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Both diabetes mellitus (DM) and tuberculosis (TB) are prevalent all across in India. TB‐DM comorbidity has emerged as a syndemic and needs more attention in India considering gaps in screening, clinical care, and research. This paper is intended to review published literature on TB and DM in India to understand the burden of the dual epidemic and its trajectory and to obtain perspectives on the gaps, constraints, and challenges in care and treatment of this dual epidemic. A literature search was carried out on PubMed, Scopus, and Google Scholar, using the key words 'Tuberculosis' OR 'TB' AND 'Diabetes' OR 'Diabetes Mellitus' AND 'India', focusing on the research published between the year 2000 to 2022. The prevalence of DM is high in patients with TB. Quantitative data on the epidemiological situation of TB/DM in India such as incidence, prevalence, mortality, and management are lacking. During the last 2 years convergence of TB‐DM syndemic with the COVID‐19 pandemic has increased cases with uncontrolled DM but also made coordinated control of TB‐DM operationally difficult and of low effectiveness. Research regarding TB‐DM comorbidity is required in the context of epidemiology and management. Detection and bidirectional screening are aggressively warranted. Management of DM in those with TB‐DM comorbidity needs more efforts, including training and supervision of frontline workers. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between glucagon‐like peptide‐1 receptor agonists (GLP‐1RA) treatment and the risk of suicide attempts in people with type 2 diabetes (T2D), with a focus on subgroups with and without a history of depression or suicide attempts. Methods: This retrospective cohort study utilized TriNetX, a federated network of real‐world data. Using the Global Collaborative Network data, we collected electronic medical records from 113 health care organizations with 135 million patient records with 8 million with T2D, 83% from the United States. The four cohorts were identified based on age, medication, diagnosis, and presence of depression or suicide attempts. Analytic methods included measures of association and number of Instances, with propensity score matching employed to mitigate potential confounders. The primary outcome was the incidence of suicide attempts among people with T2D with GLP‐1RA treatment in comparison with dipeptidyl peptidase‐4 inhibitor (DPP‐4i) treatment. Results: People with T2D treated with GLP‐1RA consistently exhibited a lower risk of suicide attempts compared to those treated with DPP‐4i. This was particularly significant in people with a history of depression or suicide attempts. The risk and odds ratios were significantly lower in the GLP‐1RA‐treated cohorts than in DPP‐4i across all analyses. Conclusion: As compared with DPP‐4i, our analysis shows a protective effect associated with GLP‐1RA treatment on the risk of suicide attempts among people with T2D. However, further research, particularly prospective and randomized studies, is necessary to confirm these observations and understand the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Hand grip strength (HGS) serves as a fundamental metric in assessing muscle function and overall physical capability and is particularly relevant to the ageing population. HGS holds an important connection to the concept of sarcopenia, which encompasses the age-related decline in muscle mass, strength, and function. It has also been reported to indicate the health of an individual. We reviewed the interplay between HGS and various health parameters, including morbidity and mortality, by carrying out a literature search on PubMed, Scopus and Google Scholar between 10 and 30 August 2023, to identify the relevant papers on the relationship between health and HGS. We used several keywords like 'hand grip strength', 'muscle strength, 'sarcopenia', 'osteosarcopenia', 'health biomarker', 'osteoporosis', and 'frailty', to derive the appropriate literature for this review. This review has shown that the HGS can be measured reliably with a hand-held dynamometer. The cut-off values are different in various populations. It is lower in Asians, women, less educated and privileged, and those involved in sedentary work. Several diseases have shown a correlation with low HGS, e.g., Type 2 diabetes, cardiovascular disease, stroke, chronic kidney and liver disease, some cancers, sarcopenia and fragility fractures. The low HSG is also associated with increased hospitalization, nutritional status, overall mortality and quality of life. We believe that there is adequate evidence to show that HGS stands as an important biomarker of health. Its utility extends to the identification of diverse health issues and its potential as a new vital sign throughout the lifespan. [ABSTRACT FROM AUTHOR]

Background: Fatty acid binding protein-2 (FABP-2) is involved in the metabolism of lipids in the intestine. FABP-2 Ala54Thr polymorphism involves a transition of G to A at codon 54 of FABP-2, resulting in an amino acid substitution Ala54 to Thr54 and is associated with elevated fasting triglycerides in some hyperlipidemic populations. In current genome builds and gene databases the variant of the Ala54Thr FABP-2 (rs 1 799 883) is annotated as c.163A>G (p. Thr55Ala). Aim and Objective: The status of this polymorphism in hyperlipidemic Asian Indians from North India has not been investigated. This study was aimed to evaluate the distribution of the polymorphic variants of the Ala54Thr FABP-2 and their association with lipids in hyperlipidemic subjects. Methods: Ala54Thr FABP-2 polymorphism in both hyperlipidemic (n = 210) and normolipidemic (n = 342) subjects was assessed by PCR-RFLP. Results: Ala54Thr genotypes and alleles distribution did not differ between the hyperlipidemic and normolipidemic groups. The heterozygous genotype FABP-2 Ala/Thr was significantly associated with higher levels of triglycerides and very low-density lipoproteins as compared to the homozygous variant (Thr/Thr) genotype and the wild type homozygous (Ala/Ala) genotype. Conclusions: The heterozygous genotype FABP-2 Ala54Thr is a risk factor for the development of hypertriglyceridemia and increased levels of VLDL-c in Asian Indians from North India. [ABSTRACT FROM AUTHOR]

Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the international diabetes federation diabetes atlas, 9th edition. In young South Asians with diabetes diagnosed below 30 years of age, an intriguing array of other diabetes phenotypes is seen including type 1 diabetes (T1D), maturity onset diabetes of the young, and a tropical variety of diabetes known as fibrocalculous pancreatic diabetes6 but these will not be discussed further. One of the hotspots of diabetes in the world is South Asia, which currently has 88 million people with diabetes, 77 million of whom live in India.1 Type 2 diabetes (T2D) in South Asians exhibits a number of characteristic features including high magnitude of insulin resistance and rapid decline in beta cell function, with diabetes occurring at lower threshold for body mass index (BMI) than in European and North American populations.2-7 This ethnic group shows low muscle mass, increased intra-abdominal adiposity, excess hepatic fat, and the characteristic dyslipidemia (low high-density lipoprotein [HDL] cholesterol and high triglycerides). [Extracted from the article]

Background: Titration of basal insulin led by either the physician or the patient is not well understood in India. This analysis of Indian subset of Asian Treat to Target Lantus Study (ATLAS) compared effectiveness of patient-led with physician-led titration of once-daily insulin glargine 100 U/mL (Glargine-U-100) in patients with type 2 diabetes mellitus (T2DM) uncontrolled on oral antidiabetes drug (OAD). Methods: In this open-label parallel group study, randomized patients (either physician-led or patient-led [self-titration] group) followed the same dose titration algorithm (fasting blood glucose [FBG] target 110 mg/dL [6.1 mmol/L]). The primary endpoint was change in mean glycated hemoglobin (HbA1c) at week 24 in the patient-led group versus the physician-led group. Results: Patients (40-75 years) were randomized to either the physician-led group (n = 39) or the patient-led group (n = 36). At week 24, self-titration led to a greater decline in HbA1c than physician-led titration (-1.3% vs. -1.1%). Mean decrease in FBG was more in the patient-led group than in the physician-led group (-53.7 mg/dL vs. -35.5 mg/dL). Mean daily dose of Glargine-U-100 at week 24 was higher in the patient-led group than in the physician-led group (30.0 U vs. 23.8 U). At any time during the study, 30.6% and 7.7% of patients in the patient-led and physician-led groups, respectively, showed target HbA1c level of <7.0% without severe hypoglycemia. Treatment satisfaction and quality of life improved in both groups. Overall, treatment was safe and well tolerated, and none of the events led to treatment discontinuation. Conclusion: Patient-led adjustment of Glargine-U-100 in outpatient setting can be a safe and effective method for glycemic control in Indian patients with T2DM uncontrolled on OADs. [ABSTRACT FROM AUTHOR]

