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Kalra A, Jose AP, Prabhakaran P, Kumar A, Agrawal A, Roy A, Bhargava B, Tandon N, Prabhakaran D. The burgeoning cardiovascular disease epidemic in Indians - perspectives on contextual factors and potential solutions. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 12:100156. [PMID: 37384064 PMCID: PMC10305862 DOI: 10.1016/j.lansea.2023.100156] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 06/30/2023]
Abstract
Cardiovascular diseases (CVD) are the leading cause of death and disability in India. The CVD epidemic in Indians is characterized by a higher relative risk burden, an earlier age of onset, higher case fatality and higher premature deaths. For decades, researchers have been trying to understand the reason for this increased burden and propensity of CVD among Indians. It can partly be explained by population-level changes and the remaining by increased inherent biological risk. While increased biological risk can be attributed to phenotypic changes caused by early life influences, six major transitions can be considered largely responsible for the population-level changes in India-epidemiological, demographic, nutritional, environmental, social-cultural and economic. Although conventional risk factors explain substantial population attributable risk, the thresholds at which these risk factors operate are different among Indians compared with other populations. Therefore, alternate explanations for these ecological differences have been sought and multiple hypotheses have been proposed over the years. Prenatal factors that include maternal and paternal influences on the offspring, and postnatal factors, ranging from birth through childhood, adolescence and young adulthood, as well as inter-generational influences have been explored using the life course approach to chronic disease. In addition to this, recent research has illustrated the importance of the role of inherent biological differences in lipid metabolism, glucose metabolism, inflammatory states, genetic predispositions and epigenetic influences for the increased risk. A multifaceted and holistic approach to CVD prevention that takes into consideration population-level as well as biological risk factors would be needed to control the burgeoning CVD epidemic among Indians.
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Affiliation(s)
- Ankur Kalra
- Cardiovascular Institute, Kalra Hospitals, New Delhi, India
| | - Arun Pulikkottil Jose
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, Haryana, India
| | - Poornima Prabhakaran
- Centre for Environmental Health, Public Health Foundation of India, Gurugram, Haryana, India
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Ohio, USA
| | - Anurag Agrawal
- Trivedi School of Biosciences, Ashoka University, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, Haryana, India
- London School of Hygiene and Tropical Medicine, London, UK
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Goel R, Malhotra B, Rastogi A, Singh T, Bhansali A, Bhadada S. Body fat patterning in lean Asian Indians with diabetes: Case-control study. Diabetes Metab Syndr 2023; 17:102728. [PMID: 36857897 DOI: 10.1016/j.dsx.2023.102728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
AIM To perform body fat patterning in Asian-Indian individuals with T2D. METHODS A total of 53 patients with recent-onset diabetes and 106 non-diabetic controls were included from screened 261 individuals. Data was divided into 2 groups; overweight/obese [(BMI ≥23 kg/m2); 45 diabetic, 84 non-diabetic] and lean [(BMI <23 kg/m2); 8 diabetic, 22 non-diabetic]. Anthropometry (weight, height, BMI, waist, hip circumference, waist-hip ratio) and lipids, adiponectin and hsCRP were measured. Body composition (BC) was assessed by bioimpedance analysis (BIA) and Dual Energy X-ray absorptiometry (DEXA). We analyzed the association of visceral adipose tissue (VAT) with anthropometric measures to identify predictors of diabetes. RESULTS Total body fat percentage was comparable between patients with T2D and non-diabetic controls in both, obese [35.0 ± 9.1% vs 36.8 ± 8.4%, p = 0.29 (BIA), 40.1 ± 6.7 vs 46.6 ± 4.1%, p = 0.052 (DEXA) and lean [25.1 ± 5.6% vs 26.0 ± 6.7%, p = 0.74 (BIA), 35.3 ± 4.8% vs 34.1 ± 6.3%, p = 0.72 (DEXA) study group. Individuals of T2D (obese or lean) had significantly higher visceral fat rating (BIA), VAT area, volume, mass and VAT corrected for total body fat percentage (DEXA). Obese T2D had lower muscle mass (57.0 ± 6.4% vs 60.0 ± 5.5%, p = 0.03) than obese controls. Intra-abdominal visceral fat (IAVF) [(VFR, VAT (mass/area/volume) and VAT mass corrected for body fat)] had the best sensitivity (71%) for incident diabetes. CONCLUSION Higher Intra-abdominal visceral fat and not total body fat is associated with incident diabetes independent of BMI. IAVF estimation by either BIA or DEXA should be performed to predict diabetes especially in lean individuals.
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Affiliation(s)
- Rohan Goel
- Deptt. Of Internal Medicine, PGIMER, Chandigarh, India
| | | | - Ashu Rastogi
- Deptt Of Endocrinology, PGIMER, Chandigarh, India.
| | - Tulika Singh
- Deptt Of Radiodiagnosis, PGIMER, Chandigarh, India
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Abstract
Metabolic syndrome (MS), a conglomeration of several conditions including obesity, type 2 diabetes mellitus (T2DM), insulin resistance, elevated blood pressure, and dyslipidemia is reaching epidemic proportions. Anemia is caused by iron deficiency or dysregulation of iron homeostasis, leading to tissue hypoxia. Coexistence of anemia and MS or its components has been reported in the literature. The term "rubrometabolic syndrome" acts as a unifying entity linking the importance of blood in health and anemia in MS; it justifies two principles - redness of blood and low-grade inflammation. Chronic low-grade inflammation in MS affects iron metabolism leading to anemia. Tissue hypoxia that results from the anemic condition seems to be a major causative factor for the exacerbation of several microvascular and macrovascular components of T2DM, which include diabetic neuropathy, nephropathy, retinopathy, and cardiovascular complications. In obesity, anemia leads to malabsorption of micronutrients and can complicate the management of the condition by bariatric surgery. Anemia interferes with the diagnosis and management of T2DM, obesity, dyslipidemia, or hypertension due to its effect on pathological tests as well as medications. Since anemia in MS is multifaceted, the management of anemia is challenging as overcorrection of anemia with erythropoietin-stimulating agents can cause detrimental effects. These limitations necessitate availability of an effective and safe therapy that can maintain and elevate the hemoglobin levels along with maintaining the physiological balance of other systems. This review discusses the physiological links between anemia and MS along with diagnosis and management strategies in patients with coexistence of anemia and MS.
