Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Physical activity tracking among Sri Lankan adults: findings from a 7-year follow-up of the Ragama Health Study(SAGE Publications, 2021) Pinidiyapathirage, J.; Kasturiratne, A.; Bennie, J.A.; Pathmeswaran, A.; Biddle, S.J.H.; de Silva, H.J.; Chackrewarthy, S.; Dassanayake, A.S.; Ranawaka, U.; Kato, N.; Wickremasinghe, A.R.ABSTRACT: Limited data are available on physical activity tracking among adults in low- and middle-income countries. Using a longitudinal design, we assessed trends and correlates of physical activity among Sri Lankan adults. Individuals selected through age-stratified random sampling, were screened initially in 2007 (n = 2986) and reevaluated in 2014 (n = 2148). On both occasions, structured interviews and clinical measurements were completed. Approximately 40% of the participants engaged in recommended levels of physical activity both at baseline and follow-up. One-fifth reported increased physical activity at follow-up, a similar proportion reported being persistently inactive or a reduction in physical activity. In the adjusted analysis, being persistently active was associated with male sex, a lower educational level and income, being free of any chronic disease conditions, better self-rated health, and sitting time <8 hours. Our findings support public health interventions to help maintain recommended physical activity levels over time, particularly for subgroups at high-risk of physical inactivity. KEYWORDS: Sri Lanka; lower middle-income countries; non-communicable diseases; physical activity; population studies.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 Metabolic syndrome in the Ragama Health Study: definitions and controversies(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Chackrewarthy, S.Although there is agreement that the Metabolic Syndrome (MetS) is a major public health challenge worldwide and consistent evidence stresses the need for intervention, the definition of the syndrome remains a matter of debate. Currently, several different definitions of MetS exist which share several features but also include important differences and limitations. Prevalence of MetS in the RHS was estimated using the two most widely used definitions of MetS: International Diabetes Federation (IDF) and revised National Cholesterol Education Program Adult Treatment Panel III (revised NCEP ATP III). Age and sex-adjusted prevalences of MetS in the RHS were 46.1% and 38.9% by revised NCEP and IDF definitions, respectively. IDF criteria failed to identify 21% of men and 7% of women identified by the revised NCEP criteria. The discrepant group had more adverse metabolic profiles despite having a lower waist circumference than those diagnosed by both criteria. This discrepancy was mainly caused by waist circumference criterion which is a prerequisite for the diagnosis of MetS based on IDF definition. In contrast, the revised NCEP definition considers abdominal obesity as one of the equally weighted criteria. The discrepant group in our study included a metabolically obese, normal weight (MONW) group of individuals who are predisposed to diabetes and CVD like people with overt obesity. MONW individuals are common in the general population and they probably represent one end of the spectrum with MetS. The study highlights the need for a unified definition of MetS which would identify individuals with an increased risk of diabetes and CVD.Item Vitamin D status and its association with serum parathyroid hormone in preschool children in a Sri Lankan Community(Sri Lanka Medical Assosiation, 2012) Marasinghe, E.; Chackrewarthy, S.; Abeysena, H.T.C.S.; Rajindrajith, S.INTRODUCTION: Despite increased awareness of the adverse health effects of low vitamin D status, data on serum vitamin D status of Sri Lankan preschool children is scarce. AIMS: To investigate the vitamin D status and its association with serum parathyroid hormone in preschool children in a community in the Ragama MOH area. METHODS: In a cross sectional study a total of 340 children (172 girls and 168 boys) aged 2-5 years were selected by random sampling. Fasting levels of serum vitamin D [as 25(OH)DJ and parathyroid hormone (PTH) were determined. The anthropometric characteristics of the children were measured using calibrated equipment. Statistical analysis was performed using SPSS 16.0. RESULTS: The mean fasting 25(OH)D and PTH concentrations were 23.47+8.9 ng/ml and 28.2±17.6 pg/ml respectively. 5.6% and 32.4% of the children had 25(OH)D concentrations indicative of vitamin D deficiency (<10 ng/ml) and insufficiency (10 - 20 ng/ml) respectively. 