There has been a rapid escalation of type 2 diabetes (T2D) in developing countries, with varied prevalence according to rural vs urban habitat and degree of urbanization. Some ethnic groups (eg, South Asians, other Asians, and Africans), develop diabetes a decade earlier and at a lower body mass index than Whites, have prominent abdominal obesity, and accelerated the conversion from prediabetes to diabetes. The burden of complications, both macro‐ and microvascular, is substantial, but also varies according to populations. The syndemics of diabetes with HIV or tuberculosis are prevalent in many developing countries and predispose to each other. Screening for diabetes in large populations living in diverse habitats may not be cost‐effective, but targeted high‐risk screening may have a place. The cost of diagnostic tests and scarcity of health manpower pose substantial hurdles in the diagnosis and monitoring of patients. Efforts for prevention remain rudimentary in most developing countries. The quality of care is largely poor; hence, a substantial number of patients do not achieve treatment goals. This is further amplified by a delay in seeking treatment, "fatalistic attitudes", high cost and non‐availability of drugs and insulins. To counter these numerous challenges, a renewed political commitment and mandate for health promotion and disease prevention are urgently needed. Several low‐cost innovative approaches have been trialed with encouraging outcomes, including training and deployment of non‐medical allied health professionals and the use of mobile phones and telemedicine to deliver simple health messages for the prevention and management of T2D. [ABSTRACT FROM AUTHOR]

Background & Aims: Diabetes and related metabolic syndromes represent a significant global health challenge, with the global burden of diabetes increasing considerably since 1990. In this article, we examined the trend of publications in Endocrinology, Diabetes and Metabolism between 1996 and 2021, focusing on Asian countries.We obtained and used the data from the Scopus database from the SCImago website (https://www.scimagojr.com/), on 1 April 2023, related to the subspecialty of Endocrinology, Diabetes and Metabolism for country rankings between 1996 and 2021. We did not include any data related to other medical specialties or other fields.There has been a steady rise in global publications on these subspecialties over the past decade, with the number of publications from Asian countries increasing significantly. Western Europe recorded the highest number of publications, followed by North America and Asia. The COVID-19 pandemic also contributed to a surge in publications in this field. In Asian countries, China and India have notably increased their global contribution to publications, with China emerging as the top Asian nation in 2021.Our findings provide valuable insights into the research output from various countries and the productivity trends in Diabetes, Endocrinology and Metabolism-related research.Methods: Diabetes and related metabolic syndromes represent a significant global health challenge, with the global burden of diabetes increasing considerably since 1990. In this article, we examined the trend of publications in Endocrinology, Diabetes and Metabolism between 1996 and 2021, focusing on Asian countries.We obtained and used the data from the Scopus database from the SCImago website (https://www.scimagojr.com/), on 1 April 2023, related to the subspecialty of Endocrinology, Diabetes and Metabolism for country rankings between 1996 and 2021. We did not include any data related to other medical specialties or other fields.There has been a steady rise in global publications on these subspecialties over the past decade, with the number of publications from Asian countries increasing significantly. Western Europe recorded the highest number of publications, followed by North America and Asia. The COVID-19 pandemic also contributed to a surge in publications in this field. In Asian countries, China and India have notably increased their global contribution to publications, with China emerging as the top Asian nation in 2021.Our findings provide valuable insights into the research output from various countries and the productivity trends in Diabetes, Endocrinology and Metabolism-related research.Results: Diabetes and related metabolic syndromes represent a significant global health challenge, with the global burden of diabetes increasing considerably since 1990. In this article, we examined the trend of publications in Endocrinology, Diabetes and Metabolism between 1996 and 2021, focusing on Asian countries.We obtained and used the data from the Scopus database from the SCImago website (https://www.scimagojr.com/), on 1 April 2023, related to the subspecialty of Endocrinology, Diabetes and Metabolism for country rankings between 1996 and 2021. We did not include any data related to other medical specialties or other fields.There has been a steady rise in global publications on these subspecialties over the past decade, with the number of publications from Asian countries increasing significantly. Western Europe recorded the highest number of publications, followed by North America and Asia. The COVID-19 pandemic also contributed to a surge in publications in this field. In Asian countries, China and India have notably increased their global contribution to publications, with China emerging as the top Asian nation in 2021.Our findings provide valuable insights into the research output from various countries and the productivity trends in Diabetes, Endocrinology and Metabolism-related research.Conclusion: Diabetes and related metabolic syndromes represent a significant global health challenge, with the global burden of diabetes increasing considerably since 1990. In this article, we examined the trend of publications in Endocrinology, Diabetes and Metabolism between 1996 and 2021, focusing on Asian countries.We obtained and used the data from the Scopus database from the SCImago website (https://www.scimagojr.com/), on 1 April 2023, related to the subspecialty of Endocrinology, Diabetes and Metabolism for country rankings between 1996 and 2021. We did not include any data related to other medical specialties or other fields.There has been a steady rise in global publications on these subspecialties over the past decade, with the number of publications from Asian countries increasing significantly. Western Europe recorded the highest number of publications, followed by North America and Asia. The COVID-19 pandemic also contributed to a surge in publications in this field. In Asian countries, China and India have notably increased their global contribution to publications, with China emerging as the top Asian nation in 2021.Our findings provide valuable insights into the research output from various countries and the productivity trends in Diabetes, Endocrinology and Metabolism-related research. [ABSTRACT FROM AUTHOR]

The article discusses the rising costs of drug and insulin treatment for diabetes in India, as of December 2017.

Prevalence of non-alcoholic fatty liver disease (NAFLD) varies in India; up to one-third of the urban population is affected by the disease. In Asian Indians, presence of NAFLD is driven by multiple factors - presence of excess abdominal fat (abdominal subcutaneous and intra-abdominal fat) and lifestyle factors (imbalanced diets and physical inactivity), and it is correlated closely with insulin resistance, the metabolic syndrome and dysglycaemia in the background of genetic predisposition (investigated genes in Asian Indians: APOC3, PNPLA-3, PPARγ, SREBP-2, adiponectin, SAMM50, PARVB and PZP). Recent studies also show that presence of NAFLD independently correlates with subclinical inflammation and surrogate markers of atherosclerosis (carotid intima-media thickness, impaired flow-mediated vasodilatation) in Asian Indians. A prediction equation (Indian Fatty Liver Index) which includes simple measures has been developed for Asian Indians. On the other hand, increased (more than 15.6 cm) liver span (surrogate marker of fatty liver), in a preliminary study, predicted diabetes in non-obese Asian Indians. Dietary factors are important for the development of NAFLD, and some evidence indicates that regular use of high monounsaturated fatty acid rich oils, and low amount of saturated fat intake are beneficial. [ABSTRACT FROM AUTHOR]

We aimed to correlate plasma glucagon levels with anthropometric measures and abdominal adipose tissue depots. Nonobese males (n=81; BMI < 25 kg/m2) with T2DM of less than one-year duration and nonobese males without diabetes (n=30) were evaluated for the following: anthropometry (BMI, waist circumference, W-HR, and truncal skinfolds), whole-body DEXA (for body fat and fat-free mass), and MRI scan (for volumes of subcutaneous abdominal adipose tissue (SCAT) including superficial and deep, intra-abdominal visceral adipose tissue (including intraperitoneal adipose tissue (IPAT), retroperitoneal adipose tissue, liver span and fatty liver, and pancreatic volume)). Plasma glucose and glucagon, serum insulin, hepatic transaminases, and lipid profile were measured. Significantly higher levels of fasting and postprandial glucagon (p<0.001) and fasting and postprandial insulin (p<0.001) were seen in patients with T2DM. The mean values of fasting and postprandial plasma glucagon levels were higher in T2DM patients with NAFLD (n=37) as compared to T2DM patients without NAFLD (n=44). Four independent predictors were derived for fasting glucagon levels in patients with T2DM, namely, W-HR, suprailiac skinfold thickness, IPAT, and deep SCAT (p<0.05; r2=0.84). These observations in Asian Indians may have significance for diabetes therapies which impact glucagon levels. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases are more prevalent and severe in Asian Indians. Simple diet-based strategies are important for prevention of cardiovascular diseases. The aim of the present study was to evaluate the effects of oats consumption on lipid parameters in mildly hypercholesterolemic Asian Indians living in India. Methods: A short-term, prospective, open-labeled, randomized controlled, parallel group study was conducted. Mildly hypercholesterolemic (total cholesterol >200 mg/dL and <240 mg/dL) subjects (n = 80) were randomized into two groups: intervention (n = 40) and usual diet (n = 40). Sample size was calculated for a two-group parallel superiority randomized control trial. Out of 80 enrolled subjects 69 subjects completed the study; 33 in the control group and 36 in the intervention group. In the intervention group, patients were served 70 g of oats twice a day in the form of porridge and upma (A thick porridge from oats with seasonings and vegetables) under observation at the study site. Lipid parameters were assessed at baseline and after 4 weeks of intervention. Results: There was a reduction of 3.1% in total cholesterol levels in the control group as against 8.1% reduction in the intervention group (p < 0.02). Greater reductions were also seen in low-density lipoprotein cholesterol in the intervention group (11.6%) as compared to control group (4.1%, p < 0.04) over a period of 28 days. Conclusion: Daily consumption of 3 g of soluble fiber from 70 g of oats leads to beneficial effects on the lipid parameters, specifically total cholesterol and low-density lipoprotein cholesterol in hypercholesterolemic Asian Indians. Large scale studies over a longer period of intervention are required to further establish the cholesterollowering effect of oat fiber. [ABSTRACT FROM AUTHOR]

An editorial is presented on patients with type 2 diabetes mellitus (T2DM). Topics mentioned include the analysis of T2DM patient's fasting blood glucose and hemoglobin A1c (HbA1c), the importance of blood glucose analysis, and the prevalence of patients with diabetes in developing countries such as China. Also mentioned are the oral glucose tolerance test and the claims of stronger connection of obesity with high HbA1c.

