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- Abstract OBJECTIVE
- Abstract BACKGROUND
- Abstract OBJECTIVES
- Knowledge, Attitude and Practice Regarding Obesity among Patients, at Aga Khan University Hospital, Karachi.
- Ethnic Differences and Determinants of Diabetes and Central Obesity among South Asians of Pakistan.
- Abstract AIMS
|PARTICIPANTS: Of the original sample of 644 children aged 7-11, 511
children were tracked and measurements were obtained from 434 children
three years after baseline.
with four sessions of focused education promoting a healthy diet and
discouraging the consumption of carbonated drinks.
and waist circumference. Body mass index (BMI) converted to z scores (SD
scores) and to centile values with growth reference curves. Waist
circumference was also converted to z scores (SD scores).
RESULTS: At three years after baseline the age and sex specific BMI z
scores (SD scores) had increased in the control group by 0.10 (SD 0.53) but
decreased in the intervention group by -0.01 (SD 0.58), with a mean
difference of 0.10 (95% conﬁdence interval -0.00 to 0.21, P=0.06). The
prevalence of overweight increased in both the intervention and control
group at three years and the significant difference between the groups seen
at 12 months was no longer evident. The BMI increased in the control
group by 2.14 (SD 1.64) and the interven on group by 1.88 (SD 1.71), with
mean diﬀerence of 0.26 (-0.07 to 0.58, P= 0.12). The waist circumference
increased in both groups a er three years with a mean diﬀerence of 0.09 (-
0.06 to 0.26, P=0.25).
CONCLUSIONS: These longitudinal results show that after a simple year
long intervention the difference in prevalence of overweight in children
seen at 12 months was not sustained at three years.
J Pak Med Assoc. 2007 May;57(5):235-9.
Frequency of The Metabolic Syndrome in Adult Type 2
Diabetics Presenting to Pakistan Institute of Medical
Mohsin A, Zafar J, Nisar YB, Imran SM, Zaheer K, Khizar B, Qazi RA.
Department of General Medicine, The Children's Hospital, Pakistan Institute
of Medical Sciences, Islamabad.
OBJECTIVE: To determine the frequency of metabolic syndrome in both
genders, in a limited adult type 2 diabe c popula on presen ng to Pakistan
Institute of Medical Sciences, Islamabad.
teaching hospital. During the six months of study period, 106 adult type 2
diabetics were examined and evaluated for the presence of metabolic
syndrome according to the ATP-III criteria. Asian standards for the waist
circumference were used.
whom 95% were females. Abdominal obesity was present in 91% females
and 86% males. Low HDL levels were present in all females and 83% males.
Seventy eight percent females and 63% males had elevated levels of
triglycerides. Hypertension was present in 68% and 73% females and males
CONCLUSION: This study showed a very high prevalence of the metabolic
syndrome in type2 diabe c popula on. Females were more aﬀected than
males in all respects.
Crit Rev Food Sci Nutr. 2007;47(4):389-96.
Guar Gum: A Miracle Therapy for Hypercholesterolemia,
Hyperglycemia and Obesity.
Butt MS, Shahzadi N, Sharif MK, Nasir M.
Institute of Food Science and Technology, University of Agriculture,
Faisalabad 38040, Pakistan.
The number of hypercholesterolemic and hyperglycemic people is
increasing rapidly in the world. The prevention against these health
problems is related to a complex management of conventional and non-
conventional risk factors. The inclusion of dietary fiber in the diet is the
right approach to reduce these risks. Cholesterol and glucose lowering
effects are most often associated with gelling, mucilaginous, and viscous
fibers such as guar gum, an edible thickening agent. It has widespread
applications in the food industry due to its ability to hydrate without
heating. The demand for guar gum is still growing rapidly because in
addition to its indispensable role in lowering serum cholesterol and glucose
levels, it is also considered helpful in weight loss programs. The main thrust
of therapeutic and medicinal properties lies in the soluble dietary fiber
content of guar gum to improve the serum biochemical profile of human
and non-human primates, reducing total serum cholesterol, triglycerides,
increasing the high density lipoprotein cholesterol level, and the
management of glycemic indices and obesity. Among the various
intervention strategies, diet diversification is the right approach to
overcome these problems. Composite flours containing wheat and legumes
have proven practical uses and are being utilized in many parts of the world
to improve the nutritional and functional properties of flour. The main
focus of this manuscript is to review the available information on various
aspects of guar gum with special reference to its effectiveness in reducing
the cardiovascular disease risk, diabetes and weight loss programs.
