant colic and infant dyschezia were diagnosed according to the Rome III criteria. RESULTS: The prevalence of infant dyschezia in Sri Lanka was 4.3%. An infant was more likely to suffer from infant dyschezia if he or she was formula-fed (9.6% vs. 7.8% in breast fed and 4.2% in those on additional foods, P = 0.025) or had a highly educated father (mean years of education 13.5 [SD 4.0] vs. 12.3 [SD 2.6] in unaffected children, P = 0.005). No significant association was found between infant dyschezia and age, sex, gestational age, birth order, birth weight, current weight, and presence of domestic violence (P > 0.05). CONCLUSIONS: Infant dyschezia is a significant health problem in Sri Lanka affecting approximately 4.3% of healthy infants. Infants with infant dyschezia are more likely to be formula-fed and have a highly educated father.Item Prevalence and risk factors for metabolic syndrome among aging adults in an urban Sri Lankan population(Sri Lanka Medical Association, 2015) Kasturiratne, K.T.A.A.; Niriella, M.A.; de Silva, S.T.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Piyaratna, T.A.C.L.; Vithiya, K.; Kottachchi, D.; Ranawaka, U.K.; Jayasinghe, C.; Rajindrajith, S.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: Metabolic syndrome (MetS) is assumed to be of high prevalence in the Asian region. However, its community prevalence and risk factors in South Asia is poorly studied. We determined the prevalence and risk factors for MetS among adults in an urban Sri Lankan population. METHOD: The study population consisted of 42-71 year old adults, selected by stratified random sampling from the Ragama Medical Officer of Health area. MetS was defined by the International Diabetic Federation criteria with ethnic specific cutoffs. Anthropometric measurements, blood pressure (BP) and body fat distribution estimates were made. Glycosylated hemoglobin, fasting serum lipids, serum alanine aminotransferase (ALT) and serum creatinine (SCr) with estimated glomerular filtration rate (eGFR) were determined. CKD was defined as GFR<60ml/min/1.72m2 (KDIGO/KDOQI classification), USS abdomen was performed to detect fatty liver and non-alcoholic fatty liver disease (NAFLD) was diagnosed on safe alcohol consumption (< 14 units/week for men, < 7 units/week for females) and absence of hepatitis B and C markers. RESULTS: 2155 (1244 [57.7%] women, mean age 59.2 years [SD, 7.7]) participated. 1014 (47.1%) [mean age 59.2 years (SD, 7.7), 256 (28.1%) men; 758 (60.9%) women] had MetS. On multivariate analysis female gender, abnormal total body fat and abnormal visceral fat level (>10%) and presence of NAFLD were independently associated with MetS. Age 65 or more, raised ALT and CKD were not associated with MetS. CONCLUSION: The prevalence of MetS among adults in this aging urban Sri Lankan community was high and is independently associated with female gender, abnormal body fat distribution and presence NAFLD.Item Prevalence and risk factors for Non-Alcoholic Fatty Liver Disease among an urban aging adult Sri Lankan population – Ragama Health Study 7-year follow up(Sri Lanka Medical Association, 2015) Niriella, M.A.; Kasturiratne, A.; de Silva, S.T.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Priyantha, T.A.C.L.; Vithiya, K.; Kottachchi, D.; Ranawaka, U.K.; Jayasinghe, Y.C.; Rajindrajith, S.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: A previous community based study reported a prevalence of 33% for non-alcoholic fatty liver disease (NAFLD) among and urban adult Sri Lankan population. In this follow up study of the same population after 7 years, e reassessed the prevalence and risk factors for NAFLD. METHODS: The study population consisted of 42-71 year old adults, originally selected by stratified random sampling. NAFLD was diagnosed on established ultrasound criteria for fatty liver, safe alcohol consumption (<14 units/week for men, <7 units/week for females) and absence of hepatitis B and C markers. Anthropometric measurements, blood pressure (BP) and body fat distribution estimates were made. HbA1c, fasting serum lipids, serum alanine aminotransferase (ALT) and serum creatinine (SCr) with estimated glomerular filtration rate (eGFR) were determined. CKD was defined as eGFR<60ml/min/1.72m2 (KDIGO/KDOQI classification). RESULTS: of the 2985 original study participants, 2155(72.2%) (1244[57.7%] women, mean age 59.2 years [SD, 7.7]) participated in the present study. 1322 [mean age 58.9 years (SD, 7.6), 483(53.0%) men and 839(67.4%) women] had NAFLD. On multivariate analysis, obesity, abnormal body fat distribution, elevated systolic BP, raised plasma triglycerides, and low HDL were independently associated wth NAFLD. Raised diastolic BP, raised HbA1c, raised ALT and presence of CKD were not associated with NAFLD. CONCLUSION: The prevalence of NAFLD among adults in this aging urban Sri Lankan community has increased over 7 years and is independently associated with constituent features of the metabolic syndrome.