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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Relationship between objectively measured physical activity, sedentary behaviour and body mass index among 11-13 year-old adolescents in Colombo(Sri Lanka Medical Association., 2019) Dabare, H.P.M.; Waidyatilaka, P.H.I.U.; de Lanerolle-Dias, M.; Wickremasinghe, R.; Jayawardena, R.; Hills, A.P.; Lanerolle, P.; Wickramasinghe, V.P.INTRODUCTION & OBJECTIVES: Inadequate physical activity (PA) and sedentary behaviour (SB) are attributed to the high prevalence of adolescent obesity in the world. This study aimed to identify the relationship between PA intensity, SB and body mass index (BMI) among I I -13 year-old adolescents in Colombo, Sri Lanka. METHODS: A purposive sample of 95 adolescent school girls and boys were recruited from the Colombo Municipal Council Area. Time spent on moderate-to-vigorous PA (MVPA) and SB were determined by accelerometers (Actigraph-WGT3X-BT) worn on the waist for 10 consecutive days. Height and weight were measured using the standard methodology and BMI was calculated. RESULTS: The sample consisted of 51.6 % of boys (n=49). Mean BMI of the boys was 17.2 ± 3.2 kgm-2 and girls was 17.2 ± 3.2 kgm-2. A significantly (p< 0.05) lower SB (487.4 ± 101.4 min/day vs. 596.4 ± 83.8 min/day) and a significantly higher time spent on MVPA (31.8 ± 15.1 min/day vs. 15 ± 6.7 min/day) were observed among normal weight (NW) girls compared to overweight (OW) girls. Similarly, compared to the OW boys, NW boys had a significantly (p< 0.05) lower SB (578.5 ± 94.1 min/day vs. 696.4 ± 87.4 min/day) and a significantly higher time spent in MVPA (52.9 ± 19.3 min/day vs. 23.4 ± 6.3 min/day). CONCLUSION: Effective strategies should be implemented to reduce SB and increase PA in order to correct the obsogenic behaviour among the adolescents.Item Association between early weight gain and later adiposity in Sri Lankan adolescents(Cambridge University Press., 2021) Samaranayake, D.; Lanerolle, P.; Waidyatilaka, I.; de Lanerolle-Dias, M.; Hills, A. P.; Wickremasinghe, A.R.; Wickramasinghe, V.P.ABSTRACT: Early growth pattern is increasingly recognized as a determinant of later obesity. This study aimed to identify the association between weight gain in early life and anthropometry, adiposity, leptin, and fasting insulin levels in adolescence. A cross-sectional study was conducted in 366 school children aged 11-13 years. Weight, height, and waist circumference (WC) were measured. Fat mass (FM) was assessed using bioelectrical impedance analysis. Blood was drawn after a 12-h fast for insulin and leptin assay. Birth weight and weight at 6 months and at 18 months were extracted from Child Health Development Records. An increase in weight SD score (SDS) by ≥0.67 was defined as accelerated weight gain. Linear mixed-effects modeling was used to predict anthropometry, adiposity, and metabolic outcomes using sex, pubertal status, accelerated weight gain as fixed factors; age, birth weight, and family income as fixed covariates, and school as a random factor. Children with accelerated weight gain between birth and 18 months had significantly higher body mass index (BMI) SDS, WC SDS, height SDS, %FM, fat mass index (FMI), fat free mass index (FFMI), and serum leptin levels in adolescence. Accelerated weight gain between 6 and 18 months was associated with higher BMI SDS, WC SDS, %FM, and FMI, but not with height SDS or FFMI. Accelerated weight gain at 0-6 months, in children with low birth weight, was associated with higher height SDS, BMI SDS, WC SDS, %FM, and FMI; in children with normal birth weight, it was associated with BMI SDS, WC SDS, height SDS, and FFMI, but not with %FM or FMI. Effects of accelerated weight gain in early life on anthropometry and adiposity in adolescence varied in different growth windows. Accelerated weight gain during 6-18 months was associated with higher FM rather than linear growth. Effects of accelerated weight gain between 0 and 6 months varied with birth weight. KEYWORDS: Early accelerated growth; adiposity; adolescence; birth weight; insulin; leptin; obesity.Item Develepment and validation of a BIA prediction equation for 11-13 year old Sri Lankan girls(Sri Lanka Medical Association, 2018) Samaranayake, D.; Dabare, H. P. M.; de Lanerolle-Dias, M.; Waidyatilaka, I.; Jayawardena, R.; Hills, A. P.; Wickremasinghe, A.R.; Lanerolle, P.; Wickramasinghe, V.P.INTRODUCTION AND OBJECTIVES: Population-specific measures of body composition are important in management of childhood obesity. This study aimed to develop and validate a bioelectrical impedance analysis (BIA) equation to assess total body water (TBW) and fat mass (FM) in Sri Lankan girls aged 11-13 years. METHODS: Forty-six 11-13 year-old healthy school girls were purposively selected and randomly divided into model development (n=30) and model validation (n=l6) sub-samples. Weight, height and impedance using BIA were measured. TBW was determined and FM was derived through the criterion Deuterium-dilution technique. Prediction equations for TBW and FM were developed