Familial concordance of nutritional status is an emerging field of study that may guide the devel... more Familial concordance of nutritional status is an emerging field of study that may guide the development of interventions that operate beyond the individual and within the family context. Little published data exist for concordance of nutritional status within Pakistani households. We assessed the associations between weight status of mothers and their children in a nationally representative sample of households in Pakistan using Demographic and Health Survey data. Our analysis included 3465 mother-child dyads, restricting to children under-five years of age with body mass index (BMI) information on their mothers. We used linear regression models to assess the associations between maternal BMI category (underweight, normal weight, overweight, obese) and child’s weight-for-height z-score (WHZ), accounting for socio-demographic characteristics of mothers and children. We assessed these relationships in all children under-five and also stratified by age of children (younger than 2 years...
ObjectiveRemote or mobile consulting (mConsulting) is being promoted to strengthen health systems... more ObjectiveRemote or mobile consulting (mConsulting) is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during COVID-19 and beyond. We explored whether mConsulting is a viable option for communities with minimal resources in low- and middle-income countries (LMICs).MethodsWe reviewed evidence published since 2018 about mConsulting in LMICs and undertook a scoping study (pre-COVID) in two rural settings (Pakistan, Tanzania) and five urban slums (Kenya, Nigeria, Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites), and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mConsulting providers, local and national decision-makers. Project advisory groups guided the study in each country.ResultsWe reviewed five empirical studies and seven reviews, analysed data from 5,219 urban slum households and engag...
Background: Smokeless tobacco (ST) use is common among youth in South Asia where 85% of the world... more Background: Smokeless tobacco (ST) use is common among youth in South Asia where 85% of the world’s 300 million ST users live and use the most lethal ST forms. Little is known about the impact of tobacco control policies on the youth ST uptake in those countries. We planned to conduct longitudinal surveys among secondary school students to evaluate existing tobacco control policies on ST uptake and use, and a feasibility study for that prospective, observational cohort study. Study objectives: (1) To demonstrate the feasibility of selection, recruitment and retention of schools and of study participants; (2) To assess the feasibility and acceptability of the study procedure and study tool (questionnaire); (3) To assess if the questionnaire can assess tobacco uptake and use, and the potential predictors of tobacco uptake and use of the envisaged main study. Methods and analysis: The feasibility study will be conducted in two administrative areas within each of three South Asian count...
Background: Smokeless tobacco (ST) use is common among youth in South Asia where 85% of the world... more Background: Smokeless tobacco (ST) use is common among youth in South Asia where 85% of the world’s 300 million ST users live and use the most lethal ST forms. Little is known about the impact of tobacco control policies on the youth ST uptake in those countries. We planned to conduct longitudinal surveys among school going adolescents to evaluate existing tobacco control policies on tobacco uptake and use, and a feasibility study for that prospective, observational cohort study. Study objectives: (1) To demonstrate the feasibility of selection, recruitment and retention of schools and of study participants; (2) To assess the feasibility and acceptability of the study procedure and study tool (questionnaire); (3) To evaluate if the questionnaire can assess tobacco uptake and use, and their potential predictors. Methods and analysis: The feasibility study will be conducted in two administrative areas within each of three South Asian countries: Bangladesh, India and Pakistan. We will ...
JPMA. The Journal of the Pakistan Medical Association, 2017
Diet is one of the most important contributors to health and disease. Developing countries such a... more Diet is one of the most important contributors to health and disease. Developing countries such as Pakistan are facing a growing epidemic of under nutrition resulting in stunting, wasting and micronutrient deficiencies in the population. This severe situation of under nutrition in the country is coupled with rising tide of non-communicable diseases (NCD) posing the double burden of disease on the country. These burden of NCD, along with over and under nutrition poses a huge burden on the already over-utilized multi-tiered health care system in Pakistan. In this alarming situation, nutrition education in the form of food based dietary guidelines (FBDGs) naturally becomes the most essential tool for promoting a health culture within the country and eventually changing behaviour.