CMAJ. 2006 Oct 24;175(9):1071-7.
Prevalence of Overweight and Obesity and Their
Association with Hypertension and Diabetes Mellitus in an
Jafar TH, Chaturvedi N, Pappas G.
Clinical Epidemiology Unit, Department of Community Health Sciences, Aga
Khan University, Karachi, Pakistan. firstname.lastname@example.org
BACKGROUND: The associations of body mass index (BMI) and chronic
disease may differ between Indo-Asian and Western populations. We used
Indo-Asian-specific definitions of overweight and obesity to determine the
prevalence of these problems in Pakistan and studied the sensitivity and
specificity of BMI cutoff values for an association with hypertension and
METHODS: We analyzed data for 8972 people aged 15 years or more from
the Na onal Health Survey of Pakistan (1990-1994). People considered
overweight or obese were those with a BMI of 23 kg/m2 or greater, and
those considered obese as having a BMI of 27 kg/m2 or greater. We built
multivariable models and performed logistic regression analysis.
general Pakistani population, was 25.0% (95% conﬁdence interval [CI]
21.8%-28.2%). The prevalence of obesity was 10.3% (95% CI 7.0%-13.2%).
The factors independently and significantly associated with overweight and
obesity included greater age, being female, urban residence, being literate,
and having a high (v. low) economic status and a high (v. low) intake of
meat. With receiver operating characteristic curves, we found that the use
of even lower BMI cutoﬀ values (21.2 and 22.1 kg/m2 for men and 21.2 and
22.9 kg/m2 for women) than those recommended for an Indo-Asian
population yielded the optimal areas under the curve for an association
with hypertension and diabetes, respectively.
classified as overweight or obese with the use of Indo-Asian-specific BMI
cutoff values. Optimal identification of those at risk of hypertension and
diabetes and healthy targets may require the use of even lower BMI cutoff
values than those already proposed for an Indo-Asian population.
J Pak Med Assoc. 2006 Sep;56(9):391-4.
Comparison of Adiponectin, Leptin and Blood Lipid Levels
in Normal and Obese Postmenopausal Women.
Jaleel F, Jaleel A, Rahman MA, Alam E.
Department of Biochemistry, Ziauddin Medical University, Karachi.
normal and obese postmenopausal women and to compare them.
METHODS: Eighty postmenopausal women were selected which included
40 normal controls and 40 obese women matched for age and height.
Adiponectin and leptin levels were determined by ELISA. Triglycerides,
cholesterol, LDL cholesterol and HDL cholesterol were determined by
standard kit methods using Clinicon 4010.
signiﬁcantly (P < 0.001) in obese women compared to controls. Similarly
triglycerides, cholesterol and LDL cholesterol were increased significantly (P
HDL cholesterol was observed in both groups. Significant correlation of
leptin with lipid profile was observed when both groups were combined.
increased significantly in obese women compared to controls. Significant
correlation exists between leptin and lipid profile in combined group.
J Pak Med Assoc. 2006 Jun;56(6):264-7.
Anthropometric Indices of Middle Socio-Economic Class
School Children in Karachi Compared with NCHS
Standards-A Pilot Study.
Aziz S, Puri DA, Hossain KZ, Hussain F, Naqvi SA, Rizvi SA.
Department of Paediatrics, Sindh Institute of Urology, Civil Hospital,
OBJECTIVE: To measure height and weight of school going children (2-18
years of age) in Karachi. By means of these parameters we were able to
document where the Pakistani paediatric population plot on NCHS growth
METHODS: A population based cross-sectional study (in government and
private schools, Karachi), in which height and weight were taken using
standardized techniques. Two thousand two hundred forty five healthy
school-going children 2 to 16 years of age (calculated from date of birth);
sex, height and weight were documented. After the survey was completed,
height and weight of the children were plotted on NCHS centiles curves.
RESULTS: P5, P25 and P50 cen les for height and weight of the Pakistani
girls and boys was much below that of NCHS. However, P95 for boys and
girls weight and height did not differ markedly in the Pakistani and NCHS
CONCLUSION: Height and weight of these children is below the NCHS
cen le for height and weight. Children plo ng near the P95 NCHS,
indicates that obesity may be a serious concern in our population. However,
further studies are required for support. This pilot study indicates the need
for development of centile charts for Pakistani paediatric population.
