LAUSR

Dear Editor, We thank Islam and Oldroyd for their comments on “Double and triple burden of noncommunicable diseases and its determinants among adults in Bangladesh: Evidence from a recent demographic and health survey”.1 Before interpreting the prevalence estimates of any health condition such as hypertension, diabetes and overweight/obesity, it is critical to understand how these were defined in that study. Firstly, we used the mean value of last two measurements of systolic and diastolic blood pressure that was presented in the original data set, so the chance of overestimating or underestimating of the prevalence of hypertension is low. However, this might be unclear in the original paper where we stated that the mean value of these measurements was considered for defining hypertension. Secondly, the World Health Organization (WHO) recommended fasting blood glucose level 6.1 to 6.9 mmol/L as prediabetes, and 7.0 mmol/L or above as diabetes.2,3 However, based on this recommendation, several studies have combined the prediabetes and diabetes and considered a participant as diabetic if fasting glucose value was >6.1 mmol/L and/or taking any medicine for diabetes.4,5 The result of our study shows the prevalence of diabetes was 23.4%, which is higher than the 201718 Bangladesh demographic and health survey (BDHS) report, as in this study we combined prediabetes and diabetes as diabetes. If we consider diabetes (FPG>7.0 mmol/L), the findings of our study show the prevalence of diabetes 10% (95% CI: 9.310.7), which is similar with the 201718 BDHS report,3 which is not presented in our study. Therefore, while interpreting the prevalence estimate for diabetes in our study or comparing the results with other studies, the cutoff point for diabetes >6.1 mmol/L should be considered. Thirdly, the 201718 BDHS report present the results using WHO global cutoff for overweight/obesity (BMI≥25kg/m2).3 Previous studies in Bangladesh610 and other South Asian countries11 also used the WHO global cutoff for overweight/obesity (BMI≥25kg/m2) instead of Asian cutoffs (BMI ≥23kg/m2), which is similar to our study. Finally, we have clearly defined hypertension, diabetes, and overweight/obesity in our study and analyzed the data accordingly. However, caution is required to interpret these definitions and compare our results with other reports due to differences in definitions and cutoff points used. Moreover, we do not think our results will create any confusion in the scientific community or result in inappropriate allocation of resources as it is unlikely that a single study is used for resource allocation.