PhD Thesis

Effects of Dietary Counseling and Physical Activities on Overweight and Obesity among Adolescents Visiting a Tertiary Care Hospital, Dhaka

Sun, 18 Oct 2026 00:00:00 GMT

Effects of Dietary Counseling and Physical Activities on Overweight and Obesity among Adolescents Visiting a Tertiary Care Hospital, Dhaka Ahsan, Mohammed Rizwanul Background: Adolescent overweight and obesity are rapidly increasing in low- and middle-income countries, including Bangladesh, due to urbanization, lifestyle transitions, and changing dietary patterns. Increased consumption of energy-dense, processed foods, reduced physical activity, and growing screen dependency have significantly contributed to this trend. These conditions are associated with an early onset of noncommunicable diseases (NCDs), such as diabetes, cardiovascular diseases, and psychological disorders. Despite the recognized importance of lifestyle modification, limited evidence exists in Bangladesh regarding the effectiveness of combined dietary counseling and physical activity interventions among adolescents. Therefore, this study aimed to assess the impact of integrated lifestyle interventions on nutritional status, dietary behavior, physical activity, and psychological well-being among adolescents attending a tertiary care hospital in Dhaka. Methodology: A mixed-methods study design was employed, incorporating both quantitative and qualitative approaches. The study was conducted at the adolescent outpatient department of Bangladesh Shishu Hospital and Institute, Dhaka. The quantitative component followed a pre-post nonrandomized experimental design involving adolescents with overweight or obesity (BMI ≥25 kg/m², Asian cut-off). Data were collected at baseline and after intervention through face-to-face interviews using a pretested semi-structured questionnaire, along with anthropometric measurements and laboratory assessments. Dietary intake was assessed using a 24-hour recall and food frequency questionnaire (FFQ), while physical activity was measured using a modified Global Physical Activity Questionnaire (GPAQ). Psychological status was evaluated using the Strengths and viii Difficulties Questionnaire (SDQ). The intervention included individualized dietary counseling, structured diet plans, promotion of regular physical activity and psychological support. Participants were followed for up to 15 months with periodic monitoring. The qualitative component included case studies and focus group discussions (FGDs) with adolescents and parents to explore behavioral, environmental, and psychosocial factors influencing obesity. Quantitative data were analyzed using SPSS (version 26), applying descriptive statistics and inferential tests such as paired t-tests and chi-square tests. Qualitative data were analyzed using thematic analysis. Results: A total of 226 adolescents participated in the study, of whom 57.5% were male and 42.5% were female, with a mean age of 13.25 years. The majority (75.2%) were aged 10–14 years, and most participants belonged to urban (92.9%), nuclear family settings (88.9%) with good socioeconomic status (76.1%). Baseline dietary assessment revealed high consumption of carbohydrates and fats, with frequent intake of rice, fast foods, and low consumption of fruits, vegetables, and dairy products. Average daily intake included high carbohydrate (18.72 servings) and fat (11.68 servings) consumption, while fruit (0.51 servings) and milk intake (0.32 servings) were inadequate. Mean caloric intake before intervention was 2461.57 kcal, indicating excess energy consumption. Physical activity levels were low at baseline, with 71.7% of participants categorized as having low activity and none engaging in vigorous activity. Following intervention, there was a significant improvement in activity levels, with 46.5% achieving high physical activity. Mean MET scores increased significantly from 2.47 to 6.32 (p < 0.001). ix Psychological outcomes also improved significantly. The mean SDQ score decreased from 26.19 at baseline to 16.25 at follow-up (p < 0.001), indicating reduced emotional and behavioral difficulties. Anthropometric outcomes showed a progressive and statistically significant reduction in BMI across follow-up visits (p < 0.001). At baseline, 64.2% of participants were overweight and 35.8% were obese. After intervention, 70.8% achieved normal BMI, while only 9.7% remained overweight and 19.5% remained obese. Qualitative findings supported these results. Adolescents reported unhealthy dietary habits, high screen time, and experiences of bullying prior to intervention. Parents demonstrated limited awareness and often encouraged unhealthy eating behaviors. Post-intervention, both adolescents and parents reported improved dietary practices, increased physical activity, reduced screen dependency, and enhanced psychological well-being. Case studies further illustrated substantial individual improvements in weight, mental health, and social functioning. Conclusion: The study demonstrates that integrated interventions combining dietary counseling, physical activity, and psychological support are highly effective in improving both physical and mental health outcomes among adolescents with obesity. Adolescent obesity is a multifactorial condition requiring a holistic, family-centered approach. Early intervention and increased parental awareness are essential for sustainable lifestyle modification and long-term prevention of obesity-related complications. This thesis is submitted for the degree of Doctor of Philosophy.