J Pak Med Assoc. 2006 Jun;56(6):267-72.
High Rates of Obesity and Cardiovascular Disease Risk
Factors in Lower Middle Class Community in Pakistan: The
Metroville Health Study.
Dennis B, Aziz K, She L, Faruqui AM, Davis CE, Manolio TA, Burke GL, Aziz S.
Department of Biostatistics, University of North Carolina, Chapel Hill, USA.
index, waist circumference and waist/ hip ratio, correlate obesity measures
to coronary heart disease risk factors in comparison to Pakistan National
METHODS: The Metroville Health Study (MHS) was an urban risk factor
reduction intervention study in Metroville Karachi. Base line data was used
which was not a random sample. Demographic data including serum
cholesterol, glucose, haemoglobin, and blood pressure were collected.
RESULTS: In MHS high cholesterol was 16% and 24% in men and women
respectively, and 25% had hypertension. Self-reported diabetes was 8%,
over-weight/obesity 34% and 49% for men and women, compared to 16%
and 25% for PNS, while high risk waist-hip ra o (WHR) was present in 41%
and 72% of men and women respec vely. Under-weight in Metroville men
was 12% and 9% in women, compared to 26% and 27% in PNS. The
anthropometry variables were significantly correlated with each other while
weight was significantly correlated with TC and waist circumference (WC).
CONCLUSION: Obesity was alarmingly prevalent in urban Metroville in
comparison to PNS. Cardio Vascular Disease (CVD) risk factors were
prevalent in Metroville and TC and WC were significantly correlated with
obesity measures. For prevention of increasing CVD in urban communities,
targeted programs of intervention are required.
J Pak Med Assoc. 2006 Feb;56(2):50-3.
Obesity Related Complica ons in 100 Obese Subjects and
Their Age Matched Controls.
Khurram M, Paracha SJ, Khar HT, Hasan Z.
Department of Medicine, DHQ Hospital, Rawalpindi Medical College, Rawalpindi.
METHODS: A case control study was conducted at Medical Unit of District
Headquarters Hospital, Rawalpindi for 6 months. Hundred obese subjects in
the age range 50-59 years and their age matched non-obese 100 controls
were included consecutively from general population. Obese subjects had
body mass index (BMI) >30Kg/m2. Controls had BMI of 18.5-22.9Kg/m2 and
normal waist hip ratio. Obesity related complications i.e., hypertension,
diabetes mellitus, ischemic heart disease, stroke, hyperlipidemia, gall
stones, varicose veins, psychological problems, sleep related problems, and
degenerative arthritis, were sought in all subjects. Waist hip ratio was
noted as measure of central distribution of body fat in obese subjects.
RESULTS: Of the 200 subjects, 59% (n=118) were female and 41% (n=82)
male. Of the obese subjects 74% and 44% of non-obese controls were
female. Mean age of obese subjects and their controls was 54.4 +/- 3.22
and 54.57 +/- 3.54 years respectively. Central obesity was noted in 84% of
obese subjects. Hyperlipidemia (87%), hypertension (71%), diabetes
mellitus (65%), gallstones (57%), ischaemic heart disease (49%),
osteoarthri s (46%), and sleep disorders (35%) were signiﬁcant (p<0.05)
obesity related complications.
CONCLUSION: Hyperlipidemia, hypertension, diabetes mellitus, gallstones,
ischaemic heart disease, osteoarthritis and sleep disorders are common
obesity related complica ons in subjects of age range 50-59 years.
Pak J Pharm Sci. 2006 Jan;19(1):62-5.
Khan NI, Naz L, Yasmeen G.
Department of Physiology, University of Karachi, Karachi-75270, Pakistan.
The role of obesity in diabetes mellitus, hyperlipidemia, colon cancer,
sudden death and other cardiovascular diseases has confirmed in many
recent research studies. In present study, it is hypothesized that obesity can
serve as an independent risk factor for the decreased activities of
cytoprotective antioxidants in humans and for the associated systemic
oxida ve stress. 150 age matched, female subjects with no history of
smoking or biochemical evidence of diabetes mellitus, hypertension,
hyperlipidemia, renal or liver disease or cancer were included in the study
and were divided into different grades of obesity according to their body
mass index (BMI). Hemoglobin and erythrocyte glutathione (GSH)
concentrations were measured for each subject. The study suggests that
increase BMI was found to be associated with a significant decrease in
erythrocyte glutathione concentration. From these observations it is
concluded that obesity even in the absence of smoking, diabetes mellitus,
hyperlipidemia, renal or liver diseases can decrease the activities of body's
protective antioxidants, and can enhance the systemic oxidative stress and
should therefore receive the same attention as obesity with complications.
