Asian Adult Population Research Articles

Risk of obstructive sleep apnoea is associated with glycaemia status in South Asian men and women in the United States

AimsTo examine the association between glycaemia status and the risk for obstructive sleep apnoea (OSA) in a cohort of South Asians living in the United States. MethodsA secondary analysis of a community based cohort of 899 participants from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. The Berlin Questionnaire was used to screen for OSA. ResultsAlmost one in four (24%) South Asians was at high risk for OSA. Compared to the normal glucose tolerance group (18%), high risk of OSA was significantly more likely in the prediabetes (24%) and diabetes (32%) groups (p = 0.007). More men (28%) than women (18%) were at high risk of OSA. Risk for OSA was also associated with higher haemoglobin A1c values, hypertension, large waist circumference, and BMI >27.5 kg/m2. In a multivariate regression analysis, sleep disordered breathing (SDB) remained significantly associated with higher haemoglobin A1c values, even after controlling for waist circumference and other demographic and clinical factors. ConclusionsThe risk for SDB and OSA was high among South Asian men and women. Given the association between dysglycaemia and risk for OSA, these health issues require simultaneous clinical assessment. Future studies using objective sleep measures such as polysomnography are warranted in the diagnosis and treatment of OSA in the South Asian adult population already at high risk for dysglycaemia.

Increased serum ferritin levels are independently associated with carotid atherosclerosis in women.

Previous studies have supported the theory that there is a positive association between ferritin and carotid atherosclerosis in Western people. Diet plays an important role in determining serum ferritin concentration. Asian dietary patterns are different from Western dietary patterns, implying that there may be a difference in the association of ferritin with carotid atherosclerosis between Asian and Western people. However, few studies focus on the association between ferritin and carotid atherosclerosis among Asians. The aim of this study was to investigate how serum ferritin levels are associated with carotid atherosclerosis in an Asian adult population. A cross-sectional assessment was performed in 8302 adults in Tianjin, China. Carotid intima-media thickness (IMT) and plaques were assessed using ultrasonography, and serum ferritin was measured using the protein chip-chemiluminescence method. Multiple logistic regression analysis was used to examine the association between quartiles of serum ferritin concentration and carotid atherosclerosis. In the present study, the overall prevalence of IMT and carotid plaques in participants is 29·2 and 22·7 %, respectively. In women, after adjustments for potentially confounding factors, the OR of IMT and carotid plaques by increasing serum ferritin quartiles were 1·00, 1·39 (95 % CI 0·98-1·99), 1·39 (95 % CI 0·99-1·97), 1·81 (95 % CI 1·30-2·55) (P for trend<0·001) and 1·00, 1·24 (95 % CI 0·89-1·73), 1·18 (95 % CI 0·85-1·65), 1·59 (95 % CI 1·15-2·20) (P for trend<0·01), respectively. However, no association was found between serum ferritin and carotid atherosclerosis in men. The study demonstrated that increased serum ferritin levels are independently associated with IMT and carotid plaques in Asian women but not in Asian men.

Prevalence and incidence of hypertension: Results from a representative cohort of over 16,000 adults in three cities of South Asia

BackgroundDespite high projected burden, hypertension incidence data are lacking in South Asian population. We measured hypertension prevalence and incidence in the Center for cArdio-metabolic Risk Reduction in South Asia (CARRS) adult cohort. MethodsThe CARRS Study recruited representative samples of Chennai, Delhi, and Karachi in 2010/11, and socio-demographic and risk factor data were obtained using a standard common protocol. Blood pressure (BP) was measured in the sitting position using electronic sphygmomanometer both at baseline and two year follow-up. Hypertension and control were defined by JNC 7 criteria. ResultsIn total, 16,287 participants were recruited (response rate=94.3%) and two year follow-up was completed in 12,504 (follow-up rate=79.2%). Hypertension was present in 30.1% men (95% CI: 28.7–31.5) and 26.8% women (25.7–27.9) at baseline. BP was controlled in 1 in 7 subjects with hypertension. At two years, among non-hypertensive adults, average systolic BP increased 2.6mm Hg (95% CI: 2.1–3.1), diastolic BP 0.7mm Hg (95% CI: 0.4–1.0), and 1 in 6 developed hypertension (82.6 per 1000 person years, 95% CI: 80.8–84.4). Risk for developing hypertension was associated with age, low socio-economic status, current alcohol use, overweight, pre-hypertension, and dysglycemia. Risk of incident hypertension was highest (RR=2.95, 95% CI: 2.53–3.45) in individuals with pre-hypertension compared to normal BP. Collectively, 4 modifiable risk factors (pre-hypertension, overweight, dysglycemia, and alcohol use) accounted for 78% of the population attributable risk of incident hypertension. ConclusionHigh prevalence and poor control of hypertension, along with high incidence, in South Asian adult population call for urgent preventive measures.