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Affiliation(s)
| | - Ankia Coetzee
- Division of Endocrinology, Stellenbosch University & Tygerberg Hospital, Cape Town, South Africa
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Joel R Saldaña
- Resultados Medicos, Desarrollo e Investigación, SC, Boulevard Valle de San Javier, Pachuca Hidalgo, Mexico City, Mexico
| | - Gary Kilov
- University of Melbourne, Launceston, Australia
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Puri R, Mehta V, Duell PB, Wangnoo SK, Rastogi A, Mohan V, Zargar AH, Kalra S, Sahoo AK, Iyengar SS, Yusuf J, Mukhopadhyay S, Singla MK, Shaikh A, Kohli S, Mathur S, Jain S, Narasingan SN, Gupta V, Agarwala R, Mittal V, Varma A, Panda JK, Shetty S, Yadav M, Muruganathan A, Dabla P, Pareek KK, Manoria PC, Nanda R, Sattur GB, Pancholia AK, Wong ND. Management of diabetic dyslipidemia in Indians: Expert consensus statement from the Lipid Association of India. J Clin Lipidol 2023; 17:e1-e14. [PMID: 36577628 DOI: 10.1016/j.jacl.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
Abstract
In 2021 an estimated 74 million individuals had diabetes in India, almost all type 2 diabetes. More than half of patients with diabetes are estimated to be undiagnosed and more 90% have dyslipidemia that is associated with accelerated development of atherosclerotic cardiovascular disease (ASCVD). Patients of Indian descent with diabetes have multiple features that distinguish them from patients with diabetes in Western populations. These include characteristics such as earlier age of onset, higher frequency of features of the metabolic syndrome, more prevalent risk factors for ASCVD, and more aggressive course of ASCVD complications. In light of the unique features of diabetes and diabetic dyslipidemia in individuals of Indian descent, the Lipid Association of India developed this expert consensus statement to provide guidance for management of diabetic dyslipidemia in this very high risk population. The recommendations contained herein are the outgrowth of a series of 165 webinars conducted by the Lipid Association of India across the country from May 2020 to July 2021, involving 155 experts in endocrinology and cardiology and an additional 2880 physicians.
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Affiliation(s)
- Raman Puri
- Senior Consultant Cardiologist, Indraprastha Apollo Hospitals, New Delhi, India(Drs Puri).
| | - Vimal Mehta
- Director-Professor, Department of Cardiology, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India(Drs Mehta and Yusuf)
| | - P Barton Duell
- Professor of Medicine, Knight Cardiovascular Institute and Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, OR, USA (Drs Duell)
| | - S K Wangnoo
- Sr. Consultant Endocrinologist & Diabetologist, Indraprastha Apollo Hospitals, New Delhi, India (Drs Wangnoo)
| | - Ashu Rastogi
- Assistant Professor, Department of Endocrinology & Metabolism, PGIMER Chandigarh, Punjab, India (Drs Rastogi)
| | - V Mohan
- Director Madras Diabetic Research Foundation & Chairman & chief Diabetologist, Dr Mohan Diabetes specialities Centre, Chennai, Tamil Nadu, India (Drs Mohan)
| | - Abdul Hamid Zargar
- Medical Director, Center for Diabetes & Endocrine Care, National Highway, Gulshan Nagar, Srinagar, J&K, India (Drs Zargar)
| | - Sanjay Kalra
- Consultant, Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India (Drs Kalra)
| | - Abhay Kumar Sahoo
- Associate Professor in Endocrinology at IMS and SUM Hospital, Bhubaneshwar, India (Drs Sahoo)
| | - S S Iyengar
- Sr. Consultant and Head, Department of Cardiology, Manipal Hospital, Bangalore, Karnataka, India (Drs Iyengar)
| | - Jamal Yusuf
- Director-Professor, Department of Cardiology, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India(Drs Mehta and Yusuf)
| | - Saibal Mukhopadhyay
- Director-Professor and Head, Department of Cardiology, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India (Drs Mukhopadhyay)
| | - Mani Kant Singla
- Director, MKS Endocrinologist, Ludhiana, Punjab, India (Drs Singla)
| | - Altamash Shaikh
- Sr. Consultant, Endocrinology, Saifee Hospital, Mumbai, Maharashtra, India (Drs Shaikh)
| | - Sunil Kohli
- Professor and Head Department of Medicine, Hamdard Institute of Medical Sciences, New Delhi, India (Drs Kohli)
| | - Sandeep Mathur
- Professor and Head of Department of Endocrinology, SMS Medical College and Hospital, Jaipur, Rajasthan, India (Drs Mathur)
| | - Sachin Jain
- Ex. Director Professor Lady Harding Medical College, New Delhi, India (Drs Jain)
| | - S N Narasingan
- Former Adjunct Professor of medicine, Dr MGR Medical University, and Managing Director, SNN Specialities Clinic, Chennai, Tamil Nadu, India (Drs Narasingan)
| | - Vipul Gupta
- Medical Director, Gupta Ultrasound & Heart care Centre, New Delhi, India (Drs Gupta)
| | - Rajeev Agarwala
- Sr. Consultant Cardiologist, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India (Drs Agarwala)
| | - Vinod Mittal
- Sr. Consultant Diabetologist & Head, Centre for Diabetes & Metabolic disease, Delhi Heart & Lung Institute, Delhi, India (Drs Mittal)
| | - Amit Varma
- Professor & Head Department of Medicine, SGRR Institute of medical and health Sciences, Dehradun, Uttarakhand, India (Drs Varma)
