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Establishing the burden of undiagnosed CVD risk factors is critical to monitoring public health efforts related to screening and diagnosis.To assess the proportion and determinants of undiagnosed diabetes, hypertension, and hypercholesterolaemia, among overweight or obese adults.A sample of 1200 participants aged 35-64 years with a BMI ≥25 kg/m2 was selected from the Colombo district. Data were collected through a questionnaire, anthropometry, blood pressure measurement, and blood sampling for fasting plasma glucose, HbA1c, and lipid profile. Undiagnosed diabetes, hypertension, and hypercholesterolaemia were defined as fasting plasma glucose ≥126 mg/dL or HbA1c ≥6.5%; systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg; total cholesterol ≥240 mg/dl respectively, in a person without a previous diagnosis. Multiple logistic regression analyses were carried out to identify determinants.The prevalence (95%CI) of diabetes was 28% (25.5, 30.5), hypertension, 33.4% (30.7, 36.1) and hypercholesterolaemia, 31.9% (29.2, 34.5). The proportion of undiagnosed diabetes was 13.8% (11.9, 15.8), undiagnosed hypertension 11.3% (9.5, 13.1), and undiagnosed hypercholesterolaemia 17.8% (15.6, 19.9). Undiagnosed cases accounted for almost half of all diabetes cases, one-third of all hypertension cases, and more than half (56%) of all high cholesterol cases. The key determinants for undiagnosed CVD risk were: male sex, low or middle income, rural residence, and relatively younger age.CVD screening programmes should be tailored to target populations based on these determinants and provide basic diagnostic facilities in all health centres. The 'proportion undiagnosed' in the population may be a useful indicator to evaluate their effectiveness.

Background: The indigenous population in Sri Lanka called “Veddas” estimated to be around 0.05% of the total population in the island. This population is unique that they used to live mostly in jungles with primitive lifestyles. The objective was to study the cardiovascular risk factors in this indigenous (Vadda) community.Methods: A descriptive cross-sectional study was carried out with convenience sampling method, by inviting all adults (> 18 years) in the indigenous village Pollebedda. Height, weight and blood pressure was measured, and fasting blood samples were analyzed for glucose, lipids and haemoglobin. Data were analyzed using SPSS (version 22)0.Results: Response rate was approximately 39%. Out of total 121 participants 47 were males and 74 were females. The mean age was 44.29 +14.75 years and 12 were elders> 65 years of age. In the sample 17.3% were obese (BMI>27.5) while 24.8%% were overweight (BMI 23-27.5). The crude prevalence of diabetes, hypertension and raised total cholesterol were 7.2%, 12.4% 7.7% respectively. Prevalence of low HDLC (< 40mg/dL in men,< 50 mg/dL in women), high LDLC (>160 mg/dL) and elevated triglycerides (>150mg/dL) were 75.2%, 7.7% and 25.6% respectively. Isolated hypertriglyceridemia was present in 20.5%.Conclusions: There is a rising trend of obesity and diabetes in this indigenous community compared to previous study. This highlights that the indigenous peoples in Sri Lanka share the relatively high rates of coronary artery risk factors observed among other indigenous groups around the world. Changes in lifestyle and diet, poverty, poor health seeking behavior and limited access to health care due to limitation in transport are possible risk factors for this trend which needs to be further evaluated. A local and global initiative is required to control cardiovascular disease risk factors among indigenous groups.

Background: Incidentalomas of endocrine glands are a common problem in endocrine practice. Data on their prevalence are limited from South Asian settings. Objective: We aimed to describe incidentalomas and other histopathological abnormalities in an autopsy series of Sri Lankans. Methods: Consecutive autopsies performed at Judicial Medical Office, Colombo from December 2014 to December 2016 were screened and the deceased without a diagnosed endocrinopathy (except diabetes) were included in the study. Pituitary, thyroid, adrenal, pancreas and ovarian specimens were sampled and examined both macroscopically and under light microscopy with Haemotoxylin Eosin stain. Results: Among 441 autopsies (mean age 52.5 years, male 77.8%) examined, pituitary, thyroid, adrenal, pancreatic and ovarian nodules were detected in 0.8%, 37.2%, 1.8%, 1.3% and 18.4% respectively. Thyroid neoplasms were present in 6.4%, of which 87.5% were papillary carcinoma or papillary microcarcinoma and it was associated with background thyroiditis (χ2 = 4.05, p = 0.04) or nodular thyroid enlargement (χ2 = 32.68, p Conclusions: In this population of Sri Lankan adults, prevalence of thyroid incidentalomas, neoplasms and thyroiditis are comparable to published studies from the West. Papillary carcinoma or microcarcinoma was the commonest type and it showed a predilection to affect thyroid glands with background thyroiditis. Pituitary, pancreatic and adrenal incidentalomas and neoplasms were less prevalent.

Introduction Establishing the burden of undiagnosed CVD risk factors is critical to monitoring public health efforts related to screening and diagnosis. Objective To assess the proportion and determinants of undiagnosed diabetes, hypertension, and hypercholesterolaemia, among overweight or obese adults. Methods A sample of 1200 participants aged 35-64 years with a BMI ≥25 kg/m2 was selected from the Colombo district. Data were collected through a questionnaire, anthropometry, blood pressure measurement, and blood sampling for fasting plasma glucose, HbA1c, and lipid profile. Undiagnosed diabetes, hypertension, and hypercholesterolaemia were defined as fasting plasma glucose ≥126 mg/dL or HbA1c ≥6.5%; systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg; total cholesterol ≥240 mg/dl respectively, in a person without a previous diagnosis. Multiple logistic regression analyses were carried out to identify determinants. Results The prevalence (95%CI) of diabetes was 28% (25.5, 30.5), hypertension, 33.4% (30.7, 36.1) and hypercholesterolaemia, 31.9% (29.2, 34.5). The proportion of undiagnosed diabetes was 13.8% (11.9, 15.8), undiagnosed hypertension 11.3% (9.5, 13.1), and undiagnosed hypercholesterolaemia 17.8% (15.6, 19.9). Undiagnosed cases accounted for almost half of all diabetes cases, one-third of all hypertension cases, and more than half (56%) of all high cholesterol cases. The key determinants for undiagnosed CVD risk were: male sex, low or middle income, rural residence, and relatively younger age. Conclusion CVD screening programmes should be tailored to target populations based on these determinants and provide basic diagnostic facilities in all health centres. The 'proportion undiagnosed' in the population may be a useful indicator to evaluate their effectiveness.

