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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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 Metformin: use as a pharmacological agent in management of childhood obesity(Sri Lanka Medical Association, 2016) Warnakulasuriya, L.S.; Fernando, M.A.M.; Adikaram, A.V.N.; Thawfeek, A.R.M.; Anurasiri, W.M.L.; Silva, K.D.R.R.; Sirasa, M.S.F.; Samaranayake, D.; Wickramasinghe, V.P.INTRODUCTION: Childhood obesity-related metabolic derangements are increasing among South Asian populations. Dietary and physical activity plans have limited effect. OBJECTIVES: This study aims to assess effectiveness of metformin against placebo in management of childhood obesity among 8-16 year-old children in Gampaha District. METHOD: A triple-blinded control trial was conducted in a sample of 150 obese school children. After 12-hour overnight fast, blood was drawn for fasting blood glucose (FBS) and lipid profile. 2-hour OGTT was done. Anthropometry, fat mass (FM) and blood pressure were measured. Children randomly received either age-adjusted dose of metformin or placebo, with advice on diet and physical activity. Anthropometry and blood investigations were repeated at 6 and 12 months. Mean difference in outcome measures, adjusted for baseline values were compared between the two groups using ANOVA. RESULTS: There were 84/150 boys and 25 (16.7%) had metabolic syndrome. A statistically significant adjusted mean reduction was observed in metformin group compared to placebo, in weight (-0.991 vs 1.394, p=0.000), BMI-SDS (-0.287 vs -0.116, p=0.000), percentage FM-SDS (-0.092 vs 0.016, p=0.04), systolic BP (-0.415 vs 0.015, p=0.015), total cholesterol (-36.48 vs -27.32, p=0.001), LDL (-26.06 vs -17.22, p=0.001) and hsCRP(-0.143 vs 0.008, p=0.013) at six months, and in BMI-SDS (-370 vs -0.222, p=0.001), WC-SDS (-0.473 vs -0.337, p=0.018), systolic BP (-0.834 vs -0.477, p=0.023) and triglycerides (-29.30 vs-12,72, p=0.019) at 12 months. CONCLUSIONS: Metformin compared to placebo has beneficial effects on anthropometric and metabolic indicators in the management of childhood obesity.Item Bordete//a pertussis specific Immunoglobulin G antibody levels among asymptomatic individuals aged 4-24 years admitted to two selected hospitals in Sri Lanka(Sri Lanka College of Microbiologists, 2015) Sigera, L.S.M.; Perera, J.; Samaranayake, D.; Ediriweera, E.P.D.S.INTRODUCTION: Pertussis continues to circulate in the community and cases among adolescents and adults have been increasing. Waning of pertussis-specific immunity following natural infection or immunisation may contribute to the persistent circulation. Even though it is not included in the extended programme of immunization in Sri Lanka, the booster doses including the adolescent booster dose of dTap, (acellular pertussis) are included into the list of recommended immunizations in several countries. Even though the protective titre yet not established, information on immunity to pertussis in this age group is needed before any vaccination policy can be considered. OBJECTIVES: To determine the antibody levels against pertussis toxin to determine the need and the optimal age for booster immunization. METHODS: The quantitative determination of specific IgG antibodies to Bordetella pertussis toxin was done by the ELISA using sera of 385 asymptomatic individuals aged 4-24 years admitted to surgical units of Lady Ridgeway Hospital, Colombo and Colombo South Teaching Hospital, Kalubowila. Mann-Whitney U test and Kruskal-Wallis test were used in analysis and p<0.05 was taken as significant. RESULTS: Median age was 12 years (IQR 8-19) with 212 (55.1 %) females. The median (IQR) anti PT antibody level was 3.31 lU/ml (0.73-15.12) and 352 (91%) had anti PT level <55 ID/ml. Median {IQR) anti PT levels were 3.18 ILJ/ml (0.591 -8.00) for 4-7 years, 1.43 Ill/ml (0.336-6.27) for 8-11 years, 4.28 lU/ml (0.978-13.39) for 12-15 years, 6.14 lU/ml (1.44-63.25) for 16-19 years and 4.89 lU/ml {1.11 -16.78) for 20-24 years and all of these difference were statistically significant (Spearman Correlation Coefficient P=0.0121). Females (p<0.003) and those having a sibling above 12 years (p=0.017) had significantly higher anti PT lev els. CONCLUSION: The majority of the study population, especially 8 to 11 years age group had very low anti PT IgG levels. The infection may occur in early adolescents, A booster dose of acellular pertussis vaccine could be considered.Item Bordetella pertussis serological profile among asymptomatic individuals aged 4-24 years.(Sri Lanka Medical Association, 2014) Sigera, L.S.M.; Perera, J.; Samaranayake, D.; Ediriweera, E.P.D.S.INTRODUCTION AND OBJECTIVES: To determine the antibody levels against pertussis toxin to determine the need and the optimal age for booster immunization. METHODS: The quantitative determination of specific IgG antibodies to Bordetellajiertussistox'm was done by the ELISA using sera of 385 asymptomatic individuals aged 4 -24 years admitted to surgical units of Lady Ridgeway Hospital, Colombo and Colombo South Teaching Hospital, Kalubowila. Mann-Whitney U test and Kruskal-Waliis test were used in analysis and p<0.05 was taken as significant. RESULTS: Median age was 12 years {IQR 8-19) with 212 (55.1%) females. The median (1QR) anti PT antibody level was 3.31 lu/ml (0.73-15.12) and 352 (91%) had anti PT level <55 lU/ml. Median {IQR) anti PT levels were 3.18 ILJ/ml (0.591-8.00) for 4-7 years, 1.43 lU/ml (0.336-6.27) for 8-11 years, 4.28 lU/ml (0.978-13.39) for 12-15 years,6.14 lU/ml (1.44-63.25) for 16-19 years and 4.89 lU/ml (1.11-16.78) for 20-24 years and this difference was statistically significant (p=0.000). Females (p<0.003) and those having a sibling above 12 years (p=0.017) had significantly higher anti PT levels. CONCLUSIONS: The majority of the study population, especially 8 to 11 years age group had very low anti PT IgG levels. The infection may occur in early adolescents. A booster dose of acellular pertussis vaccine could be considered.