Objectives: To determine changes and factors associated with child malnutrition, obesity in women and household food insecurity before and after the first wave of COVID-19 pandemic. Design: A prospective follow-up study. Setting: In 2019, the baseline Urban Health and Nutrition Study 2019 (UHNS-2019) was conducted in 603 households, which were selected randomly from 30 clusters to represent underserved urban settlements in Colombo. In the present study, 35 % of households from the UHNS-2019 cohort were randomly selected for repeat interviews, 1 year after the baseline study and 6 months after COVID-19 pandemic in Sri Lanka. Height/length and weight of children and women were re-measured, household food insecurity was reassessed, and associated factors were gathered through interviewer-administered questionnaires. Differences in measurements at baseline and follow-up studies were compared. Participants: A total of 207 households, comprising 127 women and 109 children were included. Results: The current prevalence of children with wasting and overweight was higher in the follow-up study than at baseline UHNS-2019 (18·3 % v. 13·7 %; P = 0·26 and 8·3 % v. 3·7 %; P = 0·12, respectively). There was a decrease in prevalence of child stunting (14·7 % v. 11·9 %; P = 0·37). A change was not observed in overall obesity in women, which was about 30·7 %. Repeated lockdown was associated with a significant reduction in food security from 57 % in UHNS-2019 to 30 % in the current study (P < 0·001). Conclusions: There was an increase in wasting and overweight among children while women had a persistent high prevalence of obesity. This population needs suitable interventions to improve nutrition status of children and women to minimise susceptibility to COVID-19.

Aim The present study aims to investigate the composition and availability of weight‐loss supplements in Sri Lanka and explore the evidence for their effectiveness. Methods Data were collected by visiting drug stores, searching the Internet for websites and referring to advertisements in national newspapers and magazines from August to October 2017. Results A total of 100 weight‐loss products were identified of which the majority (n = 57) were available from drug stores. Most commonly, products were available in capsule form (36.0%). The number of active ingredients in products varied from 1 to a maximum of 22 with a total of 155 different active ingredients distinguished. The ingredients mainly originated from plants (77.4%) while green tea (Camellia sinensis), garcinia (Garcinia cambogia) and caffeine anhydrous were the three most common. At least one of the top 10 ingredients was included in 75 of the products sourced. Directions for use were specified in only 72 products, while a further 6 products lacked any information on ingredients. Literature predicted positive weight‐loss effects for green tea and ginger while garcinia was reported for both positive and negative effects. Conclusions The ingredients are reported to have both beneficial and adverse effects. Many consumers may find it challenging to make informed purchase decisions as a number of products failed to provide adequate nutritional information and safety measures. Government regulatory authorities should pay closer attention to the availability and provision of products sold to the general public.

Background Vitamin D deficiency (VDD) and insufficiency (VDI) are public health problems in many countries, and limited data is available on the prevalence of VDD/VDI in Sri Lanka. Objectives To determine the prevalence and associated factors of VDD in children aged 10-18 years. Methods This was a cross-sectional study among school children aged 10-18 years at national level. A representative sample of 2525 children were recruited from July to November 2017. Serum 25(OH)D concentration and the patterns of vitamin D rich food consumption were assessed. VDD and VDI cut offs were set at serum 25(OH)D concentrations of <12 ng/mL and 12-20 ng/ mL, respectively as defined by global consensus in 2016. Results The mean serum 25(OH)D level was 19.3±7.4 ng/mL. The prevalence of VDD and VDI were 13.2% (95% CI: 11.9%-14.5%) and 45.6% (95% CI: 43.7%-47.5%), respectively. The prevalence of VDD was highest in the central province (32.2%) and highest prevalence of VDI was in the Sabaragamuwa province (58.9%). VDD and VDI were lowest in North Central province (0.7% and 34.7%, respectively). Significantly higher serum 25(OH)D levels were observed with male gender (p=0.000), BMI for age <-2SD (p=0.000), daily milk consumption (p=0.000) and residing in dry zone (p=0.000). Conclusions Though Sri Lanka is a tropical country, VDD is prevalent among school children aged 10-18 years. It is important to develop a VDD preventive strategy, especially for high risk groups.