The mediational role of physical activity, social contact and stroke on the association between age, education, employment and dementia in an Asian older adult population

BackgroundOur study aimed to investigate the pathways by which socio-demographic factors, modifiable health and lifestyle risk factors influence each other, and subsequently, lead to dementia.MethodsWe used data from the Well-being of the Singapore Elderly study, a nationally representative survey of the older adult population aged 60 years and above in Singapore. Dementia diagnosis was established using 10/66 dementia criteria. Structural equation modelling (SEM) without latent variable was applied to confirm the hypothesized model.ResultsThe results of SEM supported the hypothesized model (χ2 = 14.999, df = 10, p = 0.132). The final model showed that those aged 75–84 years and 85 years and over (vs. 60–74 years), having no formal education, who had completed primary or secondary education (vs. completed tertiary), who were homemakers and retired (vs. paid work), and with a history of stroke were directly associated with higher odds of having dementia, while those who had more frequent contact with friends and neighbors as well as being physically active were directly associated with lower odds of having dementia diagnosis. The study also found that physical activity, more frequent contact with friends and stroke played a significant role as mediators in these relationships. The overall pathways model explained 57.7% of the variance in dementia.ConclusionOur results suggest that physical activity, social contact and stroke were potential mediators in the relationship between age, education, employment and dementia. Intervention programmes focusing on physical activity such as exercise and social contact may be useful in reducing the risk of dementia among older adults.

The Variation in the Lumbar Facet Joint Orientation in an Adult Asian Population and Its Relationship with the Cross-Sectional Area of the Multifidus and Erector Spinae

Study DesignCross-sectional study of healthy volunteers.PurposeWe aimed to investigate the variation in the lumbar facet joint orientation in an adult Asian population. The relationship between the facet joint orientation and muscle cross-sectional area (CSA) of multifidus and erector spinae was also clarified.Overview of LiteratureSeveral studies have reported that lumbar pathologies, such as lumbar spondylolysis and degenerative spondylolisthesis, were related to the horizontally shaped lumbar facet joint orientation at the lower lumbar level. However, data regarding variations in the facet joint orientation in asymptomatic subjects have not been well documented.MethodsIn 31 healthy male adult Asian volunteers, the facet joint orientation and CSA of multifidus and erector spinae were measured using magnetic resonance imaging at the L4–5 and L5–S1 levels. Variation in the facet joint orientation was examined using coefficients of variation (CV). Pearson's product-moment coefficient was used to investigate the relationship between the facet joint orientation and CSA of multifidus and erector spinae.ResultsLumbar facet joint orientation had a wider range of variation at L5–S1 (CV=0.30) than at L4–5 (CV=0.18). The L4–5 facet joint orientation had a weak but significant correlation with the CSA of erector spinae (r=0.40; p=0.031). The CSA of the multifidus had no relationship with the facet joint orientation at the L4–5 (r=0.19; p=0.314) and the L5–S1 level (r=0.19; p=0.312).ConclusionsThe lumbar facet joint orientation was found to have a wide variation, particularly at the L5–S1 in the Asian adult population, and the facet joint orientation had a relationship with the CSA of the erector spinae at the L4–5.