Background: More than one-half of coronary artery disease (CAD) patients have low HDL cholesterol... more Background: More than one-half of coronary artery disease (CAD) patients have low HDL cholesterol despite having well-managed LDL cholesterol. Almond supplementation has not been shown to elevate circulating HDL cholesterol concentrations in clinical trials, perhaps because the baseline HDL cholesterol of trial subjects was not low. Objective: This clinical trial was designed to test the effect of almond supplementation on low HDL cholesterol in CAD patients. Methods: A total of 150 CAD patients (50 per group), with serum LDL cholesterol #100 mg/dL and HDL cholesterol #40 mg/dL in men and #50 mg/dL in women, were recruited from the Aga Khan University Hospital. After recording vital signs and completing a dietary and physical activity questionnaire, patients were randomly assigned to 1 of the following 3 groups: the no-intervention group (NI), the Pakistani almonds group (PA), and the American almonds group (AA). The respective almond varieties (10 g/d) were given to patients with instructions to soak them overnight, remove the skin, and eat them before breakfast. Blood samples for lipid profiling, body weight, and blood pressure were collected, and assessment of dietary patterns was done at baseline, week 6, and week 12. Results: Almonds significantly increased HDL cholesterol. At weeks 6 and 12, HDL cholesterol was 12-14% and 14-16% higher, respectively, in the PA and AA than their respective baselines. In line with previous reports, serum concentrations of total cholesterol, triglycerides, LDL cholesterol, and VLDL cholesterol; total-to-HDL and LDL-to-HDL cholesterol ratios, and the atherogenic index were reduced in both the PA and AA at weeks 6 and 12 compared with baseline (P < 0.05). Effects on serum lipids did not differ between the 2 almond groups. Dietary patterns, body weight, and blood pressure did not change in any of the 3 groups during the trial. Conclusion: A low dose of almonds (10 g/d) consumed before breakfast can increase HDL cholesterol, in addition to improving other markers of abnormal lipid metabolism in CAD patients with low initial HDL cholesterol. This trial was registered at the Australian New Zealand Clinical Trial Registry as ACTRN12614000036617.
Pathologically, Alzheimer's disease is a result of aggregation of amyloid peptides and protei... more Pathologically, Alzheimer's disease is a result of aggregation of amyloid peptides and protein tau in the brain forming neurofibrillary tangles which are highly toxic to neuronal circuits in the brain. Recent evidences report that apart from aging, estrogen deficiency is one of the risk factors predisposing to the development of Alzheimer's disease. Isofla-vones, also known as phytoestrogens, are metabolized by the body forming compounds that are known to interfere with neurotoxic pathways and through their anti-fibrillization effects they play a role in reducing apoptosis of neurons and glial cells and promote axonal regeneration. Experimental studies on transgenic models with Alzheimer's disease as well as various observational and clinical trials suggest that dietary interventions with Isoflavones may have a significant role in improving portions of memory, cognition and decreasing the risk of Alzheimer's disease.
JPMA. The Journal of the Pakistan Medical Association, 2015
Madam, life expectancy in Pakistan has increased from 46.6 years in 1960 to 65.4 years in 2010 an... more Madam, life expectancy in Pakistan has increased from 46.6 years in 1960 to 65.4 years in 2010 and is projected to reach 72.4 years in 2023. 1 With a steady increase in elderly population and poor nutrition, osteoporosis is attaining the rank of a major public health problem in Pakistan. It is estimated that the cost of hip fractures in Pakistan varies between 4000 to 10000 USD depending on the hospital setting with an average hospital stay of 7-10 days. 2 Consequently, osteoporosis is becoming a burden on the country's health infrastructure.
JPMA. The Journal of the Pakistan Medical Association, 1994
The dilemma of private practitioners is whether to prescribe or not to prescribe iron supplements... more The dilemma of private practitioners is whether to prescribe or not to prescribe iron supplements on suspicion of anaemia. This cross sectional study was done in an urban squatter settlement with a primary health care centre to assess the significance of symptoms and a history of associated diseases in the diagnosis of anaemia. A total of 321 children were sampled from 1800 children < 5 years of age in a population of 11,000, by systematic random sampling. Mothers were asked about the presence of assumed associated symptoms and diseases which were listlessness, irritability, anaemia, pica, poor weight gain, diarrhoea, acute respiratory infection and malaria in last 3 months. There was significant association between anaemia (Hb < 11 gms%) and irriability (P < .02), anorexia for solid foods (P < .04), pica (P < .001), episode of diarrhoea (P < .001) and poor weight gain (P < .006). There was no significant association between malaria, cold, cough and anaemia. Chi...