Type 2 diabetes mellitus is widely prevalent in South Asians, and has a significant effect on health, as well as the economies of South Asian countries, particularly when the disease is associated with complications. There are certain characteristics associated with the South Asian phenotype that make South Asians especially prone to diabetes, as well as its complications. Microvascular complications cause considerable morbidity and mortality. There are significant differences in the epidemiology of microvascular complications between South Asians and people of other races. There is evidence of higher prevalence of nephropathy and retinopathy in South Asians compared with Caucasians; however, recent studies indicate that this trend seems to be leveling off. Importantly, diabetic neuropathy occurs less frequently in South Asians compared with Caucasians. These observations have important implications in managing South Asian patients with diabetes and microvascular complications. [ABSTRACT FROM AUTHOR]

Diabetes is an escalating problem in India and has major socioeconomic dimensions. Rapid dietary changes coupled with decreased levels of physical activity have resulted in increases in obesity and diabetes in rural and semi-urban areas, as well as in urban-based people living in resettlement colonies. Increasing risk has also been recorded in those who suffered from poor childhood nutrition and in rural-to-urban migrants. Social inequity manifests in disparities in socioeconomic status ( SES), place of residence, education, gender, and level of awareness and affects prevention, care, and management. All these population subsets have major socioeconomic challenges: low levels of awareness regarding diabetes and prevention, inadequate resources, insufficient allotment of healthcare budgets, and lack of medical reimbursement. Unawareness and delays in seeking medical help lead to complications, resulting in many-fold increased costs in diabetes care. These costs plunge individuals and households into a vicious cycle of further economic hardship, inadequate management, and premature mortality, resulting in more economic losses. At the societal level, these are massive losses to national productivity and the exchequer. Overall, there is an immediate need to strengthen the healthcare delivery system to generate awareness and for the prevention, early detection, cost-effective management, and rehabilitation of patients with diabetes, with a focus on people belonging to the lower SES and women (with a particular focus on nutrition before and during pregnancy). Because of an enhanced awareness campaign spearheaded through the National Program on Prevention of Cardiovascular Disease, Cancer, Diabetes and Stroke ( NCPCDS) initiated by Government of India, it is likely that the level of awareness and early detection of diabetes may increase. [ABSTRACT FROM AUTHOR]

Objective: In this study, we have attempted comparison of detailed body composition phenotype of Asian Indians with non-alcoholic fatty liver disease (NAFLD) vs. those without, in a case controlled manner. We also aim to analyse prediction equations for NAFLD for non-diabetic Asian Indians, and compare performance of these with published prediction equations researched from other populations. Methods: In this case-control study, 162 cases and 173 age-and sex-matched controls were recruited. Clinical, anthropometric, metabolic, and body composition profiles, and liver ultrasound were done. Fasting insulin levels, value of homeostasis model assessment of insulin resistance (HOMA-IR), and serum high sensitive C-reactive protein (hs-CRP) levels were evaluated. Multivariate logistic and linear regression analyses were used to arrive at prediction equations for fatty liver [Indian fatty liver index (IFLI)]. Results: As compared to those without fatty liver, those with fatty liver exhibited the following; Excess dorsocervical fat (‘Buffalo hump’), skin tags, xanthelasma, ‘double chin’, arcus; excess total, abdominal and subcutaneous adiposity, and high blood pressure, blood glucose, measures of insulin resistance (fasting insulin and HOMA-IR values), lipids and hs-CRP levels. Two prediction equations were developed; Clinical [Indian Fatty Liver Index-Clinical; IFLI-C]: 1(double chin) +15.5 (systolic blood pressure) +13.8 (buffalo hump); and IFLI-Clinical and Biochemical (CB): serum triglycerides+12 (insulin)+1(systolic blood pressure) +18 (buffalo hump). On ROC Curve analysis, IFLI performed better than all published prediction equations, except one. Conclusion: Non-diabetic Asian Indians with NAFLD researched by us were overweight/obese, had excess abdominal and subcutaneous fat, multiple other phenotypic markers, had higher insulin resistance, glycemia, dyslipidemia and subclinical inflammation than those without. Prediction score developed by us for NAFLD; IFLI-C and IFLI-CB, should be useful for clinicians and researchers. [ABSTRACT FROM AUTHOR]

Objective: To evaluate body fat patterning and phenotype including hepatic fat and pancreatic volume of non-obese (BMI: < 25 kg/m2) Asian Indians with type 2 diabetes residing in North India. Methods: Non-obese patients with type 2 diabetes (n = 93) and non-obese, normo-glycemic subjects (n = 40) were recruited. BMI, waist & hip circumferences, skinfold thickness at 8 sites, body fat, lean mass and detailed abdominal fat evaluation [total abdominal fat, total subcutaneous fat (superficial, deep, anterior, and posterior), total intra-abdominal fat (intra-peritoneal, retroperitoneal)], liver span, grades of fatty liver and pancreatic volume were compared. Results: Waist circumference, subscapular skinfolds and total truncal fat (on DEXA) were higher whereas calf, total peripheral skinfolds and total leg fat (on DEXA) lower in patients. Specifically, the following volumes were higher in cases as compared to controls; total abdominal fat (19.4%), total intra-abdominal fat (49.7%), intra-peritoneal fat (47.7%), retroperitoneal fat (70.7%), pancreatic volume (26.6%), pancreatic volume index (21.3%) and liver span (10.8%). In cases, significant positive correlations were observed for pancreatic volume with BMI, waist and hip circumferences, W-HR, subscapular, abdominal and total truncal skinfolds, truncal, total subcutaneous, total intra-abdominal, intra-peritoneal, retroperitoneal fat depots, liver span and fatty liver. Conclusions: In non-obese Asian Indians with type 2 diabetes, subcutaneous and intra-abdominal obesity, including fatty liver, and pancreatic volume were higher and peripheral subcutaneous adiposity was lower than BMI matched non-diabetic subjects. Importantly, increased pancreatic volume in patients was highly correlated with multiple measures of abdominal obesity and liver fat. [ABSTRACT FROM AUTHOR]

Definitions for overweight and obesity are universally applied using body mass index (BMI), based on morbidity and mortality data derived from white populations. However, several studies have shown higher body fat, excess metabolic perturbations, and cardiovascular risk factors at lower value of BMI in Asian versus white populations. Definitive guidelines have been published to classify a BMI of ≥23 kg/m2 and ≥25 kg/m2 as overweight and obese, respectively, by the Indian Consensus Group (for Asian Indians residing in India) and a BMI of ≥23 kg/m2 for screening for diabetes by the National Institute of Health and Care Excellence of the United Kingdom (for migrant south Asians) and, in an encouraging initiative recently (2015), by the American Diabetes Association (for all Asian ethnic groups in the United States). Overall, multiple studies, and now several guidelines, emphasize early intervention with diet and physical activity in Asian ethnic groups for prevention and management of obesity-related noncommunicable diseases. By application of these guidelines, an additional 10-15% of the population in India would be labeled as overweight/obese, and more South Asians/Asians will be diagnosed with diabetes in the United Kingdom and the United States. Additional health resources need to be allocated to deal with increasing numbers of Asians with obesity-related noncommunicable diseases, and research is needed to evolve cost-effective interventions. Finally, consensus based on data is needed so that the World Health Organization and other international agencies could take definitive steps for revision of classification of BMI for Asian populations globally. [ABSTRACT FROM AUTHOR]