using impedance index (heightvimpedance; cm2/Q), weight and height as independent variables. Final equations were developed combining the two sub-samples. Validity was assessed using correlation coefficients, paired-samples T-test and Bland-Altman plots. RESULTS: In the validation sample, predicted TBW and FM showed significant correlations and did not significantly differ from reference values, Final prediction equation for TBW had a R2 of 92.3% and RMSE of l.035 while FM prediction equation had a R2 of 94.3% and RMSE of 1.38. TBW predicted from new equation (19.48± 3.45kg) was not significantly different from reference TBW (19.52±3.65kg) and the two measures were significantly correlated (r=0.975, p<0.001). Similarly, predicted FM (10.41±4.39kg) was not significantly different from reference FM (10.38±4.74kg) and predicted and reference values were significantly correlated (r=0.974, p<0.001). In both prediction equations, the majority ofresiduals were within mean± l.96SD. CONCLUSION: Newly developed prediction equations for BIA assessment of TBW and FM show high validity compared to reference technique.Item Validity of BIA prediction equations in determining the fat mass of 11-13 year old Sri Lankan girls(Sri Lanka Medical Association, 2018) Samaranayake, D.; Dabare, H. P. M.; de Lanerolle-Dias, M.; Waidyatilaka, I.; Jayawardena, R.; Hills, A. P.; Wickremasinghe, A.R.; Wickramasinghe, V.P.; Lanerolle, P.INTRODUCTION AND OBJECTIVES: Bioelectrical impedance analysis (BIA) is a simple body composition assessment method, based on use of prediction equations. Validation of equations for the specific populations is important for accurate assessment. This study aimed to determine the validity of available BIA equations in assessing the fat mass (FM) in Sri Lankan girls aged 11-13 years. METHODS: Forty-six 11-13 year-old healthy school girls were purposively selected. Weight, height and impedance using BIA were measured. Total body water was determined and FM was derived through the criterion Deuterium dilution technique. Twelve BIA prediction equations applicable to the age and sex were identified from literature. Predicted FM calculated according to each equation was compared with reference FM (assessed through isotope dilution), and validity was assessed using correlation coefficients, paired samples T-test and Bland-Altman plots. RESULTS: FM predicted by all twelve equations was significantly correlated (r>0.93, p<0.05) with reference FM. Mean (±SD) bias of predicted FM ranged from -5.32 (±1.79) kg to 5.8 (±2.1 l) kg. Only four equations predicted mean FM values that were not significantly different from the mean reference FM values, the mean bias (±SD) ranging from -0.21 (±2.23) kg to 0.06 (±l.72) kg. Of these four prediction equations, only one had a symmetric, uniform distribution of error within the ±l .96 SD limits in the Bland-Altman analysis. CONCLUSION: Most available BIA prediction equations are unsatisfactory for use in the local context. Cross validation of existing prediction equations before use or development of BIA prediction equations to suit the local populations is recommended.Item Relationship between physical activity, sedentary behaviour and body composition among 11-13 year-old adolescent girls in Colombo(Sri Lanka Medical Association, 2018) Dabare, H. P. M.; Waidyatilaka, P.H.I.U.; de Lanerolle-Dias, M.; Wickremasinghe, R.; Jayawardena, R.; Hills, A.P.; Lanerolle, P.; Wickremasinghe, V.P.INTRODUCTION AND OBJECTIVES: Physical activity (PA) is essential in reducing the risk of obesity. This study aimed to identify the relationship between the intensity of PA and body composition among 11-13 year-old adolescent girls from Colombo, Sri Lanka. METHODS: This is part of a larger study. A purposive sample of 46 adolescent school girls were recruited from the Colombo Municipal Council area. Time spent on light (LPA), moderate (MPA), vigorous (VPA), moderate-to• vigorous (MVPA) PA and sedentary behaviour were determined by waist-worn accelerometers (Actigraph• WGT3X-BT). Deuterium dilution (gold standard) was used with Fourier Transform Infrared (Agilent 4500®) spectroscopy to assess fat mass (FM) and fat-free mass. The% FM cut-off of 33.7% for Sri Lankan children was used to categorize the sample into high fat (HF) and normal fat (NF) groups. RESULTS: The mean age was 12.3 ± 1 year. %FM was significantly correlated with sedentary behaviour (r = 0.65, p < 0.001) and negatively correlated with'Mvf'A duration (r = -0.4, p < 0.01). Time spent on VPA (15.8 ± 6.7 min/day vs. 7.6 ± 3.2 min/day) and MVPA (33.9 ± 13.3 min/da vs. 15.5 ± 7.5 min/day) were significantly (p <0.01) higher among the NF group compared to the HF group. The NF group had significantly (p < 0.01) lower sedentary behaviour (379.7 ± 135 min/day vs. 622.7 ± 105.3 min/day) compared to the HF group. CONCLUSION: %FM was higher among the adolescent girls who spent more time in sedentary behaviours and among those who spent less time engaged in MVPAItem 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 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