JPMA. The Journal of the Pakistan Medical Association, 2011
Letter to the Editor Smokeless tobacco use prevention and cessation (S-TUPAC): a need of the time... more Letter to the Editor Smokeless tobacco use prevention and cessation (S-TUPAC): a need of the time Madam, Contrary to the popular belief, smokeless tobacco (ST) use is not just a South-Asian but a global public health problem. Although cigarette smoking has seen a decline in western countries, use of ST is rising worldwide especially in the young. Hundreds of millions of people use smokeless tobacco worldwide. In US alone an estimated 10-12 million people are ST users.
Objective: This study aims to identify lifestyle predictors of gestational diabetes mellitus (GDM... more Objective: This study aims to identify lifestyle predictors of gestational diabetes mellitus (GDM) in South Asian women. Pregravid body mass index, body composition, rate of weight gain during pregnancy, physical activity (PA) and dietary intake were studied. Design: Prospective cohort study (n ¼ 611) of South Asian women at Aga Khan University Hospital antenatal clinic in Karachi, Pakistan. Weight, height and body fat % were measured and data on PA, diet and socioeconomic covariates were collected at baseline. A glucose screen was performed at 29.872.6 weeks. Results: Using logistic regression analysis for the full cohort, the risk of GDM increased with older maternal age (odds ratio (OR) 1.13, confidence interval (CI) 1.06-1.21), increased body fat % (OR 1.07, CI 1.03-1.13) and the risk was inversely associated with PA (100 kcal) (OR 0.79-0.99, CI 0.89). Using a nested case (n ¼ 49) control (n ¼ 98) design to study dietary intake, the risk of GDM decreased with increasing protein (% energy) in the diet (OR 0.75, CI 0.60-0.95). Conclusions: Body fat %, physical inactivity and, possibly, diet quality are important modifiable risk factors for GDM.
Aims To evaluate the association between occupational and leisure-time physical activity (PA), ow... more Aims To evaluate the association between occupational and leisure-time physical activity (PA), ownership of goods promoting sedentary behaviour, and the risk of myocardial infarction (MI) in different socioeconomic populations of the world. Studies in developed countries have found low PA as a risk factor for cardiovascular disease; however, the protective effect of occupational PA is less certain. Moreover, ownership of goods promoting sedentary behaviour may be associated with an increased risk. Methods In INTERHEART, a case-control study of 10 043 cases of first MI and 14 217 controls who did not report previous angina or physical disability completed a questionnaire on work and leisure-time PA. Results Subjects whose occupation involved either light [multivariable-adjusted odds ratio (OR) 0.78, confidence interval (CI) 0.71-0.86] or moderate (OR 0.89, CI 0.80-0.99) PA were at a lower risk of MI, whereas those who did heavy physical labour were not (OR 1.02, CI 0.88-1.19), compared with sedentary subjects. Mild exercise (OR 0.87, CI 0.81-0.93) as well as moderate or strenuous exercise (OR 0.76, CI 0.69-0.82) was protective. The effect of PA was observed across countries with low, middle, and high income. Subjects who owned both a car and a television (TV) (multivariableadjusted OR 1.27, CI 1.05-1.54) were at higher risk of MI compared with those who owned neither. Conclusion Leisure-time PA and mild-to-moderate occupational PA, but not heavy physical labour, were associated with a reduced risk, while ownership of a car and TV was associated with an increased risk of MI across all economic regions.
Background Vitamin D deficiency has been identified as a major public health problem worldwide. S... more Background Vitamin D deficiency has been identified as a major public health problem worldwide. Sunlight is the main source of vitamin D and its measurement using dosimeters is expensive and difficult for use in population-based studies. Hence, the aim of this study was to develop and validate questionnaires to assess sunlight exposure in healthy individuals residing in Karachi, Pakistan. Methods Two questionnaires with seven important items for sunlight exposure assessment were developed. Fifty four healthy adults were enrolled based on their reported sunlight exposure (high = 17, moderate = 18, low = 19) from Aga Khan University, Karachi. Over four days, study participants were asked to wear a dosimeter between sunrise and sunset and report time spent and activities undertaken in the sun for questionnaire validation. Algorithm for item weightage was created as an average score based on ultraviolet B percentage received. Blood samples were obtained for serum vitamin D. Results The ...