6% of the children were stunted and prevalence of wasting and" underweight were 17% and 14% respectively. Prevalence of stunting was significantly higher in girls (p<0.05J. Linear regression analysis showed a.significant inverse association between serum levels of 25(OH)D and PTH (r = -0.226, p<0.02). Intake of milk and diary foods had a positive association with 25(OH)D levels although statistically insignificant (r = 0.224, p>0.05). CONCLUSIONS: This study highlights the presence of sub-optimal vitamin D status in preschool children in a tropical country. Inverse changes in PTH may deleteriously affect skeletal development and growth. The need for appropriate interventions to optimise vitamin D status is emphasized.Item Effects of white coconut oil, virgin coconut oil and grated coconut on blood glucose and serum lipids in Wistar rats(Sri Lanka Medical Association, 2015) Samaranayake, H.A.E.; Chackrewarthy, S.; Karunakaran, R.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: This study investigated the effects of white coconut oil (WCO), virgin coconut oil (VCO) and grated coconut on blood glucose and serum lipids in Wistar rats. METHOD: Four groups of male Wistar rats (1-4) were maintained on four isocaloric test diets, containing WCO, VCO, WCO + grated coconut (1:1 ratio) and VCO + grated coconut (1:1 ratio) respectively. After 36 weeks of feeding blood glucose and serum lipids were assayed. Results were analysed using SPSS version 16.0. RESULTS: Compared with the baseline levels, mean blood glucose levels decreased in all four groups; -13.87, -7.22, -41.88, and -41.85 mg/dt respectively. Rats fed with mixtures of oil and grated coconut (groups 3 and 4) showed a significantly higher decrease in blood sugar (p<0.05) compared with diets containing oil only (groups 1 and 2). No significant differences (p>0.05) in blood sugar levels were observed between groups fed with diets containing oil only or between groups fed with diets containing mixtures of oii+ grated coconut. Compared with baseline levels, mean differences in serum total cholesterol (TC) were 9.05, -8.08, 6.11,1.65 mg/dl, triglycerides -31.1, -20.75, -30.5, -49.8 mg/d! and high density lipoproteins (HDL) -1.47, 8.32, 0.816, -10.82 mg/dl in groups 1-4 respectively. Although statistically not significant, lower TC and higher HDL levels were observed in rats fed with VCO containing diet. CONCLUSION: Inclusion of grated coconut in the diet results in significant hypoglyceamic action. Although statistically not significant VCO may have beneficial effects on serum lipids which warrants further investigation.Item Cardiovascular risk profile of the estate population of Sri Lanka(Sri Lanka Medical Association, 2010) Pinidiyapathirage, M.J.; Chackrewarthy, S.; Perera, P.S.; Wijayasinghe, Y.S.; Williams, S.; Williams, S.S.; Kato, N.; Wickremasinghe, A.R.OBJECTIVES: To estimate the prevalence of biochemical and anthropometric risk markers of cardiovascular diseases in the estate population of Sri Lanka. METHODS: Using a cross sectional design, consenting adults aged 35-64 years resident in 3 selected estates in the Nuwara-Eliya District were recruited with the support of estate medical assistants and welfare officers. AH participants were subjected to an interview, blood pressure and anthropometric measurements and collection of fasting blood samples. RESULTS: Of the 401 participants recruited, 53% were females and 99% were cither Indian or Sri Lankan Tamils. The mean age of the participants was 50.3 years (SD 8.5). 47 (12%) participants had a BMI >25, 8 (2%) a BMI >30. 29 males (15%) and 29 females (14%) had a waist circumference [WC] >90cm and >80 cm, respectively. 151 (38%) participants had systolic blood pressure (SBP) > 140mmHg , 127 (32%) had diastolic blood pressure (DBF) > 90mmHg and 170 (42%) had either SBF > 140 or DBF > 90. 41(10%) participants had fasting blood glucose (FBG) >126mg/dL. In 197 (49%) participants, some form of dyslipidaemia was present. Males had a significantly higher mean BMI, FBG and triglyceride (TG) level and a significantly lower high density lipoprotein (HDL) level as compared to females. CONCLUSIONS: Obesity, as defined by BMI or WC, was low in this population as compared to other reported studies from different population groups in the country. But prevalence of hypertension and dyslipidaemia (especially high TG and low HDL levels in males) was high.Item Association between serum homocysteine and markers of insulin resistance(Sri Lanka Medical Association, 