Sri Lanka has initiated a salt reduction strategy in 2019 to reduce salt consumption to 8 g/day by 2025. Recent national level salt consumption data is lacking. Although 24hour urine (24-hU) collection is the gold standard to assess salt intake, an alternative easy option for monitoring population salt consumption is needed. Objectives of this study were to assess the current salt, potassium, and iodine intake of adults based on 24-hU, and identify the best prediction equation to estimate these nutrients from spot urine (SU) samples. A crosssectional study was conducted among adults between 25-64 years of age. 24-hU and SU samples were collected. Several equations were used to estimate salt, potassium, and iodine from SU samples. The agreement between the estimates from 24-hU and SU was assessed through Bland-Altman plots and intraclass correlation coefficients. Among 852 adults recruited, 629 provided complete 24-hU. Measured 24-hU salt, potassium and iodine were: 11.4 (IQR 7.7-17.1) g, 2.1 (95 % CI 1.9-2.2) g and 209.8 (IQR 130.9-310.9) µg, respectively. Comparison of estimates from 24-hU and SU samples showed that Kawasaki equation provided the closest estimate for salt intake [median bias -0.4(5.2-4.0) g; ICC 0.39; misclassification 13.6 %]; the equations used to estimate potassium intake performed poorly; while the Zimmerman equation provided the closest estimate for iodine [median bias -13.2 (-129.8-92.7) µg; ICC 0.33; misclassification 37.2 %]. The adult population studied in Sri Lanka had high salt, low potassium, and optimum iodine intakes compared to the WHO recommendations. Collection of 24-hU in a subset of SU samples will be important to monitor the salt reduction efforts.

IntroductionMaternal obesity is a recognised risk factor for gestational diabetes mellitus (GDM). Maidstone and Tunbridge Wells' trust protocol originally screened all women with a body mass index (BMI) ≥35 with an oral glucose tolerance test (OGTT). Recently, guidelines were unifi ed with National Institute for Health and Clinical Excellence recommendations, suggesting testing all women with a BMI ≥30. Aim To determine if the prevalence of GDM in women with BMI 30-34 justifi es screening this subgroup with an OGTT. Method The OGTT results for 139 women with BMI ≥30 over 6 months were obtained from the diabetic nurse's notes. Patient notes for women with a positive OGTT were obtained to determine additional risk factors for GDM for which they would have been tested with OGTT regardless of their BMI. Results 56/139 patients had a BMI 30-34 and 83/139 patients had a BMI ≥35. Of patients with BMI 30-34, 5/56 (8.9%) were positive for GDM, of which 4/5 (80%) had additional risk factors for GDM. Of patients with BMI ≥35, 8/83 (9.6%) had GDM, of which 4/7 (57.1%) had additional risk factors for GDM.

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Background International labour migration continues to be an integral component in Sri Lanka’s economic development. Previous research indicates an adverse perinatal outcome in association with low maternal pre-pregnancy body mass index (PBMI) and gestational weight gain (GWG). However, evidence of this association is limited in migrant families. This study aims to investigate the associations between PBMI, GWG among lactating mothers (LM), and fetal outcomes in migrant households, where the father is the migrant worker. Methods A secondary data analysis was done using a nationally representative sample of 7,199 LM. There were 284 LM whose husbands were international migrant workers. Maternal factors were taken as PBMI<18.5 kg/m2 and GWG<7kg. Preterm birth and low birth weight (LBW) were taken as fetal outcomes. Binary logistic regression was performed to assess the associated factors. Results There was significant difference between LM from migrant and non–migrant households with regards to place of residency, ethnicity, household monthly income, household food security, average household members, husband’s education and husband’s age. Among migrant, PBMI<18.5 kg/m2 was associated with current BMI and mode of delivery. Migrant LM had significantly higher weight gain (≥12 kg) during pregnancy (p=0.005), were multiparous (p=0.008), delivered in private hospital (p=0.000), lesser percentage of underweight (p=0.002) and higher birthweight (p=0.03) than non-migrant LM. Logistic regression model revealed that for each kilogram increment in birthweight and GWG, preterm delivery decreased by 89%(OR=0.11;95%CI:0.04-0.28) and LBW decreased by 12%(OR=0.89;95%CI:0.81-0.97) respectively. Caesarean deliveries were positively associated with low GWG. Conclusion Our study showed LM in migrant families had invested remittances to utilize private health facilities for deliveries, to improve weight gain during pregnancy and adequate PBMI to deliver higher birth weight babies. In depth study is needed to understand further utilisation of remittances to improve fetal outcomes by increasing birthweight and GWG in migrant families.