The health and nutrition of the global adolescent population have been under-researched, in spite... more The health and nutrition of the global adolescent population have been under-researched, in spite of its significant size (1.2 billion). This study investigates the prevalence and associated factors of malnutrition (stunting, thinness and overweight) among adolescents living in South Asia. The sample analysed was 24,053 South Asian schooled adolescents aged 12–15 years that participated in the cross-sectional Global School-Based Student Health Survey (GSHS) between 2009 and 2016. The prevalence of stunting, thinness and overweight was calculated using the World Health Organization (WHO) Child Growth Reference 2007. Associations between the three forms of malnutrition and their possible associated factors were assessed with binary logistic regression analysis using bootstrapping as a resampling method. The overall prevalence of stunting in South Asia was 13%, thinness was 10.8% and overweight was 10.8%. In the logistic regression model of the overall pooled sample, the factors associ...
International Journal of Community Medicine and Public Health, 2021
The burden of type 2 diabetes mellitus (T2DM) is on a rise. Globally, 425 million people suffer f... more The burden of type 2 diabetes mellitus (T2DM) is on a rise. Globally, 425 million people suffer from T2DM (one in eleven) and this is projected to increase to 629 million by 2045.Three quarters of people with type 2 diabetes mellitus live in low and middle income countries. One in every six pregnant women develops gestational diabetes mellitus (GDM). These women are globally seven times more likely to develop type 2 diabetes mellitus later in life as compared to other women. In Pakistan, 26.3% of the population has T2DM and 14.4% are pre-diabetics, contributing 3% of the proportionate mortality rate. In Pakistan, one in every seven women develops GDM.
The health and nutrition of the global adolescent population have been under-researched, in spite... more The health and nutrition of the global adolescent population have been under-researched, in spite of its significant size (1.2 billion). This study investigates the prevalence and associated factors of malnutrition (stunting, thinness and overweight) among adolescents living in South Asia. The sample analysed was 24,053 South Asian schooled adolescents aged 12–15 years that participated in the cross-sectional Global School-Based Student Health Survey (GSHS) between 2009 and 2016. The prevalence of stunting, thinness and overweight was calculated using the World Health Organization (WHO) Child Growth Reference 2007. Associations between the three forms of malnutrition and their possible associated factors were assessed with binary logistic regression analysis using bootstrapping as a resampling method. The overall prevalence of stunting in South Asia was 13%, thinness was 10.8% and overweight was 10.8%. In the logistic regression model of the overall pooled sample, the factors associ...
Familial concordance of nutritional status is an emerging field of study that may guide the devel... more Familial concordance of nutritional status is an emerging field of study that may guide the development of interventions that operate beyond the individual and within the family context. Little published data exist for concordance of nutritional status within Pakistani households. We assessed the associations between weight status of mothers and their children in a nationally representative sample of households in Pakistan using Demographic and Health Survey data. Our analysis included 3465 mother-child dyads, restricting to children under-five years of age with body mass index (BMI) information on their mothers. We used linear regression models to assess the associations between maternal BMI category (underweight, normal weight, overweight, obese) and child’s weight-for-height z-score (WHZ), accounting for socio-demographic characteristics of mothers and children. We assessed these relationships in all children under-five and also stratified by age of children (younger than 2 years...
ObjectiveRemote or mobile consulting (mConsulting) is being promoted to strengthen health systems... more ObjectiveRemote or mobile consulting (mConsulting) is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during COVID-19 and beyond. We explored whether mConsulting is a viable option for communities with minimal resources in low- and middle-income countries (LMICs).MethodsWe reviewed evidence published since 2018 about mConsulting in LMICs and undertook a scoping study (pre-COVID) in two rural settings (Pakistan, Tanzania) and five urban slums (Kenya, Nigeria, Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites), and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mConsulting providers, local and national decision-makers. Project advisory groups guided the study in each country.ResultsWe reviewed five empirical studies and seven reviews, analysed data from 5,219 urban slum households and engag...
Background: Smokeless tobacco (ST) use is common among youth in South Asia where 85% of the world... more Background: Smokeless tobacco (ST) use is common among youth in South Asia where 85% of the world’s 300 million ST users live and use the most lethal ST forms. Little is known about the impact of tobacco control policies on the youth ST uptake in those countries. We planned to conduct longitudinal surveys among secondary school students to evaluate existing tobacco control policies on ST uptake and use, and a feasibility study for that prospective, observational cohort study. Study objectives: (1) To demonstrate the feasibility of selection, recruitment and retention of schools and of study participants; (2) To assess the feasibility and acceptability of the study procedure and study tool (questionnaire); (3) To assess if the questionnaire can assess tobacco uptake and use, and the potential predictors of tobacco uptake and use of the envisaged main study. Methods and analysis: The feasibility study will be conducted in two administrative areas within each of three South Asian count...