2010) Chackrewarthy, S.; Wijayasinghe, Y.S.; Gunasekara, D.; Wickremasinghe, A.R.; Kato, N.OBJECTIVE: To investigate the association between serum homocysteine and markers of insulin resistance in a Sri Lankan population. Similar studies conducted in other ethnic groups have shown conflicting results. METHODS: 177 apparently healthy volunteers (91 men and 86 women) aged 35-65 years were randomly selected from residents in the Ragama MOH area. Anthropometric indices and blood pressure were measured and information on diet, lifestyle factors and medical history were recorded. Fasting plasma glucose and serum levels of homocysteine, insulin, creatinine, folate and lipid profiles were determined using standard protocols. RESULTS: Mean fasting serum homocysteine levels were higher in males compared to females (14.67 (imol/1 ± 6.02 Vs.10.16 u.mol/1 ± 4.28, pItem Evaluation of the hypoglycemic and hypolipidemic effects of an ethylacetate fraction of Artocarpus heterophyllus (jak) leaves in streptozotocin-induced diabetic rats(Medknow Publications, 2010) Chackrewarthy, S.; Thabrew, M.I.; Weerasuriya, M.K.; Jayasekera, S.Aqueous extracts of mature leaves of Artocarpus heterophyllus (jak) are used by traditional medical practitioners in Sri Lanka and India for the treatment of diabetes. This study was conducted to investigate the hypoglycemic and hypolipidemic effects of an ethylacetate (EA) fraction of the mature leaves of A. heterophyllus in a streptozotocin (STZ) induced diabetic rat model. In normoglycemic rats, administration of a single dose (20 mg/kg) of the EA fraction resulted in a significant (P < 0.05) reduction in the fasting blood glucose concentration and a significant improvement in glucose tolerance (P < 0.05), compared to the controls. In STZ-induced diabetic rats, chronic administration of the EA fraction of A. heterophyllus leaves daily for 5 weeks resulted in a significant lowering of serum glucose, cholesterol and triglyceride (TG) levels. Compared to control diabetic rats, the extract-treated rats had 39% less serum glucose, 23% lower serum total cholesterol and 40% lower serum TG levels and 11% higher body weight at the end of the fifth week. The percentage reductions in the serum parameters mediated by the test fraction were comparable with those produced by glibenclamide (0.6 mg/kg), the reference drug used in this study. It can be concluded that the EA fraction of A. heterophyllus leaves contains one or more hypoglycemic and hypolipidemic principles which have the potential to be developed further for the treatment of diabetes specifically associated with a hyperlipidemic stateItem Common variants at the GCK, GCKR, G6PC2-ABCB11 andMTNR1B loci are associated with fasting glucose in two Asian populations(Springer-Verlag, 2010) Takeuchi, F.; Katsuya, T.; Chackrewarthy, S.; Yamamoto, K.; Fujioka, A.; Serizawa, M.; Fujisawa, T.; Nakashima, E.; Ohnaka, K.; Ikegami, H.; Sugiyama, T.; Nabika, T.; Kasturiratne, A.; Yamaguchi, S.; Kono, S.; Takayanagi, R.; Yamori, Y.; Kobayashi, S.; Ogihara, T.; de Silva, A.; Wickremasinghe, R.; Kato, N.Item Prevalence and risk factors for non-alcoholic fatty liver disease among adults in an urban Sri Lankan population(Wiley-Blackwell, 2009) Dassanayake, A.S.; Kasturiratne, A.; Rajindrajith, S.; Kalubowila, U.; Chackrewarthy, S.; de Silva, A.P.; Makaya, M.; Mizoue, T.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.BACKGROUND AND AIMS: Non-alcoholic fatty liver disease (NAFLD) is an emerging problem in the Asia-Pacific region. However, its prevalence and risk factors in Asian (especially South Asian) communities is poorly studied. In this study, the aim was to determine the community prevalence and risk factors for NAFLD among adults in an urban Sri Lankan population. METHODS: The study population consisted of 35-64-year-old adults, 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. Blood pressure (BP) and anthropometric measurements were made, and fasting glucose, glycosylated hemoglobin, serum lipids, fasting serum insulin and serum alanine aminotransferase (ALT) were determined. RESULTS: Of the 2985 study participants, 974 (32.6%) had NAFLD (605 [62.1%] women, mean age 52.8 years [standard deviation, 7.3]). On multivariate analysis, obesity, acanthosis nigricans, insulin resistance, elevated diastolic BP, fasting plasma glucose, plasma triglycerides, and ALT twice the upper limit of the reference range or more were independently associated with NAFLD. CONCLUSION: The prevalence of NAFLD among adults in this urban Sri Lankan community is high and is strongly associated with constituent features of the metabolic syndrome.