Composition of plant polyphenolics in local cereals and pseudograins and their bioactivity

Tue, 04 Aug 2026 00:00:00 GMT

Composition of plant polyphenolics in local cereals and pseudograins and their bioactivity Rupa, Anjum Zerin Cereals and pseudocereals are increasingly acknowledged for their abundant polyphenolic chemicals, which exhibit advantageous health-promoting qualities, particularly in the prevention and management of non-communicable illnesses such as hyperlipidemia. Due to their higher profiles of antioxidants, flavonoids, dietary fibers, and other bioactive constituents, these grains are frequently utilized as functional foods globally. Cereal crops, including rice, wheat, maize, oats, barley, bajra, and millets (proso and foxtail), are extensively cultivated and consumed in Bangladesh, supported by established agronomic systems and governmental agricultural initiatives. In contrast, pseudocereals—quinoa (Chenopodium quinoa), chia (Salvia hispanica), buckwheat (Fagopyrum esculentum), and amaranth—exhibit limited production, consumption, and research activity. Despite their nutritional and medicinal benefits, pseudo-cereals are significantly undervalued in Bangladeshi cuisine. Current market trends indicate a probable transition towards an expanded national grain inventory as domestically cultivated pseudograins—such as chia, quinoa, cheena, and kaon—become increasingly accessible. A thorough nutritional and phytochemical analysis of both conventional cereals and novel pseudograins growing in Bangladesh is urgently required to facilitate this transformation. The ethnographic study examined the production, utilization, and socio-cultural significance of several cereals and pseudograins in Bangladesh, alongside their functional potential through biochemical analysis. The research examined the macronutrient composition of grains, total flavonoid and phenolic content, and antioxidant capacity. The in vitro assessment of their lipase inhibitory properties facilitated the determination of their potential function in regulating lipid metabolism. The study intends to ascertain the functional importance of cereals and pseudocereals in dietary management, nutrition-sensitive agriculture, and the prevention of v chronic diseases, particularly hyperlipidemia, in Bangladesh by integrating ethnographic knowledge with biochemical investigation. Methodology A qualitative, exploratory, longitudinal ethnographic study was undertaken to evaluate the production, consumption, and distribution patterns of cereals and pseudocereals throughout Bangladesh. Focus group discussions were employed to identify the patterns in local agriculture and utilization. Laboratory tests were conducted to determine the proximate composition, total phenolic content (TPC), total flavonoid content (TFC), total antioxidant capacity (TAC), total tanin content (TTC), antioxidant activity (via DPPH, ABTS, and FRAP assays), and polyphenol profiles