Abstract 20045: One in Six South Asian Adults Develop Hypertension Over a Two Year Period: Results From the CARRS Cohort Study

Introduction: Hypertension is a growing public health problem in South Asia. We examined hypertension prevalence, awareness, treatment, and control rates in adult participants at baseline in the CARRS cohort from three large cities in South Asia and report both incidence and predictors of incident hypertension using the longitudinal follow-up data. Methods: The CARRS Study recruited representative population cohorts of three metropolitan urban cities namely Chennai, Delhi and Karachi. Trained field workers collected socio-demographic and risk factor data from all eligible participants using a structured questionnaire, standardized equipment and a common study protocol. All the participants recruited at baseline were followed-up annually. Fasting blood samples were also collected at baseline and at two year follow-up for biochemical analyses of lipids, glucose and haemoglobin A1c. Blood pressure was recorded at baseline and during annual follow-up visits in the sitting position using electronic sphygmomanometer; two measurements were taken, 5 minutes apart and the mean of two was used for analyses. Results: In total, 16,287 participants were recruited at baseline (response rate=94.3%) and two year follow-up was completed in 12, 504 participants (response rate=79.2%). Hypertension (JNC-8) was prevalent in one of three men (30.1%, 95% CI: 28.7-31.5) and one of four women (26.8%, 95% CI: 25.7-27.9). Hypertension awareness, treatment and control was alarmingly low (Figure 1). One of six non-hypertensive adults at baseline developed hypertension (80.5 per 1000 person years, 95% CI: 76.3-85.0) over a two year period. Propensity to develop hypertension was higher in older age, men, participants from low socio-economic status, current alcohol users, individuals with overweight, pre-hypertension and dysglycemia. Conclusion: High incidence and poor awareness of hypertension in South Asian adult population warrants immediate policy attention.

Chronic cough: an Asian perspective. Part 1: Epidemiology.

Asia is one of the most diverse and dynamic continents. Due to recent rapid industrialisation and urbanisation, morbidity patterns are likely to be diverse in Asian populations. Chronic cough is a disease condition resulting from host-environmental interactions, and is associated with a high global epidemiological burden. However, the underlying epidemiology remains unclear, particularly in Asia. We performed a literature search to identify peer-reviewed articles on chronic cough in community-based adult Asian populations that have been published between January 2000 and June 2015. In this review, we aim to examine the epidemiological characteristics and determinants of chronic cough in several geographical areas of Asia.

Prevalence of serum celiac antibodies in a multiracial Asian population--a first study in the young Asian adult population of Malaysia.

BackgroundCeliac disease (CD) is an immune-mediated disorder induced by the ingestion of gluten in genetically susceptible persons. The prevalence of CD in Malaysia is unknown. We aim to determine the seroprevalence of CD antibodies and also investigate the correlation between H. pylori infection and CD in the young and healthy multiracial Malaysian population.MethodsHealthy young adult volunteers between the ages of 18–30 years were consecutively recruited from June 2012 to May 2014 at the University of Malaya Medical Centre (UMMC), Kuala Lumpur. Serum samples from all the participants were tested for anti-gliadin antibody immunoglobulin A/immunoglobulin G (IgA/IgG) and anti-tissue transglutaminase antibody (tTG) IgA/IgG. Samples positive for both anti-gliadin and anti-tTG were further validated for anti-human endomysial IgA antibodies (EmA). Serological diagnosis of CD was made when anti-gliadin, anti-tTG and anti-EmA were positive.Results562 qualified participants with mean age 24 ± 2.4 years old were recruited into our study. CD was found in 7 participants where most of them were asymptomatic and unaware of their CD status. The median of anti-gliadin and anti-tTG IgA/IgG value was 38.2 U/ml (interquartile range, 28.3–60.4 U/ml) and 49.2 U/ml (interquartile range, 41.1–65.9 U/ml), respectively. Seroprevalence of CD antibodies was 1.9% (6 out of 324) in female while only 0.4% (1 out of 238) in male. Seroprevalence among Malay was 0.8% (2 of 236), Chinese was 1.7% (3 of 177) and Indian was 1.3% (2 of 149). Overall, seroprevalence of CD antibodies in healthy asymptomatic adults in the Malaysian population was 1.25% (95% CI, 0.78%-1.72%). No significant relationship was discovered between CD and H. pylori infection.ConclusionsThe seroprevalence of CD antibodies in healthy young adults in the Malaysian population was 1.25% (1 in 100). CD is underdiagnosed and it could be a much greater problem in Malaysia than previously thought.

