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Background: Obesity and dyslipidemia are important risk factors for hypertension (HTN). When these two conditions coexist, they may interact in a synergistic manner and increase the risk of developing HTN and its associated complications. The aim of this study was to investigate the synergistic effect of general and central obesity with dyslipidemia on the risk of HTN. Method: Data from 40,387 individuals aged 25 to 64 years were obtained from a repeated cross-sectional study examining risk factors for non-communicable diseases (STEPS) in 2007, 2011 and 2016. Body mass index (BMI) was calculated as a measure of general obesity and waist circumference (WC) as a measure of central obesity. Dyslipidemia was defined as the presence of at least one of the lipid abnormalities. Hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or current use of antihypertensive medication. To analyze the synergistic effect between obesity and dyslipidemia and HTN, the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were calculated. A weighted logistic regression model was performed to estimate the odds ratios (ORs) for the risk of HTN. Results: The results showed an association between obesity, dyslipidemia and hypertension. The interaction between obesity and dyslipidemia significantly influences the risk of hypertension. In hypertensive patients, the presence of general obesity increased from 14.55% without dyslipidemia to 64.36% with dyslipidemia, while central obesity increased from 13.27 to 58.88%. This interaction is quantified by RERI and AP values of 0.15 and 0.06 for general obesity and 0.24 and 0.09 for central obesity, respectively. The corresponding SI of 1.11 and 1.16 indicate a synergistic effect. The OR also show that the risk of hypertension is increased in the presence of obesity and dyslipidemia. Conclusion: Obesity and dyslipidemia are risk factors for HTN. In addition, dyslipidemia with central obesity increases the risk of HTN and has a synergistic interaction effect on HTN. Therefore, the coexistence of obesity and lipid abnormalities has many clinical implications and should be appropriately monitored and evaluated in the management of HTN. [ABSTRACT FROM AUTHOR]

Background: Hyperglycemia is rising globally and its associated complications impose heavy health and economic burden on the countries. Developing effective survey-based screening tools for hyperglycemia using reliable surveillance data, such as the WHO STEPs surveys, would be of great importance in early detection and/or prevention of hyperglycemia, especially in low or middle-income regions. Methods: In this study, data from the nationwide 2016 STEPs study in Iran were used to identify socioeconomic, lifestyle, and metabolic factors associated with hyperglycemia. Furthermore, the ability of five commonly used machine learning algorithms (random forest; gradient boosting; support vector machine; logistic regression; artificial neural network) in the prediction of hyperglycemia on STEPs dataset were compared via tenfold cross validation in terms of specificity, sensitivity, and the area under the receiver operating characteristic curve. Results: A total of 17,705 individuals were included in this study, of those 29.624% (n = 5245) had (undiagnosed) hyperglycemia. Multivariate logistic regression analysis showed that older age (for the elderly group: OR = 5.096; for the middle-aged group: OR = 2.784), high BMI status (morbidly obese: OR = 3.465; obese: OR = 1.992), having hypertension (OR = 1.647), consuming fish more than twice per week (OR = 1.496), and abdominal obesity (OR = 1.464) were the five most important risk factors for hyperglycemia. Furthermore, all the five hyperglycemia prediction models achieved AUC around 0.70, and logistic regression (specificity = 70.22%; sensitivity = 70.2%) and random forest (specificity = 70.75%; sensitivity = 69.78%) had the optimal performance. Conclusions: This study shows that it is possible to develop survey-based screening tools for early detection of hyperglycemia using data from nationwide surveys, such as WHO STEPs surveys, and machine learning techniques, such as random forest and logistic regression, without using blood tests. Such screening tools can potentially improve hyperglycemia control, especially in low or middle-income countries. [ABSTRACT FROM AUTHOR]

Aims: India is the diabetes capital with home to 69.1 million people with DM, the second highest number of cases after China. Recent epidemiological evidence indicates a rising DM epidemic across all classes, both affluent and the poor in India. This article reports on the prevalence of diabetes and pre-diabetes in the North Indian state of Punjab as part of a large household NCD Risk Factor Survey. Methods: A household NCD STEPS survey was done in the state of Punjab, India in a multistage stratified sample of 5127 individuals. All the subjects were administered the WHO STEPS questionnaire, anthropometric and blood pressure measurements. Every alternate respondent in the sample (n = 2499) was assayed for blood parameters. Results: Overall prevalence of DM among the study participants was found out to be 8.3% (95% CI 7.3-9.4%) whereas prevalence of prediabetes was 6.3% (5.4-7.3%). Age group (45-69 years), marital status, hypertension, obesity and family history of DM were found to be the risk factors significantly associated with DM. Out of all persons with DM, only 18% were known case of DM or on treatment, among whom only about one-third had controlled blood glucose status. Conclusions: The study reported high prevalence of diabetes, especially of undiagnosed cases amongst the adult population, most of whom have uncontrolled blood sugar levels. This indicates the need for systematic screening and awareness program to identify the undiagnosed cases in the community and offer early treatment and regular follow up. [ABSTRACT FROM AUTHOR]