| | - Jayant Kumar Panda
- Professor & Head, PG Department of Internal Medicine, SCB Medical College, Cuttack, Odisha, India (Drs Panda)
| | - Sadanand Shetty
- Head, Department of Cardiology, K.J Somaiya Super Speciality Institute, Sion (East), Mumbai, Maharashtra, India (Drs Shetty)
| | - Madhur Yadav
- Director-Professor of Medicine, Lady Harding Medical College, New Delhi, India (Drs Yadav)
| | - A Muruganathan
- Sr. Consultant Internal Medicine, AG Hospital, Tirupur, Tamil Nadu, India (Drs Muruganathan)
| | - Pradeep Dabla
- Professor of Biochemistry, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India (Drs Dabla)
| | - K K Pareek
- Head, Department of Medicine, S. N. Pareek Hospital, Dadabari, Kota, Rajasthan, India (Drs Pareek)
| | - P C Manoria
- Director, Heart and critical Care Hospital, Bhopal, Madhya Pradesh, India (Drs Manoria)
| | - Rashmi Nanda
- Consultant Physician, Cardiac Care Centre, South Extension, New Delhi, India (Drs Nanda)
| | - G B Sattur
- Sr. Consultant Physician and Diabetologist, Sattur Medical Care, Hubli, Karnataka, India (Drs Sattur)
| | - A K Pancholia
- Head of Department, Medicine & Preventive Cardiology, Arihant Hospital & RC, Indore, Madhya Pradesh, India (Drs Pancholia)
| | - Nathan D Wong
- Professor and Director, Heart Disease Prevention Program, Division of Cardiology, University of California Irvine, USA (Drs Wong)
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Mahadevan M, Bose M, Gawron KM, Blumberg R. Metabolic Syndrome and Chronic Disease Risk in South Asian Immigrants: A Review of Prevalence, Factors, and Interventions. Healthcare (Basel) 2023; 11:healthcare11050720. [PMID: 36900725 PMCID: PMC10000781 DOI: 10.3390/healthcare11050720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023] Open
Abstract
South Asians (SAs) are among the fastest-growing ethnic groups in the U.S. Metabolic syndrome (MetS) is a condition that is characterized by multiple health factors that increase the risk for chronic diseases, such as cardiovascular disease (CVD) and diabetes. MetS prevalence among SA immigrants ranges from 27-47% in multiple cross-sectional studies using different diagnostic criteria, which is generally higher compared to other populations in the receiving country. Both genetic and environmental factors are attributed to this increased prevalence. Limited intervention studies have shown effective management of MetS conditions within the SA population. This review reports MetS prevalence in SAs residing in non-native countries, identifies contributing factors, and discusses ways to develop effective community-based strategies for health promotion targeting MetS among SA immigrants. There is a need for more consistently evaluated longitudinal studies to facilitate the development of directed public health policy and education to address chronic diseases in the SA immigrant community.
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Affiliation(s)
- Meena Mahadevan
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
- Correspondence: ; Tel.: +1-973-655-7574
| | - Mousumi Bose
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
| | | | - Renata Blumberg
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
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Sluyter JD, Plank LD, Rush EC. Identifying metabolic syndrome in migrant Asian Indian adults with anthropometric and visceral fat action points. Diabetol Metab Syndr 2022; 14:96. [PMID: 35841020 PMCID: PMC9284905 DOI: 10.1186/s13098-022-00871-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a clustering of metabolic risk factors, including large waist circumference (WC). Other anthropometric parameters and visceral fat mass (VFM) predicted from these may improve MetS detection. Our aim was to assess the ability of such parameters to predict this clustering in a cross-sectional, diagnostic study. METHOD Participants were 82 males and 86 females, aged 20-74 years, of Asian Indian ethnicity. VFM was estimated by dual-energy X-ray absorptiometry (DXA) through identification of abdominal subcutaneous fat layer boundaries. Non-anthropometric metabolic risk factors (triglycerides, HDL cholesterol, blood pressure and glucose) were defined using MetS criteria. We estimated the ability of anthropometry and VFM to detect ≥ 2 of these factors by receiver operating characteristic (ROC) and precision-recall curves. RESULTS Two or more non-anthropometric metabolic risk factors were present in 45 (55%) males and 29 (34%) females. The area under the ROC curve (AUC) to predict ≥ 2 of these factors using WC was 0.67 (95% confidence interval: 0.55-0.79) in males and 0.65 (0.53-0.77) in females. Optimal WC cut-points were 92 cm for males (63% accuracy) and 79 cm for females (53% accuracy). VFM, DXA-measured sagittal diameter and suprailiac skinfold thickness yielded higher AUC point estimates (by up to 0.06), especially in females where these measures improved accuracy to 69%, 69% and 65%, respectively. Pairwise combinations that included WC further improved accuracy. CONCLUSION Our findings indicate that cut-points for readily obtained measures other than WC, or in combination with WC, may provide improved detection of MetS risk factor clusters.