Noncommunicable diseases, including type 2 diabetes mellitus and cardiovascular diseases (CVDs), cause 7.9 million deaths every year in South Asia. India has nearly 65.1 million cases of diabetes, and Pakistan and Bangladesh are at the 12th and 13th positions in the global list of high prevalence countries, respectively. The prevalence in India is continuously increasing and is recently reported to be nearly 14% and 8% in urban areas and rural areas, respectively. Diabetes in South Asians is, in some manner, different from that in other races; it occurs nearly a decade earlier, at lower body mass index and waist circumference levels, and with more postprandial hyperglycemia, dyslipidemia, nephropathy, and CVD than in whites. Decision regarding prevention and management of diabetes should be taken in the background of heterogeneity of diet, attitudes, and cultural milieu in South Asia. A need for a low-cost, integrated, yet individualized approach specific for South Asian countries has been increasingly felt since escalating research has uncovered characteristic phenotype, dietary and socioeconomic patterns. Although most such guidelines formulated in developed countries such as the United States or the United Kingdom could be generally applied to developing South Asian countries, there are fundamental differences in applicability of lifestyle and diets (heterogeneous, different from western diets), availability and cost of drugs and insulins, monitoring methods and devices, and insulin pump. Moreover, the monitoring, education, care, and rehabilitation will differ according to different socioeconomic strata and levels of health care (primary, secondary, or tertiary). Some of the potential ethnic-specific modifications have been suggested in this review. [ABSTRACT FROM AUTHOR]

Aim: To investigate the associations of high body fat and low muscle mass with arterial stiffness in Asian Indians with type 2 diabetes mellitus (T2DM) in North India. Methods: In this cross sectional study, subjects with T2DM (males n = 110, females n = 58, mean age: 53.8 ± 10.0 years) were recruited. Anthropometry and body composition analysis were performed and measures of glycemia, lipids and PWV were analyzed. Results: Significant positive correlation was observed between PWV and body fat (p < 0.05), left leg fat (p < 0.05), and right leg fat (p < 0.01) percentages only in females. In males, significant negative correlation was observed between PWV and truncal fat free mass (p < 0.05) and fat free mass in right arm (p = 0.05) and left arm (p < 0.05). In both males and females, significant negative correlation was observed between PWV and fat free mass in left leg (p < 0.01) and for right leg fat free mass only in females. Conclusion: Excess adiposity and low fat free mass are associated with arterial stiffening in Asian Indians with T2DM in North India, with significant gender differences. [ABSTRACT FROM AUTHOR]

Prevalence of diabetes continues to increase in urban areas, and escalation is discernible in semi-urban and rural areas. It is reported to affect Asian Indians a decade earlier compared with other populations, and complications (e.g., nephropathy) occur earlier and are severe and more prevalent than in other races. Because of these adverse features and suboptimal management practices, type 2 diabetes mellitus (T2DM) poses a huge health and economic burden to the country. Simple and culturally sensitive interventions for Asian Indians have been shown to be effective in prevention/amelioration of diabetes and other cardiovascular risk factors in multiple settings, among urban and rural residents, in migrants, and in those who are healthy or obese or have metabolic syndrome or T2DM. Furthermore, short-term intensive lifestyle intervention in children improves anthropometric and metabolic parameters. Finally, intervention with specific nutrient or oil substitution in Indian diets has been reported to produce benefit in multiple metabolic cardiovascular risk factors. There is, however, further need for conducting well-designed and planned intervention trials with robust outcome data at the primary and secondary levels. These trials must be culturally sensitive and should investigate cost-effective strategies. [ABSTRACT FROM AUTHOR]

The article focuses on the research related to the obesity in diabetic patients. It focuses on the comparison of the of the total intra-abdominal adipose tissue (IAAT), liver span, and pancreatic volume in diabetics with the body mass index (BMI) matched non-diabetic subjects, with the information on receiver operating characteristic (ROC) curve analysis.

Objective: We evaluated the associations of serum 25-hydroxyvitamin D [25(OH) D] levels with clinical, biochemical, and anthropometric profiles and total abdominal adipose tissue (TAAT), subcutaneous abdominal adipose tissue (SCAT), and intraabdominal adipose tissue (IAAT) depots in Asian Indians without diabetes residing in north India. Subjects and Methods: In this cross-sectional study ( n=137; 74 males and 63 females; 18-60 years of age), anthropometric (body mass index, waist and hip circumferences, and skinfold thickness at four sites) and biochemical (fasting plasma glucose, lipid profile, and fasting insulin levels) assessments were done. Measurement of percentage body fat was done by dual energy x-ray absorptiometry, and areas of TAAT, SCAT and IAAT were measured at the L2-L3 intervertebral level by single-slice magnetic resonance imaging. Levels of 25(OH) D were measured by radioimmunoassay. Correlation analysis was used to assess relationships among clinical, biochemical, and anthropometric profiles, areas of TAAT, SCAT, and IAAT, and 25(OH) D levels. Results: The mean concentration of 25(OH) D was 40.5±8.6 ng/mL. Overall, 6.6% had vitamin D deficiency (<10 ng/mL), 87.6% had insufficiency (<30 ng/mL), and 5.8% had a sufficient level (>30 ng/mL). Levels of 25(OH) D did not correlate with demographic, biochemical, and anthropometric profiles or with abdominal fat depots (TAAT, SCAT, and IAAT). In the correlation regression model, 25(OH) D was associated with TAAT in obese subjects. Conclusions: In obese urban Asian Indians without diabetes, higher values of total abdominal fat at the L2-L3 intervertebral level were associated with low 25(OH) D levels. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the effects of pistachio nuts as an adjunct to diet and exercise on body composition, metabolic, inflammatory, and oxidative stress parameters in Asian Indians with metabolic syndrome. Methods: In this 24-wk randomized control trial, 60 individuals with the metabolic syndrome were randomized to either pistachio (intervention group) or control group (diet as per weight and physical activity profile, modulated according to dietary guidelines for Asian Indians) after 3 wk of a diet and exercise run in. In the first group, unsalted pistachios (20% energy) were given daily. A standard diet and exercise protocol was followed for both groups. Body weight, waist circumference (WC), magnetic resonance imaging estimation of intraabdominal adipose tissue and subcutaneous abdominal adipose tissue, fasting blood glucose (FBG), fasting serum insulin, glycosylated hemoglobin, lipid profile, high-sensitivity C-reactive protein (hs-CRP), adiponectin, free fatty acids (FFAs), tumor necrosis factor (TNF)-α, leptin, and thiobarbituric acid reactive substances (TBARS) were assessed before and after the intervention. Results: Statistically significant improvement in mean values for various parameters in the intervention group compared with control group were as follows: WC (P < 0.02), FBG (P < 0.04), total cholesterol (P < 0.02), low-density lipoprotein cholesterol (P < 0.006), hs-CRP (P < 0.05), TNF-α (P < 0.03), FFAs (P < 0.001), TBARS (P < 0.01), and adiponectin levels (P < 0.001). Conclusion: A single food intervention with pistachios leads to beneficial effects on the car-diometabolic profile of Asian Indians with metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background: The prevalence of overweight and obesity among children is increasing in India. However, knowledge of, attitude towards and practice of health and nutrition in mothers and children have not been researched. Objective: To assess knowledge of, attitude towards and practice of nutrition, physical activity and other lifestyle practices in a nationally representative sample of urban children and mothers in India. Methods: A cross-sectional observational study of 1,800 children aged 9-18 years and their mothers, using qualitative (focus group) and quantitative (semi-structured survey) data. Results: The overall prevalence of overweight/obesity among the children was 19.2% in males and 18.1% in females; 64.8% of mothers were either overweight [body mass index (BMI) 23.0-24.9; 23.3%] or obese (BMI >25.0; 41.5%). Household family income, related socioeconomic factors, and overweight in mothers were most significantly associated with obesity in children (all p ≤ 0.001). Dietary consumption patterns (snacking, fast food etc.) showed a marked association between mothers and children (all p ≤ 0.000). Focus group discussion revealed several interesting attitudes and misconceptions among children ('home-cooked food is old fashioned') and mothers ('a child with chubby cheeks is healthy, not fat'). Importantly, only a few mothers understood that excess weight or diets are contributory factors of morbidities in children or themselves. Conclusions: This study highlights the poor knowledge, faulty attitudes and practices of urban Asian Indian mothers and their children in a highly correlated manner. These knowledge gaps must be addressed to formulate effective strategies for the prevention of obesity and related metabolic disorders. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Diabetes has emerged as a disease of major public health importance in India affecting the rich and the poor alike. Conventionally, comprehensive diabetes management is aimed at preventing micro and macro vascular complications. However, morbidity and mortality due to infections are also significant. In developing countries like India, the concept of adult immunization is far from reality. Recently the H1N1 pandemic has triggered the necessity for considering immunization in all age groups for the prevention of vaccine-preventable fatal infectious diseases. Considering the economics of immunization in a developing country, providing free vaccines to all adults may not be a practical solution, although the free universal immunization program for children is in existence for several decades. There is no consensus on the use of vaccines in diabetes subjects in India. However, there are some clinics offering routine pneumococcal, influenza and other vaccinations. Patients with diabetes have a deranged immune system making them more prone for infections. Hospitalization and death due to pneumococcal disease and influenza are higher in diabetes patients. They, like other healthy individuals, have a normal humoral response to vaccination with clinically significant benefits. The American Diabetes Association, Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention, World Health Organization, United Kingdom Guidelines and a number of other scientific organizations have well defined guidelines for vaccination in diabetes. In this article we make some suggestions for clinicians in India, regarding use of vaccines in subjects with diabetes. [ABSTRACT FROM AUTHOR]