employing HPLC-DAD screening. The lipase inhibitory activity was evaluated using the ELISA technique, and the I ₅₀ values were derived rom the absorbance o sample extracts at varying concentrations. Regression analyses were conducted to ascertain the correlation between the dose-dependent sample concentration and lipase enzyme inhibition. Results Ethnographic research indicated that 85% of black rice, 80% of red rice, and 99% of buckwheat were sold locally, while 100% of quinoa and chia production was still in the experimental phase. Cheena and kaon had the greatest protein content among cereals, at 13.48% and 13.55%, respectively, although chia and quinoa revealed elevated amounts of protein, fat, and dietary fiber, with chia at 22.40% protein. Black rice and yellow buckwheat exhibited enhanced antioxidant capabilities and phenolic contents. The highest concentration of TPC, TFC, TAC and TTC were observed in two pigmented rice sample extracts (red and black) among cereal samples and two types of buckwheat extracts (yellow and black) among pseudograin samples, respectively. HPLC profiling verified elevated concentrations of epicatechin in quinoa and red vi rice. Lipase inhibition experiments indicated that black rice (I ₅₀ = 10.25 ± 1.06 mg/mL) and yellow buckwheat (I ₅₀ = 15.69 ± 1.09 mg/mL) exhibited significant inhibitory effects relative to the standard epicatechin (I ₅₀ = 0.320 ± 0.90 mg/mL). Regression analysis demonstrated substantial correlations (P < 0.05) between polyphenolic content and lipase inhibition in red aman rice (R² = 0.9685), quinoa (F) (R² = 0.9646) and yellow buckwheat (R² = 0.9442), signifying robust predictive associations. Conclusion This extensive investigation shows that Bangladeshi cereal and pseudograins contain bioactive compounds with nutritional and therapeutic significance. Black rice, red aman rice, chia, quinoa, and yellow buckwheat displayed high total phenolic and flavonoid contents, strong DPPH, ABTS, and FRAP tests, and increased reducing power. HPLC profiling identified the presence of distinct polyphenols, including (-) epicatechin in red aman rice and quinoa. Several grains, including black rice (I ₅₀ = 10.25 mg/mL), yellow buckwheat (15.69 mg/mL), and quinoa (23.70 mg/mL), showed significant pancreatic lipase inhibition, suggesting a role in lipid metabolism. A regression research ound strong correlations (R² > 0.94, P < 0.05) between polyphenol content in methanolic extracts and lipase inhibition activity in red aman rice, quinoa, and yellow buckwheat. Despite their health advantages, pseudocereals are underrepresented in national agriculture and food systems. The results clearly imply including nutrient-dense, bioactive-rich cereals and pseudocereals in public nutrition and agro-food policy frameworks in Bangladesh to boost dietary diversity, chronic illnesses (hyperlipidemia) and sustainable agriculture This thesis is submitted for the degree of Doctor of Philosophy.