Background: Smokeless tobacco (ST) use is common among youth in South Asia where 85% of the world... more Background: Smokeless tobacco (ST) use is common among youth in South Asia where 85% of the world’s 300 million ST users live and use the most lethal ST forms. Little is known about the impact of tobacco control policies on the youth ST uptake in those countries. We planned to conduct longitudinal surveys among school going adolescents to evaluate existing tobacco control policies on tobacco uptake and use, and a feasibility study for that prospective, observational cohort study. Study objectives: (1) To demonstrate the feasibility of selection, recruitment and retention of schools and of study participants; (2) To assess the feasibility and acceptability of the study procedure and study tool (questionnaire); (3) To evaluate if the questionnaire can assess tobacco uptake and use, and their potential predictors. Methods and analysis: The feasibility study will be conducted in two administrative areas within each of three South Asian countries: Bangladesh, India and Pakistan. We will ...
JPMA. The Journal of the Pakistan Medical Association, 2017
Diet is one of the most important contributors to health and disease. Developing countries such a... more Diet is one of the most important contributors to health and disease. Developing countries such as Pakistan are facing a growing epidemic of under nutrition resulting in stunting, wasting and micronutrient deficiencies in the population. This severe situation of under nutrition in the country is coupled with rising tide of non-communicable diseases (NCD) posing the double burden of disease on the country. These burden of NCD, along with over and under nutrition poses a huge burden on the already over-utilized multi-tiered health care system in Pakistan. In this alarming situation, nutrition education in the form of food based dietary guidelines (FBDGs) naturally becomes the most essential tool for promoting a health culture within the country and eventually changing behaviour.
Background: More than one-half of coronary artery disease (CAD) patients have low HDL cholesterol... more Background: More than one-half of coronary artery disease (CAD) patients have low HDL cholesterol despite having well-managed LDL cholesterol. Almond supplementation has not been shown to elevate circulating HDL cholesterol concentrations in clinical trials, perhaps because the baseline HDL cholesterol of trial subjects was not low. Objective: This clinical trial was designed to test the effect of almond supplementation on low HDL cholesterol in CAD patients. Methods: A total of 150 CAD patients (50 per group), with serum LDL cholesterol #100 mg/dL and HDL cholesterol #40 mg/dL in men and #50 mg/dL in women, were recruited from the Aga Khan University Hospital. After recording vital signs and completing a dietary and physical activity questionnaire, patients were randomly assigned to 1 of the following 3 groups: the no-intervention group (NI), the Pakistani almonds group (PA), and the American almonds group (AA). The respective almond varieties (10 g/d) were given to patients with instructions to soak them overnight, remove the skin, and eat them before breakfast. Blood samples for lipid profiling, body weight, and blood pressure were collected, and assessment of dietary patterns was done at baseline, week 6, and week 12. Results: Almonds significantly increased HDL cholesterol. At weeks 6 and 12, HDL cholesterol was 12-14% and 14-16% higher, respectively, in the PA and AA than their respective baselines. In line with previous reports, serum concentrations of total cholesterol, triglycerides, LDL cholesterol, and VLDL cholesterol; total-to-HDL and LDL-to-HDL cholesterol ratios, and the atherogenic index were reduced in both the PA and AA at weeks 6 and 12 compared with baseline (P < 0.05). Effects on serum lipids did not differ between the 2 almond groups. Dietary patterns, body weight, and blood pressure did not change in any of the 3 groups during the trial. Conclusion: A low dose of almonds (10 g/d) consumed before breakfast can increase HDL cholesterol, in addition to improving other markers of abnormal lipid metabolism in CAD patients with low initial HDL cholesterol. This trial was registered at the Australian New Zealand Clinical Trial Registry as ACTRN12614000036617.
Pathologically, Alzheimer's disease is a result of aggregation of amyloid peptides and protei... more Pathologically, Alzheimer's disease is a result of aggregation of amyloid peptides and protein tau in the brain forming neurofibrillary tangles which are highly toxic to neuronal circuits in the brain. Recent evidences report that apart from aging, estrogen deficiency is one of the risk factors predisposing to the development of Alzheimer's disease. Isofla-vones, also known as phytoestrogens, are metabolized by the body forming compounds that are known to interfere with neurotoxic pathways and through their anti-fibrillization effects they play a role in reducing apoptosis of neurons and glial cells and promote axonal regeneration. Experimental studies on transgenic models with Alzheimer's disease as well as various observational and clinical trials suggest that dietary interventions with Isoflavones may have a significant role in improving portions of memory, cognition and decreasing the risk of Alzheimer's disease.