Introduction: Congenital adrenal hyperplasia (CAH) requires lifelong glucocorticoid therapy (GCT). Long- term use of GCT is known to adversely affect bone metabolism. Vitamin D synthesis in the skin can be impaired by the hyperpigmentation seen in CAH patients. Objectives: To describe the effects of glucocorticoid therapy and vitamin D status on the bones in children with CAH. Method: Children with CAH followed up in the University Unit at the Lady Ridgeway Hospital, Colombo were studied. Mean values of the daily dose of hydrocortisone received, serum calcium, intact parathormone (iPTH) and 25-hydroxy vitamin D levels were compared with the duration of therapy categorized into 3 groups. Skin pigmentation was graded using the Fitzpatrick scale and was described with the biochemical parameters according to vitamin D status (sufficiency >50nmol/L). Results: Thirty eight children were studied. Mean daily dose of hydrocortisone of children treated for less than 4 years (n=6), 4 to 7 years (n=6) and more than 7 years (n=26) were 14.0, 13.4, and 14.0 mg/m2/day respectively (recommended dose 10-15 mg/m2/day). Mean serum calcium levels (2.53, 2.41, 2.28mmol/L) and iPTH levels (3.59, 4.46, 6.30pmol/L) were in the normal range and vitamin D levels (47.55, 47.97, 44.44nmol/L) were in the insufficient range. The differences between the groups were not significant. However, the difference seen in alkaline phosphatase (ALP) was significant (p=0.026). There was also an apparent inverse association of ALP with the total average daily dose of glucocorticoids (R2=0.077, F=3.0, p=0.092). Vitamin D deficiency (≤37.5nmol/L) was seen in 8 (21.1%) patients. Degree of pigmentation and biochemical parameters assessed were not significant according to vitamin D status. Conclusions: Serum ALP levels show an inverse relationship with the duration of glucocorticoid therapy indicating possible adverse outcome on bones. The apparent inverse relationship of total average daily dose of glucocorticoids with ALP failed to reach statistical significance. No relationship was found with vitamin D status and other parameters assessed.

Background Apolipoproteins B (apoB) and AI (apoAI) are strong predictors of cardiovascular disease (CVD). We describe apolipoprotein distributions and their associations with lipids and diabetes subtype in diabetic young adult South Asians. Methods In 995 subjects with diabetes, we measured fasting total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), triglycerides (TG), apoB and apoAI, glycosylated haemoglobin (HbA1c) and glutamic acid decarboxylase antibodies (GADA). Low-density lipoprotein cholesterol (LDLC) and non-HDLC (NHDLC) were calculated. We compared values in subjects aged 15–50 y from the United States National Health and Nutrition Examination Survey (NHANES). Results Median age and duration of diabetes were 38 (range 14–45) and 4 (0–24) y. Men had significantly higher TC, TG, NHDLC, TC/HDLC, apoB/AI and NHDLC/apoB, and lower apoAI than women. Compared with the reference group, patients with type 1 diabetes had lower TG, apoB:apoAI and HDLC:apoAI, and higher HDLC and apoAI. Patients with type 2 diabetes had higher TG, TC, LDLC, NHDLC, TC:HDL, apoB, apoAI and apoB:apoAI, and lower HDLC, LDLC:apoB and HDLC:apoAI. Among patients with type 2 diabetes, 54% had high apoB (>1.2 g/L) and 33% also had high TG (>1.5 mmol/L). Measures of obesity (body mass index and waist circumference) were weakly correlated with lipid and apoprotein parameters, suggesting a modest contribution to dyslipidaemia. Conclusions A large proportion of young adult Sri Lankan patients with type 2 diabetes has a low LDLC:apoB and high apoB and/or TG, suggesting that these patients are at increased risk of CVD.

AIMS/HYPOTHESIS: Diabetes mellitus is increasing among young adult South Asians. The aim of this study was to determine the prevalence and phenotypic characteristics of diabetes subtypes based on GAD65 autoantibody (GADA) status in those with young adult-onset diabetes in Sri Lanka. METHODS: Clinical, metabolic and GADA data were available for 992 consecutively recruited individuals with diabetes aged < or =45 years (age at diagnosis 16-40 years). Participants were classified according to the following definitions: type 1 diabetes, insulin-dependent or =30 years and insulin-independent > or =6 months from diagnosis; type 2 diabetes, GADA-negative and insulin-independent > or =6 months from diagnosis. RESULTS: The median (interquartile range) age at diagnosis and diabetes duration were 33.0 (29.0-36.1) and 4.0 (1.1-7.1) years, respectively; 42.1% were male. GADA positivity was seen in 5.4% of participants (n = 54) and GADA levels negatively correlated with age at diagnosis (p < 0.0001), BMI (p < 0.0001) and time to insulin requirement (p = 0.006). Type 1 diabetes, type 2 diabetes and LADA were present in 7.0%, 89.7% and 2.6%, respectively. The remaining 0.7% of the participants were GADA-positive, insulin independent > or =6 months from diagnosis and were diagnosed at age