- Research needed on central obesity, non-alcoholic fatty liver disease, dyslipidaemia, waist circumference standards in Lankan children
- Low turnout among children for blood tests, ultrasound scan procedures
- Lack of public awareness on negative impacts of being overweight/obese and related complications
In Batticaloa, the “Prevalence of obesity, overweight, and central obesity (defined as having a waist circumference above the 90th percentile according to the British standards) among adolescent girls in a national school in the Batticaloa District” by D. Karuppiah and M. Markandu found that the prevalence of overweight and obesity in teenage girls were respectively 9.4% and 5.5% while the figure for the prevalence of central obesity was 21.6%. That the prevalence of childhood obesity has been increasing over time with regional variation has also been noted by V.P. Wickramasinghe, C. Arambepola, D.M.P.S. Bandara, M. Abeysekera, S. Kuruppu, P. Dilshan, and B.S. Dissanayake in the “Validity of newly developed BMI and waist cut off values for Sri Lankan children'.
This growing prevalence, especially of central obesity, has resulted in, according to S. Rajindrajith, A. Pathmeswaran, C. Jayasinghe, D. Kottahachchi, A. Kasturiratne, S.T. de Silva, M.A. Niriella, A.S. Dassanayake, A.P. de Silva, and H.J. de Silva’s “Non-alcoholic fatty liver disease and its associations among adolescents in an urban Sri Lankan community”, metabolic derangements such dyslipidaemia, insulin resistance, and non-alcoholic fatty liver disease. Further, studies have found a link between central obesity, metabolic syndrome (described according to the literature as a combination of hypertriglyceridaemia [high amounts of triglyceride esters in the blood] and low high-density lipoprotein cholesterol, together with central obesity, hyperglycaemia [high blood sugar] and hypertension [high blood pressure], which represent a clustering of atherogenic [fatty deposits in arteries] risk factors) and Type 2 diabetes in children.
In Colombo, the prevalence of metabolic syndrome, as per V.P. Wickramasinghe, C. Arambepola, P. Bandara, M. Abeysekera, S. Kuruppu, P. Dilshan, and B.S. Dissanayake’s “Distribution of obesity-related metabolic markers among five to 15-year-old children from an urban area of Sri Lanka” was 1.6%, while 22.1% of them were obese. The prevalence of non-alcoholic fatty liver disease, which is a potential cause of chronic liver disease, was found in 8.4% of adolescents in Ragama by Rajindrajith et al.
Kiridana et al., therefore conducted a cross-sectional descriptive study in selected schools in Kandy from November 2018 to June 2019 with 1,766 students between the ages of 12-15 years, including 1,053 (59.63%) boys and 713 (40.37%) girls. In terms of sampling, during the first stage, a 20% sample from the type 1AB, 1C, and type 2 Government schools was selected using the stratified random sampling method, while in stage two, the simple random cluster sampling was used to select 50 clusters of 20 pupils from all Grade Eight, Nine, and 10 classes.
With regard to the collection of data, the entire sample population’s body weight was measured to the nearest 0.1 kg, the height was quantified to the nearest 0.1 cm, the waist circumference was measured at the narrowest point of the torso above the umbilicus and below the rib cage, and the body fat percentage was measured. In the case of participants with a BMI for age figure greater than the prescribed World Health Organisation (WHO) growth reference median, they had to undergo blood investigations (fasting lipid profile, fasting blood sugar, and liver enzymes) and ultrasound abdominal scan.
As per “Defining anthropometric cut off levels related to metabolic risk in a group of Sri Lankan children” by Wickramasinghe and Lamabadusuriya et al., the total body fat percentages – 35% for girls and 25% for boys – were considered as the cut-off values for obesity-related morbidity in a study which found a central obesity percentage of 43.88%.
The findings of Kiridana et al.’s study included that: 258 (14.6% – one in seven) were overweight or obese; a significant difference was observed by the school type in the age adjusted mean BMI of boys where the lowest was observed among students of type-two schools; the mean BMI by age categories indicated a significant difference with the highest being among the oldest category; the prevalence of being overweight was 138 (7.81%) and for obesity it was 120 (6.8%), which included 106 girls, out of whom, 64 (8.98%) were overweight and 42 (5.89%) were obese, and 152 boys, out of whom, 74 (7.03%) and 78 (7.41%) were overweight and obese, respectively, while the total body fat percentages in the case of 78 boys and 92 girls were beyond the gender cut off values; there is a difference of the mean BMI values of the boys in type-one schools and type-two schools; central obesity was seen in 299 (16.93%) while 76 (5.04%) of them had normal BMI, and out of the overweight and obese children (258), 223 (86.43%) had a waist circumference above the 90th percentile, which Kiridana et al., explained, means that there is increased metabolic risk among this age group.
The study also found that: out of the 258 children who were overweight or obese, only 85 (32.9%) were reported for blood investigations and the prevalence of metabolic syndrome was in turn found in five girls and five boys; all the participants had normal blood pressure; a considerable number had high levels of cholesterol, triglycerides, low density lipoprotein cholesterol (27.06%), and low levels of high density lipoprotein cholesterol (more than one-third having according to Kiridana et al., an adiposity [being severely overweight or obese] related dyslipidemia pattern, which is also possible due to the presence of familial hyperlipidemia [acquired or genetic disorders that result in a high level of lipids/fats/cholesterol/triglycerides circulating in the blood]), along with elevated levels of liver enzymes (reported in 33/38.82% and seven/8.24% of the 85 children who underwent blood investigations.
In addition, it revealed that: non-alcoholic fatty liver disease in the form of Grade One fatty liver was seen in 14, while Grade Two fatty liver was seen in three (also had elevated liver enzyme levels, thus indicating a correlation between elevated liver enzyme levels and the presence of fatty liver); hypertriglyceridemia and low high density lipoprotein cholesterol levels in the abnormal range were found in one in three overweight children; and fasting blood sugar was abnormal only in 9.41%, with the results for hypertriglyceridemia, low high-density lipoprotein cholesterol and fasting blood sugar highlighting, according Kiridana et al.’s analysis, the abundance of central obesity with dyslipidemia in this urban child population.
In the context of these findings, it was noted by N.P. Naotunna, M. Dayarathna, H. Maheshi, G.S. Amarasinghe, V.S. Kithmini, M. Rathnayaka, L. Premachandra, N. Premarathna, P.C. Rajasinghe, G. Wijewardana, and T.C. Agampodi in the “Nutritional status among primary school children in rural Sri Lanka: a public health challenge for a country with high child health standards” that being underweight and showing stunted growth have a significant prevalence in rural communities.
With regard to the presence of non-alcoholic fatty liver disease, Kiridana et al., explained that it is difficult to derive any significance from the result for this due to the lesser number of children presenting to undergo the ultrasound scan procedure (there was also a poor response rate as far as presenting for blood investigations was concerned), which they observed, could be in turn attributed to the lack of awareness among the public including parents and children in this instance concerning the negative impacts of being overweight and obese, and their complications.