J Ayub Med Coll Abbottabad. 2004 Jul-Sep;16(3):32-4.
Knowledge, Attitude and Practice Regarding Obesity
among Patients, at Aga Khan University Hospital, Karachi.
Qidwai W, Azam SI.
Family Medicine Department, Aga khan University Hospital, Karachi,
BACKGROUND: Obesity is a major public health problem and responsible
for significant morbidity and mortality among our patients. It is important
to study the knowledge, attitude and practices with regard to obesity
among patients, in order to devise interventional strategies.
METHODS: Patients visiting the out-patient clinics of Aga Khan University
Hospital, Karachi, were included in the study. The interview was
questionnaire-based and recorded the demographic profile of the patients
and questions relevant to the objective of the study. The ethical
requirements for the study were met. SPSS computer software was used for
data management. A hundred patients were surveyed.
RESULTS: Women (55%) were more than men (45%), under 39 years (73%),
married (55%), with graduate or more educa on (65%), in private service
(44%) and housewives (19%). A substan al number of respondents (75%)
understood the meaning of obesity and considered it a major health
problem (90%). More respondents felt the need to reduce weight (52%),
despite the fact that lesser number considered themselves to be
overweight or obese (34%). A majority of the respondents did exercise
(59%) but a minority did it more than ﬁve mes a week (17%) and more
than 30 minutes on each occasion (31%). A substan al propor on of the
respondents stated their preference for oily food (34%), sweets (34%), fried
food (40%), red meat (21%), fast food (37%), bu er, cheese and cream
CONCLUSIONS: We have found a significant level of understanding about
obesity among our patients. Physical exercise and dietary measures to
control body weight are lacking despite the desire to have appropriate body
weight. There is a need and we strongly recommend patient education
programs to control obesity.
Diabet Med. 2004 Jul;21(7):716-23.
Ethnic Differences and Determinants of Diabetes and
Central Obesity among South Asians of Pakistan.
Jafar TH, Levey AS, White FM, Gul A, Jessani S, Khan AQ, Jafary FH, Schmid
CH, Chaturvedi N.
Clinical Epidemiology Unit, Department of Community Health Sciences, The
Aga Khan University, PO Box 3500,
Stadium Road, Karachi, Pakistan.
AIMS: To study the within ethnic subgroup variations in diabetes and
central obesity among South Asians.
METHODS: Data from 9442 individuals age > or = 15 years from the
Na onal Health Survey of Pakistan (NHSP) (1990-1994) were analysed.
Diabetes was defined as non-fas ng blood glucose > or =7.8 mmol/l, or
known history of diabetes. Central obesity was measured at the waist
circumference. Distinct ethnic subgroups Muhajir, Punjabi, Sindhi, Pashtun,
and Baluchi were defined by mother tongue.
RESULTS: The age-standardized prevalence of diabetes varied among
ethnic subgroups (P = 0.002), being highest among the Muhajirs (men 5.7%,
women 7.9%), then Punjabis (men 4.6%, women 7.2%), Sindhis (men 5.1%,
women 4.8%), Pashtuns (men 3.0%, women 3.8%), and lowest among the
Baluchis (men 2.9%, women 2.6%). While diabetes was more prevalent in
urban vs. rural dwellers [odds ra o (OR) 1.50, 95% conﬁdence interval (CI)
1.24, 1.82], this diﬀerence was no longer signiﬁcant a er adjus ng for
central obesity (OR 1.15, 95% CI 0.95, 1.42). However, the ethnic
differences persisted after adjusting for major sociodemographic risk
factors (unadjusted OR for Pashtun vs. Punjabi 0.59, 95% CI 0.42, 0.84,
adjusted OR 0.54, 95% CI 0.37, 0.78). Ethnic varia on was also observed in
central obesity, which varied with gender, and did not necessarily track with
ethnic differences in diabetes.
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