Frontal recess anatomy in Japanese subjects and its effect on the development of frontal sinusitis: Computed tomography analysis

BackgroundComprehensive understanding of frontal recess anatomy is essential for the successful treatment of patients with frontal sinus disease. This study was designed to determine the prevalence of specific frontal recess cells in Japanese subjects and the association of these cells with the development of frontal sinusitis.MethodsFrontal recess anatomy was analyzed using high-resolution spiral computed tomography images of paranasal sinuses from December 2008 through September 2011. The distribution of various frontal recess cells in patients with and without frontal sinusitis was compared by logistic regression analysis.ResultsA total of 150 patients met the criteria, and 300 sides were analyzed. Agger nasi cells were present in 88.0 % of sides; frontal cell types 1 (FC1), 2 (FC2), 3 (FC3), and 4 (FC4) were present in 37.0 %, 6.3 %, 4.3 %, and 1.3 %, respectively; supraorbital ethmoid cells in 6.0 %, suprabullar cells in 37.0 %, frontal bullar cells (FBC) in 7.0 %, and interfrontal sinus septal cells in 8.6 %. Multiple logistic regression analysis showed that the presence of FBCs was significantly associated with the development of frontal sinusitis (p = 0.043).ConclusionsThe frequencies of frontal recess cells in Japanese adult patients were similar to those reported for other East Asian adult populations, including Chinese, Korean, and Taiwanese. Anatomically, FBCs may show a greater association with the development of frontal sinusitis than other frontal recess cells.

Abstract 14919: Short Adult Stature is an Independent Predictor of Cardiovascular Disease Risk Factors and Subclinical Vascular Changes in a Larger Population Based Sample

Background: Studies have demonstrated strong association between short adult stature (a marker of adverse nutritional and sanitary environment in early years) and cardiovascular disease (CVD) mortality. The reasons for this association are not understood although early childhood epigenetic programming has been invoked. Here we analyze the association between adult height and CVD risk factors and subclinical vascular changes in a Southeast Asian population that has experienced rapid income growth with increasing prevalence of CVD over the last decade. Methods: In a population-based study of 8,080 South Indians (mean age 42 years; 58% women), assessments included blood pressure, socioeconomic (SE) and physical activity (PA) status, triglycerides (TG), total cholesterol (TC), glucose tolerance test, carotid intimal medial thickness (IMT), arterial stiffness by carotid-femoral pulse wave velocity (PWV) and endothelial function by brachial artery flow mediated dilatation (FMD). Results: The prevalence of CVD risk factors and values of subclinical vascular parameters by height quartile is shown in the Table. After adjustments for age, weight, SE and PA status and smoking, in comparison to highest height quartile the odds ratio (95% CI) for diabetes, hypertension and elevated levels of TG (≥ 150 mg/dl) and TC (≥ 200 mg/dl) in the lowest height quartile was 1.3 (0.97, 1.6), 1.7 (1.4 - 2.2), 1.4 (1.1, 1.8), 1.5 (1.2, 1.9) in women and 2.01 (1.5, 2.7), 1.9 (1.5, 2.5), 1.5 (1.2, 1.9), 1.9 (1.5, 2.5) in men, respectively. In multi-linear regression models that included both genders, height was independently correlated with FMD (β= 0.31, p &lt;0.01), IMT (β= 0.06, p &lt;0.01) and PWV (β= -0.06, p &lt;0.01). Conclusion: Adult Stature is an independent predictor of CVD risk factors and subclinical vascular changes. Adverse environment in early years may be one of the contributing factors to the increasing prevalence of CVD in the Southeast Asian adult population.

A systematic review of the global prevalence of personality disorders in adult Asian populations.

No systematic reviews have been conducted into the prevalence of personality disorders (PD) in Asian populations. This review aims to investigate the prevalence of all PD subtypes within community and clinical Asian (Chinese, Indian, Japanese and South Korean) populations worldwide. Seven databases were searched in addition to manual examination and reference tracking. Exclusion criteria were applied with the remaining studies subjected to quality appraisal. Nineteen studies were included for review. Results were grouped by community studies in Asian countries, clinical studies in Asian countries and comparative studies. Prevalence of PD assessed by clinical judgement was lower than that by diagnostic tools. The highest rates of PD were found in suicidal cohorts within the various countries. Four of the five comparative studies found lower prevalence rates of PD in Asians compared with the overall sample. Insufficient consistent research has been published to ascertain the prevalence of PD in Asians and whether it is higher or lower than in Western cohorts. Asians presenting with suicidal ideation may benefit from PD assessment.

