Bishwajit Bhowmik

Bio: Bishwajit Bhowmik is an academic researcher from University of Oslo. The author has contributed to research in topics: Population & Diabetes mellitus. The author has an hindex of 13, co-authored 36 publications receiving 826 citations. Previous affiliations of Bishwajit Bhowmik include Bangladesh University & Bangladesh Institute of Research and Rehabilitation for Diabetes Endocrine and Metabolic Disorders.

Serum Lipid Profile and Its Association with Diabetes and Prediabetes in a Rural Bangladeshi Population

Abstract: Dyslipidemia is commonly associated with diabetes (T2DM). This has been demonstrated for the Caucasian population, but few data are available for Asian Indians. The paper aims to investigate serum lipids (separately or in combination) and their association with glucose intolerance status (T2DM and prediabetes) in a rural Bangladeshi population. A sample of 2293 adults (≥20 years) were included in a community based cross-sectional survey in 2009. Anthropometric measures, blood pressure, blood glucose (fasting and 2-h oral glucose tolerance test) and fasting serum lipids (total cholesterol, T-Chol; triglycerides, Tg; low density lipoprotein cholesterol, LDL-C and high density lipoprotein cholesterol, HDL-C) were registered. Analysis of covariance (ANCOVA) and regression analysis were performed. High Tg levels were seen in 26% to 64% of the participants, depending on glucose tolerance status. Low HDL-C levels were seen in all groups (>90%). Significant linear trends were observed for high T-Chol, high Tg and low HDL-C with increasing glucose intolerance (p for trend <0.001). T2DM was significantly associated with high T-Chol (Odds ratio (OR): 2.43, p < 0.001), high Tg (OR: 3.91, p < 0.001) and low HDL-C (OR: 2.17, p = 0.044). Prediabetes showed a significant association with high Tg (OR: 1.96, p < 0.001) and low HDL-C (OR: 2.93, p = 0.011). Participants with combined high Tg and low HDL-C levels had a 12.75-fold higher OR for T2DM and 4.89 OR for prediabetes. In Asian Indian populations an assessment of serum lipids is warranted not only for T2DM patients, but also for those with prediabetes.

Prevalence of obesity in a rural Asian Indian (Bangladeshi) population and its determinants.

Abstract: Obesity has reached epidemic proportions worldwide including Bangladesh. To assess the prevalence and associated factors of general and central obesity in a rural Bangladeshi population based on newly proposed cut off level for Asian population. 2293 subjects aged ≥20 years from rural Bangladesh were randomly recruited to participate in a population-based, cross sectional survey, conducted in 2009. Both socio-demographic and anthropometric measurements were recorded. Age adjusted data for anthropometric indices were examined. The age standardized prevalence of overweight (BMI 23-24.9 kg/m2) and obesity (BMI ≥25 kg/m2) were 17.7 (95 % confidence interval (CI): 16.1, 19.2 %) and 26.2 % (95 % CI: 24.4, 27.9 %), respectively. The age standardized prevalence of central obesity based on WC (M ≥90 & F ≥80 cm) and WHR (M ≥0.90 & F ≥0.80) were 39.8 % (95 % CI: 37.9, 41.7 %) and 71.6 % (95 % CI: 69.8, 73.4 %) respectively. The result shows that prevalence of central obesity was more in female than male. Study shows middle age, medium and high socioeconomic status (SES), low education levels, physical inactivity, high consumption of carbohydrate, protein and fat, were significant risk indicators for general and central obesity. Smoking was shown as protective factor for both general and central obesity. In rural Bangladeshi population, the prevalence of both general and central obesity was high among both sexes with the use of newly proposed cut off points for Asian population. Gender, diet, physical activity, education levels and SES were associated with the increase prevalence of obesity.