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Affiliation(s)
- John D. Sluyter
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, 28 Park Road, Auckland, 1023 New Zealand
| | - Lindsay D. Plank
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Elaine C. Rush
- School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Chan ML, Eng CW, Gilsanz P, Whitmer RA, Mungas D, Meyer O, Farias ST. Prevalence of Instrumental Activities of Daily Living Difficulties and Associated Cognitive Predictors Across Racial/Ethnic Groups: Findings From the KHANDLE Study. J Gerontol B Psychol Sci Soc Sci 2022; 77:885-894. [PMID: 34486659 PMCID: PMC9071392 DOI: 10.1093/geronb/gbab163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Cognitive functioning is associated with instrumental activity of daily living (IADL) performance among older adults. The present study examines potential differences in the prevalence of IADL difficulty and association with cognition across diverse groups. METHOD Participants included 455 non-Hispanic Whites, 395 Blacks, 370 Asians, and 296 Latinos aged 65 years and older without a current dementia diagnosis from the Kaiser Healthy Aging and Diverse Life Experience cohort. Participants' self-reported IADL functioning and cognition was measured across episodic memory and executive functioning. RESULTS Older age, male gender, and being Black were associated with more IADL difficulties. Executive functioning showed a stronger association with IADLs than memory, and it was independent of health status, whereas memory was not. In joint models including both cognitive domains, executive functioning remained a significant predictor of IADL difficulty, but memory did not. Results for both cognitive domains were attenuated with self-rated health added to the joint model. These relationships did not significantly differ across racial/ethnic groups. CONCLUSIONS Our study supports previous work suggesting that Black older adults are at increased risk for IADL disability. This is the first study we are aware of that examined the association between specific cognitive domains and IADL performance across multiple racial/ethnic groups. Findings indicate that cognitive functioning has similar associations with self-reported IADL disability across diverse groups, and that executive functioning plays a particularly important role in IADL disability among older adults without dementia; however, health status largely attenuates the relationship between IADL difficulty and cognition.
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Affiliation(s)
- Michelle L Chan
- Department of Neurology, University of California, Davis, California, USA
| | - Chloe W Eng
- Department of Epidemiology and Translational Science, University of California, San Francisco, California, USA
| | - Paola Gilsanz
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Rachel A Whitmer
- Department of Public Health Sciences, University of California, Davis, California, USA
| | - Dan Mungas
- Department of Neurology, University of California, Davis, California, USA
| | - Oanh Meyer
- Department of Neurology, University of California, Davis, California, USA
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Kondal D, Patel SA, Ali MK, Mohan D, Rautela G, Gujral UP, Shivashankar R, Anjana RM, Gupta R, Kapoor D, Vamadevan AS, Mohan S, Kadir MM, Mohan V, Tandon N, Prabhakaran D, Narayan KMV. Cohort Profile: The Center for cArdiometabolic Risk Reduction in South Asia (CARRS). Int J Epidemiol 2022; 51:e358-e371. [PMID: 35138386 PMCID: PMC9749725 DOI: 10.1093/ije/dyac014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/28/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- Dimple Kondal
- Public Health Foundation of India, New Delhi, India,Centre for Chronic Disease Control, New Delhi, India
| | - Shivani A Patel
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mohammed K Ali
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - Unjali P Gujral
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Ruby Gupta
- Public Health Foundation of India, New Delhi, India
| | - Deksha Kapoor
- All India Institute of Medical Sciences, New Delhi, India
| | - Ajay S Vamadevan
- Centre for Chronic Disease Control, New Delhi, India,Healthcare management, Goa Institute of Management, Sanquelim, Goa, India
| | | | | | | | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Dorairaj Prabhakaran
- Corresponding author. Public Health Foundation of India, Plot no 47, Sector 44, Gurgaon, Haryana 122002, India. E-mail:
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Deol RM, Thompson LM, Chun KM, Chesla C. Managing Type 2 Diabetes: Beliefs and Daily Practices in First Generation Asian Indians in the United States. SAGE Open Nurs 2022; 8:23779608211054814. [PMID: 35024446 PMCID: PMC8744191 DOI: 10.1177/23779608211054814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Diabetes management and control remain poor in Asian Indians (AI) and is influenced by personal beliefs and cultural practices. Since AIs have a high prevalence of diabetes and are more likely develop complications earlier than any other ethnic group, understanding their beliefs and practices of diabetes management is essential. The purpose of this study was to examine and understand beliefs and practices about diabetes self-management in first-generation AI Hindus and Sikhs. Method Interpretative phenomenology was used to interview 12 first generation AI participants with type 2 diabetes to elicit beliefs and daily self-management practices of diabetes. Interpretative and thematic analysis were completed. Results Diabetes self-management was a balancing act influenced by Ayurvedic principles, allopathy and dietary practices; gender roles, insufficient knowledge and culturally inappropriate diabetes education. Discussion Culturally appropriate strategies that incorporate Ayurvedic principles, dietary practices, gender roles should be developed to improve diabetes management.