The prevalence of primary angle closure glaucoma in adult Asians: a systematic review and meta-analysis.

BackgroundPrimary angle closure glaucoma (PACG) is higher in Asians than Europeans and Africans, with over 80% of PACG worldwide in Asia. Previous estimates of PACG were based largely on early studies, mostly using inappropriate case definitions. Therefore, we did a systematic review and meta-analysis to estimate the prevalence of PACG in adult Asian populations and to quantify its association with age, gender, and region.MethodsAll primary reports of population-based studies that reported the prevalence of PACG in adult Asian populations were identified. PACG case definition was compatible with the ISGEO definition. Twenty-nine population-based studies were included. The overall pooled prevalence estimates were calculated using a random effect model, and ethnicity-, age- and gender-specific pooled prevalence estimates were also calculated.ResultsThe overall pooled prevalence of PACG in those of adult Asians was 0.75% (95% CI, 0.58, 0.96). Ethnicity-specific pooled prevalence estimates were 0.97% (0.22, 4.27) in Middle East group, 0.66% (0.23, 1.86) in South East Asia group, 0.46% (0.32, 0.64) in India group, 1.10% (0.85, 1.44) in China group, and 1.19% (0.35, 3.98) in Japan group, respectively. Age-specific prevalence was 0.21% (0.12, 0.37) for those 40–49 years, 0.54% (0.34, 0.85) for those 50–59 years, 1.26% (0.93, 1.71) for those 60–69 years, and 2.32% (1.74, 3.08) for those 70 years or above. The overall female to male ratio of the PACG prevalence was 1.51∶1 (95% CI 1.01, 2.28).ConclusionsPACG affects approximately 0.75% adult Asians, increasing double per decade, and 60% of cases being female. The prevalence rates vary greatly by ethnic region.

Low vitamin D levels are associated with atopic dermatitis, but not allergic rhinitis, asthma, or IgE sensitization, in the adult Korean population

The effect of vitamin D on allergic conditions is unclear. In particular, large-scale, population-based studies examining this relationship in adult Asian populations are lacking. To evaluate the association between serum vitamin D levels and allergic conditions in the general adult Korean population. A cross-sectional study was performed by using data collected from 15,212 individuals 19 years or older who participated in the Korean National Health and Nutrition Examination Survey from 2008 to 2010. The confounder-adjusted mean serum 25-hydroxyvitamin D (25[OH]D) levels of participants with and without allergic conditions (including atopic dermatitis, asthma, allergic rhinitis, and increased total and allergen-specific serum IgE) were compared by using multiple linear regression analyses. Multiple logistic regression analyses with confounder adjustment estimated the odds ratios (ORs) for developing each condition according to adequate, inadequate, or deficient serum 25(OH)D levels. After adjusting for potential confounders, mean serum 25(OH)D levels were significantly lower in participants diagnosed with atopic dermatitis than in those without this diagnosis (mean ± SE, 18.58 ± 0.29 ng/mL vs 19.20 ± 0.15 ng/mL; P = .02). Compared with participants with adequate vitamin D levels (≥20 ng/mL), confounder-adjusted ORs of atopic dermatitis were significantly higher in those with inadequate (12-19.99 ng/mL) or deficient (<12 ng/mL) levels (OR [95% CI], 1.50 [1.10-2.06] and 1.48 [1.04-2.12], respectively; P = .02). This relationship was not observed in participants with the other allergic conditions. Vitamin D-insufficient adult individuals within the general Korean population have an increased likelihood of atopic dermatitis, but not asthma, allergic rhinitis, or IgE sensitization.