Abstract: Asia bears the world''s greatest burden of type 2 diabetes (T2DM) and prevalence is increasing rapidly. Compared to other races, Asians develop T2DM younger, at a lower degree of obesity, suffer longer from its complications and die earlier. Curbing this epidemic requires an integrated, risk-based, and multidisciplinary approach. Inadequately managed T2DM has macrovascular and microvascular sequelae, Asians with T2DM being particularly susceptible to diabetic nephropathy. Earlier and more intensive monitoring and management of risk factors are required, especially for patients with, or at risk of, renal impairment. Particular challenges of T2DM management in Asia include: lack of access to specialist healthcare, insufficient clinical evaluation and delayed diagnosis. As in Caucasians, conventional treatment modalities are limited by deteriorating glycaemic control with disease progression and there is an unmet need for efficacious, safe, cost-effective and convenient pharmacotherapies for treating different stages of T2DM and preventing its complications, particularly in high-risk patients. There is a trend towards increasing use of DPP-IV inhibitors, which are no less efficacious and safe in Asians than Caucasians and may have some advantages over existing oral antidiabetic agents, particularly for certain high-risk groups. Such agents may play a significant future role in the management of T2DM. [Copyright &y& Elsevier]

India is facing an 'epidemic' of diet-related non-communicable diseases (DR-NCDs), along with widely prevalent undernutrition resulting in substantial socioeconomic burden. The aim of this paper is to review secular trends in food groups and nutrient intake, and implications for DR-NCDs in India so as to understand optimal choices for healthy diets for the prevention of DR-NCDs. The literature search was carried out in PubMed (National Library of Medicine, Bethesda, MD, USA) and Google Scholar search engines up to April 2011. A manual search for all other references, national and medical databases was also carried out. Nutrition transition over the past 30 years (1973-2004), has resulted in a 7% decrease in energy derived from carbohydrates and a 6% increase in energy derived from fats. A decreasing intake of coarse cereals, pulses, fruits and vegetables, an increasing intake of meat products and salt, coupled with declining levels of physical activity due to rapid urbanization have resulted in escalating levels of obesity, atherogenic dyslipidemia, subclinical inflammation, metabolic syndrome, type 2 diabetes mellitus, and coronary heart disease in Indians. Studies also suggest that adverse perinatal events due to maternal nutritional deprivation may cause low-birth weight infants, which, coupled with early childhood 'catch-up growth', leads to obesity in early childhood, thus predisposing to NCDs later in life. In view of rapidly increasingly imbalanced diets, a multisectoral preventive approach is needed to provide balanced diets to pregnant women, children and adults, and to maintain a normal body weight from childhood onwards, to prevent the escalation of DR-NCDs in India. [ABSTRACT FROM AUTHOR]

Summary Objective To determine the frequency distribution of LMNA 1908 C> T SNP and its association with generalized obesity, abdominal obesity and coexistent metabolic disorders in nondiabetic Asian Indians living in a metropolitan city of north India. Design A cross-sectional population-based study of LMNA 1908 C>T polymorphism with obesity and insulin resistance as outcome. Patients Five hundred and fifty-one Asian Indians, with 240 obese and 289 nonobese subjects. Measurements Allelic and genotypic frequency of LMNA 1908 C> T were determined by PCR-RFLP. Association of LMNA alleles and genotypes was analysed with various measures of obesity [BMI ≥25 kg/m2, percentage body fat (by DEXA); subcutaneous and intra-abdominal fat at L2-3 level by single slice MRI in a subsample and surrogate marker of insulin resistance (fasting serum insulin levels >10 μU/ml in men and >11 μU/ml in women). Results Forty-six per cent of the subjects had generalized obesity while 54% had abdominal obesity. Frequency of C and T alleles was 0·71 and 0·29, respectively. Higher frequency of variant allele ( T) was observed in obese than nonobese individuals ( P = 0·001). On multivariate analysis adjusting for age, gender and serum insulin levels, subjects with LMNA1908T/T genotype were at 5·6 times higher risk [OR (95% CI): 5·6 (2·5-12·2), P = 0·001], while individuals with genotypes with at least one T allele, i.e. 1908C/T and T/T genotypes, were at 2·7 times higher odds to develop generalized obesity [OR (95% CI): 2·7 (1·8-4·1), P = 0·001]. Conclusion LMNA 1908T/T and C/T genotypes emerged as independent genetic risk factors for generalized obesity in Asian north Indians. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of abdominal obesity including intra-abdominal and subcutaneous adiposity along with other cardiometabolic risk factors in urban Asian Indians living in New Delhi. Methods: We conducted a cross-sectional epidemiological descriptive study with 459 subjects (217 males and 242 females), representing all socio-economic strata in New Delhi. The anthropometric profile [body mass index (BMI), waist circumference (WC) and skinfold thickness], fasting blood glucose (FBG) and lipid profile were recorded. Percent body fat (%BF), total abdominal fat (TAF), intra-abdominal adipose tissue (IAAT) and subcutaneous abdominal adipose tissue (SCAT) were quantified using predictive equations for Asian Indians. Results: The overall prevalence of obesity was high [by BMI (>25 kg/m2), 50.1%]. The prevalence of abdominal obesity (as assessed by WC) was 68.9%, while that assessed by TAF was 70.8%. Increased IAAT was significantly higher in females (80.6%) as compared to males (56.7%) (p = 0.00) with overall prevalence being 69.3%. The overall prevalence of high SCAT was 67.8%, more in males (69.1%) vs. females (66.5%, p = 0.5). The prevalence of type 2 diabetes, the metabolic syndrome and hypertension was 8.5%, 45.3% and 29.2%, respectively. Hypertriglyceridemia, hypercholesterolemia and low levels of HDL-c were prevalent in 42.7%, 26.6% and 37% of the subjects, respectively. The prevalence of hypertriglyceridemia was significantly higher in males (p = 0.007); however, low levels of HDL-c were more prevalent in females as compared to males (p = 0.00). Conclusion: High prevalence of generalized obesity, abdominal obesity (by measurement of WC, TAF, IAAT and SCAT) and dysmetabolic state in urban Asian Indians in north India need immediate public health intervention. [ABSTRACT FROM AUTHOR]

Aims: The objective of this study was to assess the prevalence of overweight, obesity and abdominal obesity and their associated factors in a large sample of urban Indian schoolchildren. Methods: This is a cross-sectional study conducted in 5 cities in India. Height and weight were measured in 38,296 children and waist circumference was measured in 29,244 children aged 8-18 years. The prevalence was compared with respect to age, gender, type of school and city of residence. Results: The mean ± standard deviation for age was 13.3 ± 2.4 years and 18.3 ± 4.3 kg/m2 for BMI. The prevalence of overweight and obesity in 8- to 18-year-old children, respectively, was 14.4 and 2.8% by IOTF cutoffs, 14.5 and 4.8% by CDC cutoffs and 18.5 and 5.3% by WHO cutoffs. When applying the cutoffs specific for Indian ethnicity in 14- to 18-year-old children, the prevalence was higher (21.1 and 12.3%, respectively) as compared to the IOTF, WHO and CDC cutoffs. The overall prevalence of abdominal obesity in urban Indian schoolchildren was 4.5%. The prevalence of overweight and abdominal obesity was significantly higher in females than males (p < 0.001). High socioeconomic status and residing in cities with a population greater than 4 million were independently associated with overweight and abdominal obesity (p < 0.001). On extrapolating these data, more than 15 million children would currently be overweight and 4 million abdominally obese in urban India. Conclusions: There is a substantial burden of childhood obesity in India, which necessitates comprehensive urban-based campaigns for its prevention and control. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