Prevalence of Type 2 Diabetes and Impaired Glucose Regulation with Associated Cardiometabolic Risk Factors and Depression in an Urbanizing Rural Community in Bangladesh: A Population-Based Cross-Sectional Study

Abstract: Background To determine the prevalence of type 2 diabetes (T2DM) and impaired glucose regulation (impaired fasting glucose [IFG] and impaired glucose tolerance [IGT]) in an urbanizing rural population of Bangladesh and associated cardiometabolic risk indicators and depression. Methods A total of 2,293 subjects aged ≥20 years in an urbanizing rural Bangladeshi community were investigated. Socio-demographic and anthropometric details, blood pressure, fasting plasma glucose (FPG), 2 hours after 75 g plasma glucose (2hPG), glycosylated hemoglobin, fasting serum insulin and lipid profiles were studied. Presence of depressive symptoms using Montogomery-Asberg Depression Rating Scale was also assessed. Results The prevalence of IFG, IGT, IFG+IGT, and T2DM were 3.4%, 4.0%, 1.2%, and 7.9%, respectively. The prevalence of T2DM and impaired glucose regulation differed between males and females, but, both increased with age in both sexes. FPG and 2hPG had positive correlation. Employing logistic regression, it was found that increased age, waist to hip ratio, systolic blood pressure, total cholesterol, triglycerides, and depression were independent risk indicators for diabetes. Both insulin resistance and β-cell deficiency were significantly related for causation of diabetes. Among the study population, 26.2% had general obesity, 39.8% central obesity, 15.5% hypertension, 28.7% dyslipidemia, 17.6% family history of diabetes, and 15.3% had depression. Physical inactivity and smoking habits were significantly higher in male. Conclusion Rising prevalence of diabetes and impaired glucose regulation in this urbanizing rural population exist as a significant but hidden public health problem. Depression and other cardiometabolic risk indicators including obesity, hypertension, and dyslipdemia were also prevalent in this population.

Prevalence of Diabetes Mellitus and its Associated Risk Indicators in a Rural Bangladeshi Population

Abstract: Background: Substantial racial heterogeneity in diabetes leads to the necessity of conducting epidemiological studies in different communities. Such studies are still inadequate in Bangladeshi population, particularly in truly respective rural areas. The objectives of the study were to estimate the prevalence of diabetes and to identify its associated risk indicators in a rural population of Bangladesh. Methods: This population based cross-sectional study was conducted in remote rural areas of Northern Bangladesh, which included a total of 836 participants aged at or above 25 years through screening in camp settings. Diabetes was diagnosed by WHO criteria after a 2-sample OGTT. BMI, waist-hip ratio, blood pressure, lipid profile and serum creatinine were also estimated. Results: The prevalence of diabetes was found to be 7.2% (95% CI 5.4-9.0) and that of impaired glucose regulation (including both impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG)) was 6.5% (95% CI 4.8-8.2). The prevalence of diabetes and impaired glucose regulation differed between males and females, but, both increased with age in males as well as females. A good correlation was observed between fasting blood glucose and 2hr after glucose (Kappa value 0.86) among the study participants. After adjusting for potential confounders BMI and WHR were found as significant independent risk indicators for the occurrence of diabetes in this population.

Standards of Medical Care in Diabetes

Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Abstract: Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss

Abstract: Diabetic retinopathy (DR) is a leading cause of vision-loss globally. Of an estimated 285 million people with diabetes mellitus worldwide, approximately one third have signs of DR and of these, a further one third of DR is vision-threatening DR, including diabetic macular edema (DME). The identification of established modifiable risk factors for DR such as hyperglycemia and hypertension has provided the basis for risk factor control in preventing onset and progression of DR. Additional research investigating novel risk factors has improved our understanding of multiple biological pathways involved in the pathogenesis of DR and DME, especially those involved in inflammation and oxidative stress. Variations in DR prevalence between populations have also sparked interest in genetic studies to identify loci associated with disease susceptibility. In this review, major trends in the prevalence, incidence, progression and regression of DR and DME are explored, and gaps in literature identified. Established and novel risk factors are also extensively reviewed with a focus on landmark studies and updates from the recent literature.