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Affiliation(s)
- Rupinder M Deol
- Family Health Nursing, University of California, San Francisco, CA
| | - Lisa M Thompson
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia
| | - Kevin M Chun
- College of Arts and Psychology, San Francisco, CA
| | - Catherine Chesla
- Family Health Nursing, University of California, San Francisco, CA
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Girisha B, Philip N, Shetty S, Pinto A, Noronha T. Estimation of metabolic syndrome in acanthosis nigricans - A hospital based cross-sectional study. Indian J Dermatol 2022; 67:92. [PMID: 35656279 PMCID: PMC9154168 DOI: 10.4103/ijd.ijd_442_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and Objectives Acanthosis nigricans is characterized by hyperpigmentation and velvet-like thickening of the skin. It symmetrically involves the neck, axilla, groins, antecubital and popliteal fossae, umbilical, and perianal areas. Acanthosis nigricans is a marker for insulin resistance and is increasingly found to be associated with metabolic syndrome. We conducted this study to estimate the frequency of metabolic syndrome in acanthosis nigricans. Methods In this hospital-based, cross-sectional study, we evaluated 60 patients with acanthosis nigricans with neck involvement. They were examined for other areas of involvement by acanthosis nigricans. Axillary and neck severity was graded based on the scale described by Burke et al. Insulin resistance was interpreted using homeostatic model assessment (HOMA-IR). Metabolic syndrome was diagnosed according to the SAM-NCEP criteria. Collected data were analyzed using IBM SPSS Statistics, Version 22 (Armonk, NY: IBM Corp). Results Axilla was the most common site involved in 51 patients (85%) followed by knuckles (55%). Metabolic syndrome was found in 78.3% of our patients, and 56.66% had insulin resistance. A statistically significant association of severity grading of axillary acanthosis nigricans with both metabolic syndrome (P = 0.001) and insulin resistance (P = 0.03) was noted. However, no meaningful association was found between the severity grading of neck acanthosis nigricans with both metabolic syndrome (P = 0.4) and insulin resistance (P = 0.08). The association of neck texture grading of acanthosis nigricans with insulin resistance was statistically significant (P = 0.005). Conclusions Metabolic syndrome was seen in 78.3% of acanthosis nigricans. Axillary severity grading was associated with metabolic syndrome.
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Jaffer S, Foulds HJA, Parry M, Gonsalves CA, Pacheco C, Clavel MA, Mullen KA, Yip CYY, Mulvagh SL, Norris CM. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women-Chapter 2: Scope of the Problem. CJC Open 2021; 3:1-11. [PMID: 33458627 PMCID: PMC7801195 DOI: 10.1016/j.cjco.2020.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
Background This Atlas chapter summarizes the epidemiology of cardiovascular disease (CVD) in women in Canada, discusses sex and gender disparities, and examines the intersectionality between sex and other factors that play a prominent role in CVD outcomes in women, including gender, indigenous identity, ethnic variation, disability, and socioeconomic status. Methods CVD is the leading cause of premature death in Canadian women. Coronary artery disease, including myocardial infarction, and followed by stroke, accounts for the majority of CVD-related deaths in Canadian women. The majority of emergency department visits and hospitalizations by women are due to coronary artery disease, heart failure, and stroke. The effect of traditional cardiovascular risk factors and their association with increasing cardiovascular morbidity is unique in this group. Results Indigenous women in Canada experience increased CVD, linked to colonization and subsequent social, economic, and political challenges. Women from particular racial and ethnic backgrounds (ie, South Asian, Afro-Caribbean, Hispanic, and Chinese North American women) have greater CVD risk factors, and CVD risk in East Asian women increases with duration of stay in Canada. Conclusions Canadians living in northern, rural, remote, and on-reserve residences experience greater CVD morbidity, mortality, and risk factors. An increase in CVD risk among Canadian women has been linked with a background of lower socioeconomic status, and women with disabilities have an increased risk of adverse cardiac events.
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Affiliation(s)
- Shahin Jaffer
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather J A Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Christine Pacheco
- Pierre-Boucher Hospital, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Marie-Annick Clavel
- Laval University, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Ville de Québec, Québec, Canada
| | - Kerri A Mullen
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Cindy Y Y Yip
- HeartLife Foundation of Canada, Toronto, Ontario, Canada
| | - Sharon L Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, Alberta, Canada
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12
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Syukri M, Virnardo R, Salwani D, Sofyan H. The prevalence and associated factors of metabolic syndrome among patients with end-stage renal failure undergoing hemodialysis in Indonesia. Diabetes Metab Syndr 2020; 14:2069-2072. [PMID: 33120282 DOI: 10.1016/j.dsx.2020.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Various components of Metabolic Syndrome (MetS) have been studied in general population, but few among patients undergoing hemodialysis (HD). This study aims to assess the metabolic profiles and to estimate the prevalence of MetS among patients with End-Stage Renal Failure (ESRF) undergoing HD. METHODS Patients undergoing HD during October 2016-August 2017 in three General Hospitals in Aceh - Indonesia were included in the study. MetS was defined according to the modified NCEP-ATP III criteria for South Asians. RESULTS The overall prevalence of MetS was 50.2%. Male patients have higher MetS prevalence (58.3%) than female (41.7%). MetS was only associated with gender and history of diabetes, and not with other demographic variables. Alteration central obesity was the most common metabolic abnormality among the patients (57.2%), followed by hypertension (30.7%), diabetes (30%), raised triglycerides (27.4%) and reduced HDL (23.7%). Pre-metabolic syndrome was found in 48.3%, leaving only 1.4% of patients free from metabolic abnormality. CONCLUSIONS Half of the patients undergoing HD in Indonesia suffered from MetS and almost half had pre-metabolic syndrome. High rate of metabolic abnormalities in patients with ESRF requires intensive examination and collaboration between nephrologists and endocrinologists to prevent the deterioration of patients' condition during HD.