JPMA. The Journal of the Pakistan Medical Association, 2015
Madam, life expectancy in Pakistan has increased from 46.6 years in 1960 to 65.4 years in 2010 an... more Madam, life expectancy in Pakistan has increased from 46.6 years in 1960 to 65.4 years in 2010 and is projected to reach 72.4 years in 2023. 1 With a steady increase in elderly population and poor nutrition, osteoporosis is attaining the rank of a major public health problem in Pakistan. It is estimated that the cost of hip fractures in Pakistan varies between 4000 to 10000 USD depending on the hospital setting with an average hospital stay of 7-10 days. 2 Consequently, osteoporosis is becoming a burden on the country's health infrastructure.
JPMA. The Journal of the Pakistan Medical Association, 1994
The dilemma of private practitioners is whether to prescribe or not to prescribe iron supplements... more The dilemma of private practitioners is whether to prescribe or not to prescribe iron supplements on suspicion of anaemia. This cross sectional study was done in an urban squatter settlement with a primary health care centre to assess the significance of symptoms and a history of associated diseases in the diagnosis of anaemia. A total of 321 children were sampled from 1800 children < 5 years of age in a population of 11,000, by systematic random sampling. Mothers were asked about the presence of assumed associated symptoms and diseases which were listlessness, irritability, anaemia, pica, poor weight gain, diarrhoea, acute respiratory infection and malaria in last 3 months. There was significant association between anaemia (Hb < 11 gms%) and irriability (P < .02), anorexia for solid foods (P < .04), pica (P < .001), episode of diarrhoea (P < .001) and poor weight gain (P < .006). There was no significant association between malaria, cold, cough and anaemia. Chi...
JPMA. The Journal of the Pakistan Medical Association, 2011
Letter to the Editor Smokeless tobacco use prevention and cessation (S-TUPAC): a need of the time... more Letter to the Editor Smokeless tobacco use prevention and cessation (S-TUPAC): a need of the time Madam, Contrary to the popular belief, smokeless tobacco (ST) use is not just a South-Asian but a global public health problem. Although cigarette smoking has seen a decline in western countries, use of ST is rising worldwide especially in the young. Hundreds of millions of people use smokeless tobacco worldwide. In US alone an estimated 10-12 million people are ST users.
Objective: This study aims to identify lifestyle predictors of gestational diabetes mellitus (GDM... more Objective: This study aims to identify lifestyle predictors of gestational diabetes mellitus (GDM) in South Asian women. Pregravid body mass index, body composition, rate of weight gain during pregnancy, physical activity (PA) and dietary intake were studied. Design: Prospective cohort study (n ¼ 611) of South Asian women at Aga Khan University Hospital antenatal clinic in Karachi, Pakistan. Weight, height and body fat % were measured and data on PA, diet and socioeconomic covariates were collected at baseline. A glucose screen was performed at 29.872.6 weeks. Results: Using logistic regression analysis for the full cohort, the risk of GDM increased with older maternal age (odds ratio (OR) 1.13, confidence interval (CI) 1.06-1.21), increased body fat % (OR 1.07, CI 1.03-1.13) and the risk was inversely associated with PA (100 kcal) (OR 0.79-0.99, CI 0.89). Using a nested case (n ¼ 49) control (n ¼ 98) design to study dietary intake, the risk of GDM decreased with increasing protein (% energy) in the diet (OR 0.75, CI 0.60-0.95). Conclusions: Body fat %, physical inactivity and, possibly, diet quality are important modifiable risk factors for GDM.