Development, validity and reliability of the short multidimensional positive mental health instrument

The 47-item positive mental health (PMH) instrument measures the level of PMH in multiethnic adult Asian populations. This study aimed to (1) develop a short PMH instrument and (2) establish its validity and reliability among the adult Singapore population. Two separate studies were conducted among adult community-dwelling Singapore residents of Chinese, Malay or Indian ethnicity where participants completed self-administered questionnaires. In the first study, secondary data analysis was conducted using confirmatory factor analysis (CFA) to shorten the PMH instrument. In the second study, the newly developed short PMH instrument and other scales were administered to 201 residents to establish its factor structure, validity and reliability. A 20-item short PMH instrument fulfilling a higher-order six-factor structure was developed following secondary analysis. The mean age of the participants in the second study was 41 years and about 53% were women. One item with poor factor loading was further removed to generate a 19-item version of the PMH instrument. CFA demonstrated a first-order six-factor model of the short PMH instrument. The PMH-19 instrument and its subscales fulfilled criterion validity hypotheses. Internal consistency and test-retest reliability of the PMH-19 instrument were high (Cronbach's α coefficient = 0.87; intraclass correlation coefficient = 0.93, respectively). The 19-item PMH instrument is multidimensional, valid and reliable, and most importantly, with its reduced administration time, the short PMH instrument can be used to measure and evaluate PMH in Asian communities.

Prevalence and Associations of Excessive Daytime Sleepiness in an Asian Multiethnic Adult Population

Objectives: Investigate the prevalence and associations of excessive daytime sleepiness (EDS) in a multi-ethnic Asian adult population in Singapore. Methods: A cross-sectional study was conducted in an urban town using an interviewer-administered questionnaire in 2008. 1003 subjects over 40 years of age were selected after randomization. EDS was assessed using the Epworth Sleepiness Scale. A score of 10-12 indicated mild-moderate EDS; a score greater than 12 indicated severe EDS. Information on lifestyle, socio-economic conditions and medical comorbidities were collected. Results: The prevalence of EDS was 21.43%. Increased risk of EDS was associated with larger housing types, Prevalence Ratio (PR) 2.21 (95% CI 1.73-2.82); clinical depression, PR 1.95 (95% confidence interval [CI] 1.07-3.59); monthly household income higher than US$4846 (S$6000), PR 1.79 (95% CI 1.27-2.05); desk-bound vocations, PR 1.77 (95% CI 1.39-2.25); younger age (40-49 years old), PR 1.67 (95% CI 1.23-2.26); alcohol consumption, PR 1.62 (95% CI 1.23-2.14); employment, PR 1.61 (95% CI 1.27-2.05); working night shift, PR 1.60 (95% CI 1.09-2.36); tertiary education, PR 1.50 (95% CI 1.15-1.93); male gender, PR 1.49 (95% CI 1.13-1.95); and presence of 2 or more symptoms of depression PR 1.39 (95% CI 1.00-1.93). Conclusions: The prevalence of EDS is comparable to the levels in the United States. EDS was associated with socioeconomic, lifestyle factors, depression, and depressive symptoms. Ethnicity, body-mass-index, and waist circumference were not found to be significant.

Diagnostic Performance of the ISNT Rule for Glaucoma Based on the Heidelberg Retinal Tomograph

We determined the accuracy of the inferior > superior > nasal > temporal (ISNT) neuroretinal rim area rule and its variants in adult Asian populations, and evaluated whether disc area impacts its performance characteristics. Participants in the Singapore Malay Eye Study (SiMES) and Singapore Indian Eye Study (SINDI) underwent standardized ocular examinations, including optic disc imaging with the Heidelberg retinal tomograph (HRT). Glaucoma was defined using the ISGEO criteria. HRT rim areas in the superior, inferior, nasal, and temporal quadrants were quantified. We determined sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values of violating the ISNT rule and 4 variants (I > S > T, I > S, I > T, and combined I > T and S > T). The influence of disc area was analyzed with multivariate marginal logistic regression. There were 6112 participants (mean age: 57.6 ± 10.3 years). Glaucoma was present in 194 individuals (3.2%). Among 11,840 eyes, 232 (93.2%) of 249 glaucomatous eyes and 9768 (84.3%) of 11,591 nonglaucomatous eyes, violated the ISNT rule. The ISNT rule had highest sensitivity (93.5%), but lowest specificity (15.7%); I > T had highest specificity (98.2%), but low sensitivity (7.4%). For all variants, PPVs were low (2.1%-8.4%) and NPVs were high (97.9-99.1%). Larger disc area was associated with reduced specificity for the ISNT rule (P < 0.001), and reduced sensitivity (P = 0.01) and increased specificity for I > S > T (P < 0.05). PPV increased (P < 0.05) and NPV decreased (P < 0.001) with increasing disc area. The ISNT rule based on HRT has high sensitivity, and the I > T, S > T, and combined I > T and S > T variants have high specificity. Disc area influences sensitivity, specificity, PPV, and NPV of the ISNT rule and its variants. The high sensitivity of the ISNT rule, and high specificities of its variants, may have potential utility when used in combination with other HRT algorithms for glaucoma assessment.