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Affiliation(s)
- Maimun Syukri
- Department of Internal Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.
| | - Ricky Virnardo
- Department of Internal Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Desi Salwani
- Department of Internal Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Hizir Sofyan
- Department of Statistics, Universitas Syiah Kuala, Banda Aceh, Indonesia
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13
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Alenaini W, Parkinson JRC, McCarthy JP, Goldstone AP, Wilman HR, Banerjee R, Yaghootkar H, Bell JD, Thomas EL. Ethnic Differences in Body Fat Deposition and Liver Fat Content in Two UK-Based Cohorts. Obesity (Silver Spring) 2020; 28:2142-2152. [PMID: 32939982 DOI: 10.1002/oby.22948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Differences in the content and distribution of body fat and ectopic lipids may be responsible for ethnic variations in metabolic disease susceptibility. The aim of this study was to examine the ethnic distribution of body fat in two separate UK-based populations. METHODS Anthropometry and body composition were assessed in two separate UK cohorts: the Hammersmith cohort and the UK Biobank, both comprising individuals of South Asian descent (SA), individuals of Afro-Caribbean descent (AC), and individuals of European descent (EUR). Regional adipose tissue stores and liver fat were measured by magnetic resonance techniques. RESULTS The Hammersmith cohort (n = 747) had a mean (SD) age of 41.1 (14.5) years (EUR: 374 men, 240 women; SA: 68 men, 22 women; AC: 14 men, 29 women), and the UK Biobank (n = 9,533) had a mean (SD) age of 55.5 (7.5) years (EUR: 4,483 men, 4,873 women; SA: 80 men, 43 women, AC: 31 men, 25 women). Following adjustment for age and BMI, no significant differences in visceral adipose tissue or liver fat were observed between SA and EUR individuals in the either cohort. CONCLUSIONS Our data, consistent across two independent UK-based cohorts, present a limited number of ethnic differences in the distribution of body fat depots associated with metabolic disease. These results suggest that the ethnic variation in susceptibility to features of the metabolic syndrome may not arise from differences in body fat.
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Affiliation(s)
- Wareed Alenaini
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
| | - James R C Parkinson
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
| | - John P McCarthy
- School of Healthcare Practice, University of Bedfordshire, Luton, Bedfordshire, UK
| | - Anthony P Goldstone
- PsychoNeuroEndocrinology Research Group, Neuro-psychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Imperial College London-Hammersmith Hospital, London, UK
| | - Henry R Wilman
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
- Perspectum Diagnostics, Oxford, UK
| | | | - Hanieh Yaghootkar
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
- Genetics of Complex Traits, Medical School, University of Exeter-Royal Devon & Exeter Hospital, Exeter, UK
- Division of Medical Sciences, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Jimmy D Bell
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
| | - E Louise Thomas
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, UK
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14
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Sex Difference in Risk Factors, GRACE Scores, and Management among Post-Acute Coronary Syndrome Patients in Sri Lanka. Cardiol Res Pract 2020; 2020:4560218. [PMID: 32802496 PMCID: PMC7414373 DOI: 10.1155/2020/4560218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To assess sex-based differences in the prevalence of risk factor, their management, and differences in the prognosis among acute coronary syndrome (ACS) in Sri Lanka. Methods Patients diagnosed with ACS were recruited from hospitals throughout the island. The Joint European Societies guidelines were used to assess recommended targets for coronary heart disease risk factors, and the GRACE score was used to assess the post-ACS prognosis. Age-adjusted regression was performed to calculate odds ratios for men versus women in risk factor control. Results A total of 2116 patients, of whom 1242 (58.7%) were men, were included. Significant proportion of women were nonsmokers; OR = 0.11 (95% CI 0.09 to 0.13). The prevalence of hypertension (p < 0.001), diabetes (p < 0.001), and dyslipidemia (p=0.004) was higher in women. The LDL-C target was achieved in a significantly higher percentage of women (12.6%); OR = 0.33 (95% CI 0.10 to 1.05). When stratified by age, no significant differences were observed in achieving the risk factor targets or management strategies used except for fasting blood sugar (p < 0.05) where more men achieved control target in both age categories. Majority of the ACS patients had either high or intermediate risk for one-year mortality as per the GRACE score. In-hospital and 1-year mean mortality risk was significantly higher among men of less than 65 years of age (p < 0.05). Conclusions Smoking is significantly lower among Sri Lankan women diagnosed with ACS. However, hypertension, diabetes, and dyslipidemia were more prevalent among them. There was no difference in primary and secondary preventive strategies and management in both sexes but could be further improved in both groups.
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15
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Enas EA, Varkey B, Gupta R. Expanding statin use for prevention of ASCVD in Indians: Reasoned and simplified proposals. Indian Heart J 2020; 72:65-69. [PMID: 32534692 PMCID: PMC7296246 DOI: 10.1016/j.ihj.2020.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/28/2020] [Indexed: 01/21/2023] Open
Abstract
Atherosclerosis, a systemic disease, is the predominant cause of cardiovascular disease (CVD) that far exceeds other causes (egs: congenital, hypertension, arrhythmia). CVD is the leading cause of mortality globally (18 million lives, including 9 million from coronary artery disease (CAD) annually).1 The Global Burden of Disease study reported that in the year 2017, India had one of the highest mortality, most of them premature, from CVD (2.64 million, women 1.18, men 1.45) and CAD (1.54 million, women 0.62, men 0.92) in the world.2 A systemic disease of this magnitude and impact warrants a proactive preventive strategy and not a reactive, invasive and focal approach. In this editorial, we call for a wider use of statins in Indians, explain our rationale based on risk factors and risk-enhancing factors, and present a simplified and cost effective approach to combat CVD.