COVID-19 infection alters kynurenine and fatty acid metabolism, correlating with IL-6 levels and renal status.

Abstract: BACKGROUNDReprogramming of host metabolism supports viral pathogenesis by fueling viral proliferation, by providing, for example, free amino acids and fatty acids as building blocksMETHODSTo investigate metabolic effects of SARS-CoV-2 infection, we evaluated serum metabolites of patients with COVID-19 (n = 33; diagnosed by nucleic acid testing), as compared with COVID-19-negative controls (n = 16)RESULTSTargeted and untargeted metabolomics analyses identified altered tryptophan metabolism into the kynurenine pathway, which regulates inflammation and immunity Indeed, these changes in tryptophan metabolism correlated with interleukin-6 (IL-6) levels Widespread dysregulation of nitrogen metabolism was also seen in infected patients, with altered levels of most amino acids, along with increased markers of oxidant stress (eg, methionine sulfoxide, cystine), proteolysis, and renal dysfunction (eg, creatine, creatinine, polyamines) Increased circulating levels of glucose and free fatty acids were also observed, consistent with altered carbon homeostasis Interestingly, metabolite levels in these pathways correlated with clinical laboratory markers of inflammation (ie, IL-6 and C-reactive protein) and renal function (ie, blood urea nitrogen)CONCLUSIONIn conclusion, this initial observational study identified amino acid and fatty acid metabolism as correlates of COVID-19, providing mechanistic insights, potential markers of clinical severity, and potential therapeutic targetsFUNDINGBoettcher Foundation Webb-Waring Biomedical Research Award; National Institute of General and Medical Sciences, NIH; and National Heart, Lung, and Blood Institute, NIH

BMI(Body Mass Index)가 소득에 미치는 영향

Abstract: 개인의 소득에 영향을 미치는 요인으로 교육수준, 숙련도, 개인의 능력 등 무수히 많은 요인들을 생각할 수 있다. 본 연구는 이러한 여러 요인들 중에서 특히 체형(Bodily shape)가 소득에 어느 정도 영향을 미치는가에 대한 정확한 인과관계를 고찰하고자 하였다. 본 논문에서는 체형에 대한 대리변수(Proxy variable)로 체질량지수(Body Mass Index: BMI)를 사용하였으며, BMI가 갖는 내생성을 통제하여 기존의 연구들이 정확히 고찰하지 못한 BMI가 소득에 얼마나 영향을 미치는 지에 대한 인과관계를 규명하려고 하였으며 이를 위해 Two stage estimation method를 사용하였다. 1단계 추정과정에서 식료품 소비자물가지수를 도구변수로 활용하여 BMI를 추정하였고, 이렇게 추정된 BMI를 2단계 추정과정에 사용하여 체형이 소득에 미치는 영향을 고찰하였다. 추정 결과, 전체 표본을 대상으로 한 분석에서 소득수준이 낮은 구간에서는 BMI로 표현된 체형이 소득수준에 미치는 영향이 유의하였으나, 소득수준이 높은 구간에서는 이러한 영향이 유의하지 않았다. 이를 성별로 구분하여 분석해본 결과, 여성의 경우에는 BMI가 과소체중 상태(Underweight) 및 과체중 상태(Overweight)에 해당될 경우 모두 정상체중 상태의 사람에 비해 해당소득구간 대비 고소득구간에 포함될 확률이 낮아진다는 사실을 알수 있었던 반면 남성의 경우에는 과소체중 상태의 사람들의 소득수준에 BMI의 음의 영향이 발견되었을 뿐, 과체중 상태에 있는 사람의 경우 음의 영향이 발견되지 않았다. 따라서 남성의 경우보다 여성의 경우 BMI의 소득에 미치는 영향력이 상대적으로 큰 것으로 나타났다.