India is undergoing rapid nutritional transition, resulting in excess consumption of calories, saturated fats, trans fatty acids, simple sugars, salt and low intake of fiber. Such dietary transition and a sedentary lifestyle have led to an increase in obesity and diet-related non-communicable diseases (type 2 diabetes mellitus [T2DM], cardiovascular disease [CVD], etc.) predominantly in urban, but also in rural areas. In comparison with the previous guidelines, these consensus dietary guidelines include reduction in the intake of carbohydrates, preferential intake of complex carbohydrates and low glycemic index foods, higher intake of fiber, lower intake of saturated fats, optimal ratio of essential fatty acids, reduction in trans fatty acids, slightly higher protein intake, lower intake of salt, and restricted intake of sugar. While these guidelines are applicable to Asian Indians in any geographical setting, they are particularly applicable to those residing in urban and in semi-urban areas. Proper application of these guidelines will help curb the rising 'epidemics' of obesity, the metabolic syndrome, hypertension, T2DM, and CVD in Asian Indians. [ABSTRACT FROM AUTHOR]

This study compared difference in diabetes, obesity, metabolic syndrome (MetS), C-reactive protein (hs-CRP), homocysteine, and other cardiovascular risk factors between rural and urban Asian Indians using similar/standardized field measurements. The design used a cross-sectional and population-based study among rural (Tamil Nadu) and urban (Delhi) Asian Indians aged 18 years and older. 574 rural Indians and 508 urban Indians completed face-to-face interviews, and anthropometric measurements. Fasting venous blood samples were obtained for fasting plasma glucose and serum lipid tests. The mean age was 42.6 ± 11.8 y (urban) and 39.5 ± 13.9 y (rural). Although the prevalence of type 2 diabetes (T2DM) was lower in rural (8.4%) than urban (13.6%) areas, rural Asian Indians had a higher percent of undiagnosed cases (25%), poorer glycemic control, and unawareness of diabetes than their urban peers. Urban Indians had elevated rates of the MetS (as defined by NCEP and IDF criteria), hs-CRP, total cholesterol, LDL, and hypertension than their rural peers. Females in general had significantly higher central obesity and lower HDL-C than males. Homocysteine levels (measured only among urban respondents) was higher among males than females ( p = .04). Prevalence of hypertension increased with age ( r = .37, p < .001) and correlated with respondents' blood glucose levels ( r = .11, p < .001). There was a step-wise worsening of risk factors as individuals progressed from normal to IFG to T2DM. High burden of diabetes and other cardiovascular risk factors in urban and rural Asian Indians provide basis for tailored and cost-effective prevention and intervention programs, in such resource-constrained settings. [ABSTRACT FROM AUTHOR]

The role of apolipoprotein E (apo E) in lipid metabolism and cholesterol transport is well established. About 14 per cent of the variation in plasma cholesterol levels is attributed to polymorphisms in APO E gene (APO E). APO E consists of three common alleles, designated as ε2, ε3 and ε4 which code for E2, E3 and E4 proteins respectively resulting in three homozygous (E2/E2, E3/E3, E4/E4) and three heterozygous (E3/E2, E4/E2 and E4/E3) phenotypes. Different populations studied worldwide inherit variable frequencies of the APO E alleles and genotypes, with the most frequent allele being ε3. The ε4 allele has been consistently shown to be associated with Alzheimer's disease, coronary heart disease and cerebrovascular disorders. In this review, we have discussed the role of APO E polymorphisms in cerebrovascular and coronary heart diseases. The status of APO E polymorphisms and their disease associations in Asian Indians besides, other populations has also been discussed. Further, studies elucidating the pathophysiology of apo E deficiency conducted in knock-out mice have been reviewed. [ABSTRACT FROM AUTHOR]

Hypothesis Subcutaneous abdominal adipose tissue (SCAT) compared with intra-abdominal adipose tissue (IAAT) would be more significantly associated with the metabolic syndrome in Asian Indians. Design Cross-sectional study. Setting Tertiary care medical institution. Subjects 100 healthy adults without known heart disease or diabetes. Interventions Magnetic resonance imaging to measure cross-sectional areas of abdominal adipose tissue compartments at the L3-L4 intervertebral level. Dual energy x-ray absorptiometry to measure fat percentage (BF%) and lean mass of total body, trunk, legs and arms. Results Subjects with the metabolic syndrome (n=35) had a significantly higher BF%, SCAT and IAAT than those without it. Both SCAT and IAAT showed a significant correlation with blood pressure and triglycerides. One SD increase in IAAT (odds ratio (OR) 3.43; 95% CI 1.78 to 6.63) or SCAT area (OR 6.35; 95% CI 2.75 to 14.7) was significantly associated with the metabolic syndrome. On comparing them in the same model, SCAT was the only significant factor associated with the metabolic syndrome (OR 4.92; 95% CI, 1.95 to 12.38). In receiver operating characteristic curve analysis, significant areas under the curves (AUC) were noted for IAAT (0.77) and SCAT (0.89). On comparing the equality of AUC by C statistics, SCAT was a more significant predictor of the metabolic syndrome than IAAT (p=0.009). Only SCAT was significantly associated with the metabolic syndrome after adjusting for BF%, lean body mass or trunk lean mass. Conclusion SCAT is a more important predictor of the metabolic syndrome in Asian Indians than IAAT. The significance of SCAT in the pathogenesis of atherosclerosis and diabetes needs to be investigated further in Asian Indians [ABSTRACT FROM AUTHOR]

Aim: To assess and compare the secular trends in anthropometric and biochemical parameters over 5 years (2003–2008) amongst Asian Indian adolescents in north India. Methods: Adolescents matched for age, gender, socioeconomic strata and school grade were taken from two school-based studies (2003, n = 106, girls = 50 and boys = 56; 2008, n = 134, girls = 59 and boys = 75) in north India. Assessment included anthropometric measures [body mass index (BMI), waist circumference (WC), waist to hip ratio (W-HR), and triceps skinfold thickness] and biochemical parameters [fasting blood glucose (FBG), serum triglycerides and high-density lipoprotein cholesterol (HDL-c)]. Results: A significant increase in WC (7.2 cm, p < 0.0001), W-HR (0.8, p < 0.0001), triceps skinfold thickness (6.5 mm; p = 0.0001) and FBG (3.5 mg/dl, p = 0.04) was noted in girls, while a significant decrease was noted for HDL-c (–4.6 mg/dl, p = 0.0002) in boys. A higher increase was noted for BMI, WC and FBG in girls as compared to boys. Over 5 years, a marked increase in prevalence (%) of obesity was seen, as indicated by the >95th percentile for age and gender-specific cutoffs of BMI: 11.5% (girls), WC: 19% (girls) and triceps skinfold thickness: 11.7% (girls), 8.8% (boys). Conclusion: Over the last 5 years, there has been a significant increase in abdominal obesity and FBG and a decrease in HDL-c amongst Asian Indian adolescents from north India, which puts them at risk for metabolic disorders at an early age. In view of these data, primary prevention strategies for childhood obesity need to be strengthened. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA), a condition with important implications for hypertension, diabetes, and cardiovascular disease, has been less researched for diabetes-associated microvascular disease. Such research is particularly important for developing countries (in particular, China and India), which are showing rapidly increasing prevalence of obesity, diabetes, and diabetic nephropathy (DN). In particular, independent association between OSA and DN needs more research inputs, keeping commonalty of risk factor profile for both diseases in mind. Finally, although weight loss remains the most effective strategy for OSA and also to some extent for DN, whether treatment with continuous positive airway pressure improves DN, similar to its positive effects on insulin resistance and glucose metabolism, remains to be established. [ABSTRACT FROM AUTHOR]