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Affiliation(s)
- Enas A Enas
- Coronary Artery Disease in Indians (CADI) Research Foundation, Lisle, IL, USA.
| | - Basil Varkey
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rajeev Gupta
- Department of Preventive Cardiology & Internal Medicine, Eternal Heart Care Centre & Research Institute, Jaipur, India
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16
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Banerjee J, Dhas Y, Mishra N. HOMA-Adiponectin Closely Associates with Cardiometabolic Risk Markers in Middle-Aged Indians with Metabolic Syndrome. Exp Clin Endocrinol Diabetes 2020; 129:449-456. [PMID: 32189318 DOI: 10.1055/a-1120-8163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Unhealthy dietary habits and sedentary lifestyles have raised alarming concerns for the rising prevalence of metabolic syndrome (MetS) and associated cardiometabolic risk among Indians at an early age. Insulin resistance and adiposity are the important risk factors associated with MetS. The present study aimed to investigate the relationship between a modified marker of insulin resistance (homeostatic model assessment-adiponectin (HOMA-AD)) and cardiometabolic risk among middle-aged Indians. METHODS The study comprised of 144 subjects of age-group 31-50 years, where 83 subjects were diagnosed for MetS according to the guidelines given by the International Diabetes Federation. We measured cardiometabolic risk indicators such as fasting blood glucose (FPG), fasting plasma insulin (FPI), homeostatic model assessment- insulin resistance (HOMA-IR), adiponectin, high sensitivity C-reactive protein (hs-CRP), oxidized LDL (oxLDL), monocyte chemoattractant protein-1 (MCP-1), and atherogenic index, among others. We calculated HOMA-AD by the formula: [FPG (mmol/l) × FPI (µIU/ml)] / [22.5 × Adiponectin (µg/ml)]. RESULTS HOMA-IR and HOMA-AD were highly increased (p<0.001) in the MetS subjects than controls. Adiponectin was significantly (p<0.01) lower whereas cardiac risk markers such as atherogenic index, hs-CRP, oxLDL, and MCP-1 were significantly (p<0.01) elevated in MetS group than controls. Linear regression showed positive and significant associations (p<0.01) of HOMA-AD with all the cardiometabolic risk markers except MCP-1. HOMA-AD showed higher AUC (0.806) than HOMA-IR (0.791) for predicting MetS. CONCLUSION HOMA-AD could be a surrogate adipokine-based marker correlated significantly with components of MetS and cardiometabolic risk indicators. It appeared to be a better predictor of MetS among middle-aged Indians than HOMA-IR.
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Affiliation(s)
- Joyita Banerjee
- Symbiosis School of Biological Sciences, Symbiosis International (Deemed University), Lavale, Pune, India
| | - Yogita Dhas
- Symbiosis School of Biological Sciences, Symbiosis International (Deemed University), Lavale, Pune, India
| | - Neetu Mishra
- Symbiosis School of Biological Sciences, Symbiosis International (Deemed University), Lavale, Pune, India
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17
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Kulshreshtha B, Sharma N, Pant S, Prasad A, Chitkara A, Pahuja B, Pahuja I. Predictors of Metabolic Syndrome among Polycystic Ovary Syndrome Sisters. J Hum Reprod Sci 2020; 12:334-340. [PMID: 32038085 PMCID: PMC6937762 DOI: 10.4103/jhrs.jhrs_172_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/15/2019] [Accepted: 09/24/2019] [Indexed: 11/04/2022] Open
Abstract
Aims Metabolic syndrome among PCOS sisters may vary depending on the phenotype. The aim of the present study was to analyze the prevalence of metabolic syndrome among different phenotypes of PCOS sisters. Design Case control study. Materials and Methods Two hundred sisters of PCOS patients and 99 age matched healthy controls underwent history, clinical examination, biochemical parameters for metabolic syndrome and hormonal assessment. Results Of 200 sisters, 85 were unaffected (UA group), 21 sisters had hyperandrogenemia (HA group), and 94 sisters had irregular periods or hyperandrogenemia. We observed that the frequency of metabolic syndrome among PCOS sisters was comparable to age and weight matched controls (30% vs 27%). The prevalence of metabolic syndrome was higher in HA and AFFECTED sisters (around 30% in both) compared to UA sisters (20%). The presence of metabolic syndrome was significantly associated with age, BMI, HOMA-IR and free testosterone. After correction for age and BMI, metabolic syndrome was significantly associated with HOMA-IR (P - 0.05) and free testosterone (P - 0.03). Conclusion Based on above findings, we conclude that affected sisters and those with higher age, BMI and hyperandrogenemia have a high risk of metabolic syndrome compared to unaffected sisters.
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Affiliation(s)
| | - Neera Sharma
- Department of Biochemistry, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Shubhi Pant
- Department of Endocrinology, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Akhila Prasad
- Department of Radiodiagnosis, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Anubhuti Chitkara
- Department of Biochemistry, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Bhawna Pahuja
- Department of Endocrinology, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Isha Pahuja
- Department of Endocrinology, PGIMER, Dr. RML Hospital, New Delhi, India
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18
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Yazdanpanah MH, Sayyadipoor S, Hojati SR, Nikmanesh A, Farjam M, Homayounfar R. The Association of Metabolic Syndrome and Its Components with Electrocardiogram Parameters and Abnormalities Among an Iranian Rural Population: The Fasa PERSIAN Cohort Study. Diabetes Metab Syndr Obes 2020; 13:2975-2987. [PMID: 32943893 PMCID: PMC7467662 DOI: 10.2147/dmso.s263093] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/04/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) as a set of cardiac risk factors and its growing prevalence is one of the major concerns in different societies. In this study, we aimed to investigate the relationship between Mets and electrocardiogram (ECG) parameters and abnormalities as indicators for subclinical cardiovascular diseases (CVD). METHODS In this sub-analysis study, we used the data from Fasa PERSIAN Cohort Study which includes subjects age 35-70 years. Subjects with available ECG data included in the study (n=7002) and subjects with missing data on MetS components and non-sinus rhythm ECG were excluded (n=44). The MetS definition based on the Adult Treatment Panel (ATP) III guidelines and also a 12-lead ECG was obtained from all participants. RESULTS Our study population (n=6958) showed a mean age of 48.60±9.34 years and also 1656 (24.2%) subjects had MetS. Except for P duration, PR interval and S amplitude in men and P amplitude, S amplitude, Sokolow-Lyon Index, and QT interval in women, other ECG parameters differ significantly between subjects with and without Mets (P<0.05). Also among ECG abnormalities, prolonged P duration (≥120ms), QRS duration (≥100ms), and QTc interval (>450ms in male, >470ms in female) had a significant association with MetS in the total population. Waist circumferences (WC) showed the most count of significant relationship with ECG parameters in both genders. In males, WC more than ATP cut-points had significant associations with prolonged P and QRS duration, and also blood pressure (BP) had significant associations with prolonged P and QRS durations and QTc interval. In females, the MetS component except triglyceride had at least a significant relationship with prolonged P and/or QRS duration. CONCLUSION MetS and its component especially WC and BP were associated with ECG parameters and abnormalities. These associations with ECG as a marker of subclinical CVD showed the importance of MetS and each component in our population to monitor in the further longitudinal studies.