Aims To evaluate the association between occupational and leisure-time physical activity (PA), ow... more Aims To evaluate the association between occupational and leisure-time physical activity (PA), ownership of goods promoting sedentary behaviour, and the risk of myocardial infarction (MI) in different socioeconomic populations of the world. Studies in developed countries have found low PA as a risk factor for cardiovascular disease; however, the protective effect of occupational PA is less certain. Moreover, ownership of goods promoting sedentary behaviour may be associated with an increased risk. Methods In INTERHEART, a case-control study of 10 043 cases of first MI and 14 217 controls who did not report previous angina or physical disability completed a questionnaire on work and leisure-time PA. Results Subjects whose occupation involved either light [multivariable-adjusted odds ratio (OR) 0.78, confidence interval (CI) 0.71-0.86] or moderate (OR 0.89, CI 0.80-0.99) PA were at a lower risk of MI, whereas those who did heavy physical labour were not (OR 1.02, CI 0.88-1.19), compared with sedentary subjects. Mild exercise (OR 0.87, CI 0.81-0.93) as well as moderate or strenuous exercise (OR 0.76, CI 0.69-0.82) was protective. The effect of PA was observed across countries with low, middle, and high income. Subjects who owned both a car and a television (TV) (multivariableadjusted OR 1.27, CI 1.05-1.54) were at higher risk of MI compared with those who owned neither. Conclusion Leisure-time PA and mild-to-moderate occupational PA, but not heavy physical labour, were associated with a reduced risk, while ownership of a car and TV was associated with an increased risk of MI across all economic regions.
Background Vitamin D deficiency has been identified as a major public health problem worldwide. S... more Background Vitamin D deficiency has been identified as a major public health problem worldwide. Sunlight is the main source of vitamin D and its measurement using dosimeters is expensive and difficult for use in population-based studies. Hence, the aim of this study was to develop and validate questionnaires to assess sunlight exposure in healthy individuals residing in Karachi, Pakistan. Methods Two questionnaires with seven important items for sunlight exposure assessment were developed. Fifty four healthy adults were enrolled based on their reported sunlight exposure (high = 17, moderate = 18, low = 19) from Aga Khan University, Karachi. Over four days, study participants were asked to wear a dosimeter between sunrise and sunset and report time spent and activities undertaken in the sun for questionnaire validation. Algorithm for item weightage was created as an average score based on ultraviolet B percentage received. Blood samples were obtained for serum vitamin D. Results The ...
The health and nutrition of the global adolescent population have been under-researched, in spite... more The health and nutrition of the global adolescent population have been under-researched, in spite of its significant size (1.2 billion). This study investigates the prevalence and associated factors of malnutrition (stunting, thinness and overweight) among adolescents living in South Asia. The sample analysed was 24,053 South Asian schooled adolescents aged 12–15 years that participated in the cross-sectional Global School-Based Student Health Survey (GSHS) between 2009 and 2016. The prevalence of stunting, thinness and overweight was calculated using the World Health Organization (WHO) Child Growth Reference 2007. Associations between the three forms of malnutrition and their possible associated factors were assessed with binary logistic regression analysis using bootstrapping as a resampling method. The overall prevalence of stunting in South Asia was 13%, thinness was 10.8% and overweight was 10.8%. In the logistic regression model of the overall pooled sample, the factors associ...
International Journal of Community Medicine and Public Health, 2021
The burden of type 2 diabetes mellitus (T2DM) is on a rise. Globally, 425 million people suffer f... more The burden of type 2 diabetes mellitus (T2DM) is on a rise. Globally, 425 million people suffer from T2DM (one in eleven) and this is projected to increase to 629 million by 2045.Three quarters of people with type 2 diabetes mellitus live in low and middle income countries. One in every six pregnant women develops gestational diabetes mellitus (GDM). These women are globally seven times more likely to develop type 2 diabetes mellitus later in life as compared to other women. In Pakistan, 26.3% of the population has T2DM and 14.4% are pre-diabetics, contributing 3% of the proportionate mortality rate. In Pakistan, one in every seven women develops GDM.
The health and nutrition of the global adolescent population have been under-researched, in spite... more The health and nutrition of the global adolescent population have been under-researched, in spite of its significant size (1.2 billion). This study investigates the prevalence and associated factors of malnutrition (stunting, thinness and overweight) among adolescents living in South Asia. The sample analysed was 24,053 South Asian schooled adolescents aged 12–15 years that participated in the cross-sectional Global School-Based Student Health Survey (GSHS) between 2009 and 2016. The prevalence of stunting, thinness and overweight was calculated using the World Health Organization (WHO) Child Growth Reference 2007. Associations between the three forms of malnutrition and their possible associated factors were assessed with binary logistic regression analysis using bootstrapping as a resampling method. The overall prevalence of stunting in South Asia was 13%, thinness was 10.8% and overweight was 10.8%. In the logistic regression model of the overall pooled sample, the factors associ...
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