Background: Oral diseases remain a significant public health problem in Nepal, as do oral health behaviours. Sociodemographic factors play a crucial role in driving oral hygiene practices. This study aims to identify oral hygiene practices and associated socio-demographic factors in Nepalese population. Methods: This descriptive, cross-sectional study recruited 4200 adults (15-69 years) through multistage cluster sampling. Data obtained from the WHO NCD STEPS instrument version 2.2 were analysed in STATA 13.0 using complex sample weighted analysis. Results: Prevalence of cleaning teeth at least once a day was 94.9 % (95 % CI: 93.7-95.9), while that of cleaning teeth at least twice a day was 9.9 % (95 % CI: 8.2-11.9). Use of fluoridated toothpaste was seen among 71.4 % (95 % CI: 67.9-74.7) respondents. A 3.9 % (95 % CI: 3.1-5.0) made a dental visit in the last 6 months. The 45-69 years age group had lesser odds of cleaning teeth at least once a day (AOR: 0.4; 95 % CI: 0.2-0.8), in comparison to 15-29 years age group. Women had greater odds of cleaning teeth at least twice a day (AOR: 1.7; 95 % CI: 1.1-2.4) and having visited a dentist in the last 6 months (AOR: 2.2; 95 % CI: 1.2-3.8) compared to men. With reference to rural residents, urban population had higher odds of using fluoridated toothpaste (AOR: 2.3; 95 % CI: 1.4-3.4) and making a dental visit within the last 6 months (AOR: 1.9; 95 % CI:1.1-3.6). Inhabitants of the Terai had five-fold (AOR: 4.9; 95 % CI: 3.1-7.8) greater odds of cleaning teeth once per day than did hill residents. Those with higher education had greater odds than non-formal education holders of cleaning teeth at least once a day (AOR: 9.0; 95 % CI: 2.9-27.7), cleaning teeth at least twice a day (AOR: 5.6; 95 % CI: 2.9-10.6), using fluoridated toothpaste (AOR: 13.9; 95 % CI: 8.4-23.1), and having visited a dentist in the last 6 months (AOR: 2.8; 95 % CI: 1.4-5.4). Conclusions: Cleaning teeth at least once a day is widely prevalent in Nepal and a substantial number of population use fluoridated toothpaste. However, cleaning teeth twice a day and visiting a dentist is less common. Being women, Terai residents, urban residents, and educated were significantly associated with oral hygiene practices assessed in this study. [ABSTRACT FROM AUTHOR]

Background: The rising morbidity and mortality due to non-communicable diseases can be partly attributed to the urbanized lifestyle leading to unhealthy dietary practices and increasing physical levels of inactivity. The demographic and nutrition transition in India has also contributed to the emerging epidemic of non-communicable diseases in this country. In this context, there is limited information in India on dietary patterns, levels of physical activity and obesity. The aim of the present study was thus to assess the urban rural differences in dietary habits, physical activity and obesity in India.Methods: A household survey was done in the state of Punjab, India in a multistage stratified sample of 5127 individuals using the WHO STEPS questionnaire.Results: No rural urban difference was found in dietary practices and prevalence of overweight and obesity except the fact that a significantly higher proportion of respondents belonging to rural area (15.6 %) always/often add salt before/when eating as compared to urban area (9.1 %). Overall 95.8 % (94.6-97.0) of participants took less than 5 servings of fruits and/or vegetables on average per day. No significant urban rural difference was noted in both sexes in all three domains of physical activity such as work, transport and recreation. However, rural females (19.1 %) were found to be engaged in vigorous activity more than the urban females (6.3 %). Males reported high levels of physical activity in both the settings. Absence of recreational activity was reported by more than 95 % of the subjects. Higher prevalence of obesity (asian cut offs used) was seen among urban females (34.3 %) as compared to their rural counterparts (23.2 %). Abdominal obesity was found to be significantly higher among females in both the settings compared to males (p < 0.001).Conclusions: Poor dietary practices and physical inactivity seems to fuel the non-communicable disease epidemic in India. Non communicable disease control strategy need to address these issues with a gender equity lens. Rapid urbanization of rural India might be responsible for the absence of a significant urban rural difference. [ABSTRACT FROM AUTHOR]