Effects of Vitamin-D 3 Supplement on the Cognitive Status in Patient with Systemic Lupus Erythematosus with Neuropsychiatric Phenomenon

Sun, 19 Apr 2026 00:00:00 GMT

Effects of Vitamin-D 3 Supplement on the Cognitive Status in Patient with Systemic Lupus Erythematosus with Neuropsychiatric Phenomenon Sultana, Nasreen Systemic Lupus Erythematosus (SLE) is a complicated autoimmune illness that affects several organ systems, including the central nervous system. Neuropsychiatric (NP) SLE (NPSLE) is characterized by neurological and psychiatric symptoms such as cognitive dysfunction, mood problems, and seizures, and has been linked to severe impairments in memory, attention, and executive functioning can lead to altered brain perfusion. Vitamin D3 has shown promise in neuro-protection and cognitive improvement, which may benefit NPSLE patients. This study investigates the effects of Vitamin D3 supplementation on cognitive function and brain perfusion in NPSLE patients. Material & Methods This randomized controlled trial (RCT) included NPSLE patients (N=72), divided into an intervention group (n=34) receiving Vitamin D3 supplementation, and a control group (n=38) without supplementation. Baseline and six-month evaluations of serum Vitamin D levels, Mini-Mental State Examination (MMSE) scores, and brain perfusion using Single-photon emission computed tomography (SPECT) imaging (Z-scores) were conducted at National Institute of Nuclear Medicine & Allied Science (NINMAS), Dhaka. The intervention group received 40,000 IU of Vitamin D3/week for six weeks, followed by a maintenance dose of 2000 IU/day for three months, along with standard SLE management. Both verbal and written informed consent was obtained, and adherence was encouraged through weekly reminders via text or calls. After six months, outcomes were analyzed to assess the impact of Vitamin D3 on cognitive function and brain perfusion in NPSLE patients. xv Results Baseline characteristics (age, gender, BMI, and waist-to-hip ratio/WHR) were indifferent (P>0.05) between groups (Control vs. cases). No significant differences (P>0.05) were found between groups in age (28.24±7.18 vs. 26.32±7.94,), gender distribution (predominantly female), BMI (19.0±1.4 vs.19.2±2.0,), and waist-to-hip ratio (0.78±0.11 vs. 0.76±0.10). Moreover, at baseline, vitamin D levels were low and similar across both groups (14.5±5.3 ng/ml vs. 16.2±4.9, p=0.173). After the study period, a significant (p<0.001) increase in vitamin D3 levels (28.3±5.3 ng/ml) was observed in the intervention group as compared to controls (15.1±3.4 ng/ml), indicating effective supplementation. Moreover, at baseline, MMSE scores were similar (24.1±1.7 vs. 24.3±1.5) between groups (P=0.677) while at the end line, the intervention group (26.5±1.4) showed a significant improvement in MMSE scores than control (23.8±2.25; p<0.001). This suggests a positive effect of Vitamin D3 supplementation on cognitive function. Brain perfusion was analyzed using SPECT imaging techniques (Z-scores), and at baseline, abnormal perfusion was prevalent in both groups (81.6% vs. 88.2%, P=.522), primarily in the frontal, parietal lobes, and precuneus regions (z-score: 1.4 vs. 1.46, P=0.549). This baseline homogeneity indicates effective randomization and establishes comparable initial conditions between the study groups. However, at the end line, mean z-scores were insignificantly (P=.457) higher in the control group (n=13, z-scores=1.84) than intervention group (n=21, z- scores=1.66) while 65.8% (n=25) of the Brain SPECT of the controls were not available at end line, as compared to cases (n=13). On top of that, significant between-group differences emerged in performing perfusion test results (Fisher’s exact test= 6.997, p = 0.028) when considered comparison in missing cases between groups, which indicates among available controls (n=13), eleven xvi showed abnormal brain perfusion. Furthermore, the intervention group demonstrated distinct patterns of perfusion compared to controls, suggesting a potential effect of Vitamin D3 supplementation on cerebral perfusion parameters. These findings suggest that despite the study groups (intervention vs. control) exhibited indifferent (all P>0.05) vitamin D3 levels, MMSE scores, and perfusion characteristics at the baseline, significant differences emerged between groups especially in the MMSE-scores (small effect size, Partial eta squared=.460 for MMSE between case and. control) attributable to the effective vitamin D3 supplementation (High effect size, Partial eta squared=.714 for Vitamin D, Case vs. control) following the intervention period (6-months). Conclusion Vitamin D3 supplementation led to substantial improvements in serum vitamin D levels, cognitive function (MMSE scores), and brain perfusion in the intervention group. These findings support the potential role of Vitamin D3 as an adjunctive therapy in NPSLE, enhancing cognitive performance and cerebral perfusion. Further studies are recommended to validate these results and assess the long-term benefits of Vitamin D3 in managing NPSLE-related cognitive impairment This thesis is submitted for the degree of Doctor of Philosophy.

Evaluation of Nutritional and Developmental Consequences and Renal Function of Children who Recovered from Hypernatremia