Is there a divergence in time trends in the prevalence of impaired glucose tolerance and diabetes? A systematic review in South Asian populations

Recently, diabetes prevalence has increased in South Asians making it a global public health priority. There are suggestions that pre-diabetes, including impaired glucose tolerance (IGT), may not be increasing. We conducted a systematic review to explore the paradox. Research Design and Methods We searched electronic databases from inception to June 2009 for cross-sectional studies providing prevalence of pre-diabetes (using WHO criteria) in South Asian adult populations. Two reviewers independently screened articles, performed data extraction, quality appraisal and study classification with any discrepancies resolved by consensus. Repeated cross-sectional studies, categorized by pre-specified criteria, were used for the primary analysis, supplemented by analysis of comparable and all studies. In total, 79 cross-sectional data sets (from 69 published studies) were identified resulting in the inclusion of 179 408 people. Four sets of repeated cross-sectional studies, conducted in Chennai, rural Tamil Nadu, Mauritius and Singapore (n = 30,399), provided time trend information. Three of them showed an increase in diabetes prevalence (P < 0.001) whereas IGT fell in two (P < 0.05), and was stable in the remainder. A similar pattern was seen among three other sets of comparable studies (n = 58,820) and in scatterplots of all 79 data sets. This novel systematic review is the first to assess secular trends of pre-diabetes in any population. The data show diabetes prevalence is rising, whereas IGT prevalence is stable or falling. Explanations include: recent environmental or lifestyle changes favouring an increased rate of conversion from IGT to diabetes, or a cohort effect with improving maternal and infant nutrition resulting in reduced IGT with a fall in diabetes to follow.

Gambling in Asian Communities in Great Britain

This paper examines the prevalence of gambling and problem gambling among people of Indian, Pakistani, and Bangladeshi cultural backgrounds living in Great Britain. Information was gathered from the last two versions of a large-scale national adult prevalence survey and a similar survey of children aged 11 to 15 years, all conducted since 2007. Together, the surveys yielded sub-samples of 589 Asian adults and 482 Asian children from a combined total of more than 16,000 adults and nearly 9,000 children. In both adult and child Asian populations, the 7-day participation rate in gambling (22% and 13%, respectively) was found to be low relative to that in the white majority community, yet problem gambling prevalence, measured by the adult Diagnostic and Statistical Manual of Mental Disorders, 4th edition screen (1.4%) and its juvenile equivalent (2.9%), was significantly higher, including among women. It therefore follows that those Asians who do gamble are unusually prone to experiencing problems, which has implications for public health policies such as the provision of information and help in minority languages. The relevance of the findings seems likely to extend to other countries with significantly sized Asian communities.

Gambling in Asian Communities in Great Britain

Abstract This paper examines the prevalence of gambling and problem gambling among people of Indian, Pakistani, and Bangladeshi cultural backgrounds living in Great Britain. Information was gathered from the last two versions of a large-scale national adult prevalence survey and a similar survey of children aged 11 to 15 years, all conducted since 2007. Together, the surveys yielded sub-samples of 589 Asian adults and 482 Asian children from a combined total of more than 16,000 adults and nearly 9,000 children. In both adult and child Asian populations, the 7-day participation rate in gambling (22% and 13%, respectively) was found to be low relative to that in the white majority community, yet problem gambling prevalence, measured by the adult Diagnostic and Statistical Manual of Mental Disorders, 4th edition screen (1.4%) and its juvenile equivalent (2.9%), was significantly higher, including among women. It therefore follows that those Asians who do gamble are unusually prone to experiencing problems, which has implications for public health policies such as the provision of information and help in minority languages. The relevance of the findings seems likely to extend to other countries with significantly sized Asian communities.

P2-131 Falling prevalence of impaired glucose tolerance in south Asian populations

IntroductionRecently, diabetes prevalence has soared in South Asians making it a global public health priority. However, there are suggestions from the PODOSA trial and elsewhere that pre-diabetes, including impaired glucose...