Objective Biochemical measures for assessment of insulin resistance are not cost-effective in resource-constrained developing countries. Using classification and regression tree (CART) and multivariate logistic regression, we aimed to develop simple predictive decision models based on routine clinical and biochemical parameters to predict insulin resistance in apparently healthy Asian Indian adolescents. Design Community based cross-sectional study. Subjects and patients Data of apparently healthy 793 adolescents (aged 14–19 years) were used for analysis. WHO's multistage cluster sampling design was used for data collection. Methods and measurements Homeostasis Model of Assessment value > 75th centile was used as cut-off for defining the main outcome variable insulin resistance. CART was used to develop the decision tree models and multivariate logistic regression used to develop the clinical prediction score. Results Three classification trees and an equation for prediction score were developed and internally validated. The three decision trees were termed as CART I, CART II and CART III, respectively. CART I based on anthropometric parameters alone has sensitivity 88·2%, specificity 50·1% and area under receiver operating characteristic curve (aROC) 77·8%. CART II based on anthropometric and routine biochemical parameters has sensitivity 94·5%, specificity 38·3% and aROC 73·6%. CART III based on all anthropometric, biochemical and clinical parameters together has sensitivity 70·7%, specificity 79·2% and aROC 77·4%. Prediction score for insulin resistance = 1 × (waist circumference) + 1·1 × (percentage body fat) + 1·6 × (triceps skin-fold thickness) – 1·9 × (gender). A score cut-off of > 0 (using values marked for each) was a marker of insulin resistance in the study population (sensitivity 82·4%, specificity 56·7%, and aROC 73·4%). Conclusion These simple and cost-effective classification rules may be used to predict insulin resistance and implement population based preventive interventions in Asian Indian adolescents. [ABSTRACT FROM AUTHOR]

Insulin resistance is associated with type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD). These abnormalities have been aggravated because of imbalanced and excess nutrition in developed countries, and rapid nutritional and lifestyle transition occurring in developing countries. This review presents evidence linking dietary nutrients with insulin resistance and its metabolic correlates, and also describes these issues from a Asian Indians and South Asian perspective. Despite possible influences from genetic and perinatal factors, diet and physical activity are likely to have greater and often overriding influence in pathogenesis of the insulin resistance, the metabolic syndrome, and T2DM. In animal studies, a link has been established between dietary nutrients and insulin resistance. However, in human studies evidence is not as strong as in animals. Data suggest that dietary (ω-3 polyunsaturated fatty acids (PUFAs) improve lipid profile and may have beneficial effect on insulin resistance. Dietary saturated fatty acids intake is positively associated with insulin resistance. Also, low glycaemic index foods and whole grain intake decrease insulin resistance. Importantly, high carbohydrate diets increase plasma triglycerides, cause hyperinsulinaemia and decreases low-density lipoprotein cholesterol. Among micronutrients, high magnesium and calcium intake have been reported to decrease insulin resistance. High intake of dietary carbohydrate and ω-6 PUFAs, low intake of ω-3 PUFAs and fiber, and high ω6/ω-3 PUFAs ratio have been reported in South Asians. Our recent investigations have shown that increased dietary ω-6 PUFAs and saturated fat intake are significantly associated with fasting hyperinsulinaemia and sub-clinical inflammation, respectively. Such imbalanced diets contribute to high prevalence of insulin resistance, the metabolic syndrome and T2DM in South Asians and Asian Indians. [ABSTRACT FROM AUTHOR]

Abstract: We report the determination of intramyocellular lipids (IMCLs) of the soleus muscle of patients with type 2 diabetes mellitus (T2DM) using proton magnetic resonance spectroscopy. In addition, the various anthropometric and biochemical profiles of these patients were determined, including estimation of C-reactive protein (CRP), an inflammatory marker of coronary heart disease, and insulin resistance [Homeostasis Model Assessment (HOMA-IR)]. The estimated CRP level and the IMCL content in these patients were correlated with body mass index, percentage of body fat, other measures of abdominal obesity, serum lipoproteins, fasting and post-oral glucose load serum insulin levels and other surrogate markers of insulin resistance. The IMCL content (P=.04), CRP (P=.008) and insulin resistance (P=.0007) were significantly higher in T2DM patients compared to healthy controls. However, IMCL content did not correlate with values of fasting insulin, HOMA-IR or CRP in either group. These findings have strong implications of increased cardiovascular risk in Asian Indians with T2DM. The absence of relationship between CRP and IMCL needs to be explored further in a study using a large sample size. [Copyright &y& Elsevier]

OBJECTIVE -- To evaluate the effect of supervised progressive resistance-exercise training (PRT) protocol on insulin sensitivity, glycemia (blood glucose and A1C levels), lipids, and body composition in Asian Indians with type 2 diabetes. RESEARCH DESIGN AND METHODS -- Thirty patients with type 2 diabetes underwent 12 weeks of PRT of six muscle groups (two sets, 10 repetitions each). The subjects were evaluated with detailed anthropometry and with measurements of the disappearance of glucose per unit time (K) during the short insulin tolerance test (K[sub ITT]) for assessment of insulin sensitivity; of fasting blood glucose, A1C, lipids, and high-sensitivity C-reactive protein (hsCRP); of total body fat, regional fat, and lean body mass by dual-energy X-ray absorptiometry; and of cross-sectional skeletal muscle area of upper arm and thigh by computed tomography scan. RESULTS -- Insulin sensitivity improved significantly from mean ± SD K[sub ITT] 1.22 ± 0.73 to 2.13 ± 0.75 (P < 0.0001) after the intervention. Significant decline (mean difference ± SD) from baseline was recorded in levels of the following parameters: A1C (0.54 ± 0.4% P < 0.001), fasting blood glucose (2.7 ± 2.2 mmol/l, P < 0.001), total cholesterol (0.39 ± 0.7 mmol/l, P = 0.003), serum triglycerides (0.39 ± 0.5 mmol/l, P < 0.001), and truncal and peripheral subcutaneous adipose tissue compartments (SCAT) (P < 0.001). However, no significant changes were noticed in BMI or levels of total body fat, truncal fat, lean body mass, cross-sectional skeletal muscle area of the extremities, or hsCRP levels. CONCLUSIONS -- Moderate-intensity PRT for 3 months resulted in significant improvement in insulin sensitivity, glycemia, lipids, and truncal and peripheral SCAT in patients with type 2 diabetes. Resistance training should be an integral part of exercise regimen in Asian Indians with type 2 diabetes. [ABSTRACT FROM AUTHOR]

The article focuses on the complexities of the metabolic syndrome. It describes metabolic syndrome as a cluster of metabolic abnormalities, such as impaired glucose metabolism and hypertension. It questions whether metabolic syndrome predicts risks of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). It also notes that insulin resistance may not explain the presence of metabolic syndrome in totality.

Recent data indicate a rise in obesity both in children and adolescents in developing countries. The overall prevalence of overweight/obesity in urban children in New Delhi has shown an increase from 16% in 2002 to about 24% in 2006-2007. Our recent data show that the prevalence among adolescent children was 29% in private schools and 11.3% in government funded schools. While India already has highest number of patients with type 2 diabetes mellitus (T2DM) globally, rapid rise of obesity in children is the prime reason for increasing insulin resistance, the metabolic syndrome, dyslipidemia, polycystic ovarian syndrome and raised levels of C-reactive protein. Excess body fat, thick truncal subcutaneous fat, and abdominal adiposity are important predisposing factors for development of insulin resistance in Asian Indian children. As compared to other ethnic groups, children with ancestral origin in South Asia manifest adiposity, insulin resistance and metabolic perturbations earlier in life and these derangements are of higher magnitude than white Caucasian children. Since the metabolic syndrome and obesity track into adulthood, these clinical entities need to be recognized early for effective prevention of T2DM and coronary heart disease. Therapeutic lifestyle changes, maintenance of high levels of physical activity and normal weight are most important prevention strategies. Both high-risk surveillance and cost-effective population intervention programs are urgently needed. In this context, we have launched one of the largest program ("MARG", The Path) to curb childhood obesity in India. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective of this review is to discuss definition, determinants, and management issues of the metabolic syndrome in children with a focus on South Asians. Methods: The literature search was done using the PubMed search engine (National Library of Medicine, Bethesda, MD, USA). Manual searches for other important references and medical databases were also done. Results: There is a need for an integrated definition of the metabolic syndrome in children and adolescents, taking cognizance of the ethnic-specific variations. Obesity and body fat patterning are important determinants of insulin resistance and the metabolic syndrome in children and ethnic variations in these parameters are seen. Excess body fat and thicker truncal subcutaneous fat are important predisposing factors for development of insulin resistance in South Asian children. Because the metabolic syndrome tracks into adulthood, its manifestations need to be recognized early for prevention of diabetes and coronary heart disease. Therapeutic lifestyle changes, maintenance of high levels of physical activity and normal weight are most important strategies; pharmacologic therapy for individual components of the metabolic syndrome is occasionally needed. Conclusion: The metabolic syndrome in children is an important clinical marker of diabetes and coronary heart disease in adults. In view of the rapid increase in the metabolic syndrome in most populations, high-risk screening and effective public-intervention educational programs are urgently needed. [Copyright &y& Elsevier]