Sun, 19 Apr 2026 00:00:00 GMT

Evaluation of Nutritional and Developmental Consequences and Renal Function of Children who Recovered from Hypernatremia Huq, Sayeeda Hypernatremia (HN), defined as high sodium in the blood (≥145 μmol/L), is a serious complication of diarrheal diseases in children. However, clinical manifestations are usually observed in children in developing countries at the level of 150 μmol/L The primary cause of HN is excessive water loss relative to sodium loss. The resulting hyperosmolality can lead to neuronal cell shrinkage, causing brain injury, including widespread cerebral hemorrhage, thrombosis, subdural effusion, and permanent neurological deficits. Retrospective study conducted in icddr,b showed that 2.4-5.1% children with diarrhea had hypernatremia and case fatality ranges from 15-9%(Chisti et al., 2016).Deaths are often attributed to the severe effects of HN on the brain or to rapid rehydration, which can result in cerebral edema. A prospective observational study was conducted at Dhaka Hospital of icddr,b from August 2013 to October 2015. In total, 259 children under five years old were enrolled. After treatment, 224 children were successfully discharged. The death rate was 13.5%, with neurological sequelae in 29.9%, acute kidney injury in 32.4%, and severe malnutrition in 44% of the children. However, post hypernatremia impact in long term on morbidity, nutritional status, cognitive development, and renal function is largely unknown. Therefore, it is imperative to evaluate nutritional status, growth, cognitive development, and renal function in long term among children recovered from hypernatremia. vi Methodology: This Observational longitudinal study was conducted among children under five years of age who had hypernatremia and participated in the prospective observational study conducted from August 2013 to October 2015. The original study aimed to investigate neurologic complications and developmental consequences in children with hypernatremia. The sample size is based on 224 children who successfully recovered from the initial hypernatremia study. Accounting for a 25% attrition rate, the sample size was estimated to be 168. However, due to dropouts during follow-up, 143 children were successfully followed up in the present study. The study lasted from March 2016 to March 2017, and children were examined at the Dhaka Hospital of icddr, b. All children were brought to Dhaka Hospital inpatient ward for a complete physical, nutritional, neurological, and cognitive assessment. A spot urine analysis was also performed to evaluate their kidney function. Upon arrival, each child's weight, height, and mid-upper arm circumference (MUAC) were measured using standard procedures. Data were collected using pre-designed and pre-tested Case Report Forms (CRFs), which included the child’s medical records, exact address, socio-demographic information, family status, living conditions, history of illness, and immunization status. Cognitive, motor and neuropsychological development were assessed by a trained psychologist using standard procedures. Two different tools were used depending on the child's age. The Bayley Scales of Infant Development-III (BSID-III) was used for children under 36 months, while the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) was used for children older than 36 months. Motor function was assessed using the Movement Assessment Battery for Children-II (MABC-II). A spot urine sample was collected from each child for vii microscopic examination, and the protein-to-creatinine ratio was calculated to detect potential glomerular damage. Results: Of the 224 recovered hypernatremia children, 143 (64%) parents consented to participate in this study. The mean age of the children was 35 ± 8 months, and 59% were male. Mean± SD of weight and height of the study participants were 12.4 ±3.1 kg and 89.5 ±7.5 cm, respectively. Malnutrition was not significant in this study population. After stratified by two age groups, children aged up to 36 months and those older than 36 months, Median (IQR) of family income, 13000(10000,20000) vs. 11500 (8000,18000); maternal, 7(4,10) vs. 8(5,10); and paternal, 6(4, 9) vs. 8(1,10) education levels were comparable. Around 50% of the study children commonly presented with upper respiratory infections. After 12 months of recovering from hypernatremia, half of the children had an increased protein-to- creatinine ratio. Children with mild hypernatremia were more likely to have raised urinary Pr/Cr ratio, though none presented with any evidence of urinary problems or glomerular damage. Eighty-six percent (86%) of the children from better socioeconomic status were less likely to have a high Pr/Cr ratio in comparison with their poorest counterparts (p=<0.001). Children under 36 months are twice more likely to have raised urinary Pr/Cr compared to those more than 36 months; 2.31(1.06, 5.02); p-0.035. The mean cognitive score improved significantly at 12 months’ post-recovery (86.1± 16.3; p=0.002), as well as the motor and language composite score; 83. ±15.7, and 80.9± 13.8 respectively. These developmental scores were similar between male and female participants. viii However, 10% of the children showed poor cognitive performance (<69) after 12 months. After adjusting for age and weight-for-age Z-scores (WAZ), composite scores of cognitions and socioemotional domain of development showed a significant difference between baseline and end-line assessment (p=0.002 and p=0.013, respectively). On the other hand, after 12 months’ children mostly presented with average IQ. The mean Movement Assessment score indicated that children are at risk of movement difficulties during the post-hypernatremia recovery period. Conclusion: Long-term evaluation of children's nutritional status and renal function recovered from hypernatremia did not reveal any significant clinical abnormalities. However, developmental assessments indicated that most children exhibited average neurocognitive development and IQ. Further studies are required to validate the spot urine method against the gold standard 24-hour urine collection method for assessing proteinuria in post-hypernatremia children. This thesis is submitted for the degree of Doctor of Philosophy.