Abstract: In this review, we discuss the impact of migration on the incidence and prevalence of obesity and type 2 diabetes mellitus (T2DM) in different ethnic groups and populations. We also analyze the determinants of such phenomena in view of the global increase in the migration and escalating prevalence of obesity and T2DM. The risk escalation of the obesity and T2DM followed a gradient, as migrants (Blacks, Hispanics, Chinese, South Asians, etc.) became more affluent and urbanized, indicating an important role of environmental factors. A stepwise increase in the prevalence of obesity in Blacks along the path of migration (5% in Nigeria, 23% in Jamaica, and 39% in the United States) is a classic example. Furthermore, South Asian migrants, who are particularly predisposed to develop insulin resistance and T2DM, showed nearly four times prevalence rates of T2DM than rural sedentee populations. Similar observations were also reported in intracountry migrants and resettled indigenous populations. The determinants were found to include nutrition transition, physical inactivity, gene-environment interaction, stress, and other factors such as ethnic susceptibility. However, certain contradictory trends were also seen in some migrant communities and have been explained by various phenomena such as healthy migrant effect, “salmon bias”, and adherence to traditional diets. A review of the evidence suggests a critical role of environmental factors in conferring an increased risk of obesity and T2DM. The important contributory factors to this phenomenon were urbanization, mechanization, and changes in nutrition and lifestyle behaviors, but the role of stress and as yet unknown factors remain to be determined. [Copyright &y& Elsevier]

Diabetes during the COVID-19 pandemic: A global call to reconnect with patients and emphasize lifestyle changes and optimize glycemic and blood pressure control Individuals with diabetes, obesity, and hypertension are at heightened risk of adverse outcome of coronavirus-associated disease 2019 (COVID-19). An emphasis on the potential of improved outcome of COVID-19 when diabetes and hypertension are under good control is reasonable. [Extracted from the article]

Abstract: Objective: To assess the phenotypic correlations of insulin resistance with obesity and its relationship with the metabolic syndrome in Asian Indian adolescents. Design and subjects: We analyzed clinical, anthropometric (body mass index [BMI], waist circumference [WC]) and laboratory (fasting blood glucose [FBG], lipids and fasting serum insulin) data from 793 subjects (401 males and 392 females) aged 14–19 years randomly selected from Epidemiological Study of Adolescents and Young (ESAY) adults (n =1447). The percentile cut-offs for 14–19 years age from ESAY cohort were used for defining abnormal values of variables. We devised three sets of definitions of metabolic syndrome by including BMI and fasting insulin levels with other defining variables. Results: Nearly 28.9% of adolescents had fasting hyperinsulinemia despite normal values of BMI, WC, FBG, lipids, and blood pressure. Remarkably, NCEP criteria with appropriate percentile cut-off points for Asian Indian adolescents identified metabolic syndrome in only six (0.8%) subjects. Inclusion of both BMI and WC in the definition resulted in increase in the prevalence of metabolic syndrome to 4.3%. With inclusion of hyperinsulinemia, the prevalence of metabolic syndrome increased to 4.2% (from 0.8%) in the modified NCEP definition, 5.2% (from 0.9%) when BMI was substituted for WC, and 10.2 (from 4.3%) when both BMI and WC were included. Conclusions: Our data show marked heterogeneity of phenotypes of insulin resistance and poor value of NCEP definition to identify metabolic syndrome. We propose that BMI and fasting insulin should be evaluated in candidate definitions of metabolic syndrome in Asian Indian adolescents. [Copyright &y& Elsevier]

Abstract: Objective: There is a wide disparity in prevalence and cardiovascular disease mortality in different Indian states. To determine significance of various nutritional factors and other lifestyle variables in explaining this difference in cardiovascular disease mortality we performed an analysis. Methods and results: Mortality data were obtained from the Registrar General of India. In 1998 the annual death rate for India was 840/100,000 population. Cardiovascular diseases contribute to 27% of these deaths and its crude mortality rate was 227/100,000. Major differences in cardiovascular disease mortality rates in different Indian states were reported varying from 75–100 in sub-Himalayan states of Nagaland, Meghalaya, Himachal Pradesh and Sikkim to a high of 360–430 in Andhra Pradesh, Tamil Nadu, Punjab and Goa. Lifestyle data were obtained from national surveys conducted by the government of India. The second National Family Health Survey (26 states, 92,447 households, 301,984 adults) conducted in 1998–1999 reported on various demographic and lifestyle variables and India Nutrition Profile Study reported dietary intake of 177,841 adults (18 states, 75,229 men, 102,612 women). Cardiovascular disease mortality rates were correlated with smoking, literacy levels, prevalence of stunted growth at 3-years (as marker of fetal undernutrition), adult mean body mass index, prevalence of overweight and obesity, dietary consumption of calories, cereals and pulses, green leafy vegetables, roots, tubers and other vegetables, milk and milk products, fats and oils, and sugar and jaggery. As a major confounder in different states is poverty, all the partial correlation coefficients were adjusted for illiteracy, fertility rate and infant mortality rate. There was a significant positive correlation of cardiovascular disease mortality with prevalence of obesity (R =0.37) and dietary consumption of fats (R =0.67), milk and its products (R =0.27) and sugars (R =0.51) and negative correlation with green leafy vegetable intake (R =−0.42) (p <0.05). Conclusions: There are large disparities in cardiovascular disease mortality in different Indian states. This can be epidemiologically explained by difference in dietary consumption of fats, milk, sugar and green-leafy vegetables and prevalence of obesity. [Copyright &y& Elsevier]

Abstract: Determination of cutoff points of waist circumference is of paramount importance for prevention, optimum management, and prognostication of obesity, the metabolic syndrome, type 2 diabetes mellitus, and coronary heart disease. Heterogeneity of composition of abdominal tissues, in particular adipose tissue and skeletal muscle, and their location-specific and changing relations with metabolic factors and cardiovascular risk factors in different ethnic groups do not allow a simple definition of abdominal obesity that could be applied uniformly. In particular, Asians appear to have higher morbidity at lower cutoff points for waist circumference than do white Caucasians. International health agencies that deal with obesity (World Health Organization, International Obesity Task Force) should take cognizance of these data and consider formulating new cutoff points for waist circumference to define abdominal obesity for Asian populations. [Copyright &y& Elsevier]

OBJECTIVES -- We aimed to evaluate eight candidate definitions of the metabolic syndrome (MS) against the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) definition as the reference for optimally defining MS in adult Asian Indians. RESEARCH DESIGN AND METHODS -- We used clinical and biochemical data from our previous cross-sectional epidemiological studies. Candidate definitions of MS were proposed by modifying the NCEP ATPIII definition. These modifications included the following: waist circumference cutoffs as >90 cm in men and >80 cm in women, BMI cutoff as >23 kg/m², and a measure of truncal subcutaneous fat (subscapular skinfold thickness [SST] > 18 mm). RESULTS -- The highest prevalence (29.9%) of MS was observed by the inclusion of modified cutoffs of waist circumference and BMI and SST in place of the existing cutoffs of waist circumference in the NCEP ATPIII criteria. Further, this modified definition showed the maximum absolute gain in the percentage of prevalence of MS over the NCEP ATPIII definition, and it was the best predictor for MS in subjects with impaired fasting glucose, type 2 diabetes, and different age-groups. The lowest percentage of prevalence of MS was observed with the definition that excluded biochemical variables and blood pressure. CONCLUSIONS -- The criteria for defining MS in adult Asian Indians need revision. Inclusion of modified cutoffs of waist circumference and BMI and measures of truncal subcutaneous fat in the NCEP ATPIII definition requires further validation. [ABSTRACT FROM AUTHOR]