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Affiliation(s)
- Mohammad Hosein Yazdanpanah
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | | | - Sayed Reza Hojati
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Amirreza Nikmanesh
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Mojtaba Farjam
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Reza Homayounfar
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
- National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Correspondence: Reza Homayounfar Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, IranTel +989125140840 Email
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Naskar K, Mishra O, Chattopadhyay A, Kumar A, Banerjee A, Nahar L, Singh S, Asthana R, Luthra J, Karim M, Banerjee TS, Ali SKS, Basu A, Koley M, Saha S. Efficacy of Dioscorea villosa 6CH in treatment of dyslipidemia: A double-blind, randomized, placebo-controlled, clinical trial. JOURNAL OF PHARMACEUTICAL NEGATIVE RESULTS 2020. [DOI: 10.4103/jpnr.jpnr_13_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Yadav R, Yadav RK, Khadgawat R, Pandey RM, Upadhyay AD, Mehta N. Randomized Controlled Trial of A 12-Week Yoga-Based (Including Diet) Lifestyle vs. Dietary Intervention on Cardio-Metabolic Risk Factors and Continuous Risk Score in Indian Adults with Metabolic Syndrome. Behav Med 2020; 46:9-20. [PMID: 30615583 DOI: 10.1080/08964289.2018.1538098] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Metabolic syndrome, a prediabetic and precardiovascular pathologic condition that begins early in life, tracks into adulthood and magnifies with age. Randomized controlled trials evaluating efficacy of yoga-based lifestyle vs. dietary intervention on metabolic syndrome are lacking. Here, the efficacy of a 12-week yoga-based lifestyle intervention vs. dietary intervention on cardio-metabolic risk factors and metabolic syndrome risk scores have been assessed in Indian adults with metabolic syndrome. In this two-arm, open label, parallel group, randomized controlled trial, 260 adults (20-45 years) diagnosed with metabolic syndrome as per joint interim statement, 2009 were randomized to yoga-based (including diet) lifestyle or dietary intervention alone (n = 130, each) for 12 weeks. Primary endpoints were the 12-week changes in cardio-metabolic risk factors and metabolic risk scores. The secondary endpoints were the 12-week changes in the proportion of subjects recovered from metabolic syndrome, dietary intake, and physical activity. Intent-to-treat analysis was performed including all the subjects with baseline data with imputed missing data. Treatment × time interaction showed yoga-based lifestyle intervention had a greater treatment effect over dietary intervention by significantly reducing waist circumference, continuous metabolic syndrome z-score, and dietary intake/day while significantly increasing physical activity. High-density lipoprotein cholesterol showed a significantly greater reduction following dietary intervention than yoga-based lifestyle intervention. A significantly greater proportion of subjects recovered from metabolic syndrome in yoga-based lifestyle (45.4%) vs. dietary intervention group (32.3%). A 12-week yoga-based lifestyle intervention is more efficacious than usual dietary intervention in improving cardio-metabolic risk factor and metabolic risk score in Indian adults with metabolic syndrome.
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Affiliation(s)
- Rashmi Yadav
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Raj Kumar Yadav
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Datt Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Nalin Mehta
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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21
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Jain V, Kumar A, Ahmad N, Jana M, Kalaivani M, Kumar B, Shastri S, Jain O, Kabra M. Genetic polymorphisms associated with obesity and non-alcoholic fatty liver disease in Asian Indian adolescents. J Pediatr Endocrinol Metab 2019; 32:749-758. [PMID: 31216264 DOI: 10.1515/jpem-2018-0543] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/23/2019] [Indexed: 12/28/2022]
Abstract
Background The objective of this study was to investigate the association of polymorphisms in four genes, tumor necrosis factor-α (TNFA), patatin-like phospholipase domain containing 3 (PNPLA3), adiponectin (ADIPOQ) and apolipoprotein C3 (APOC3), with obesity and non-alcoholic fatty liver disease (NAFLD) in Asian Indian adolescents. Methods In this case-control study, 218 Asian Indian adolescents with overweight/obesity and 86 lean healthy adults without fatty liver were enrolled. Hepatic steatosis was assessed and graded by ultrasonography (USG). Serum insulin, lipids, alanine aminotransferase (ALT), aspartate aminotransferase (AST), TNF-α, adiponectin and apolipoprotein C3 were measured and genotyping was done. Frequencies of variant and wild genotypes in all adolescents and in the subgroups without steatosis, with grade 1 steatosis and with grade 2 or 3 steatosis were compared to those in the controls. The frequencies were also compared in the overweight adolescents with grade 2 or 3 steatosis and without steatosis. Results Variant genotypes of polymorphisms -863 C > A and -1031 T > C of the TNFA gene, 455 T > C of the APOC3 gene and the wild type of +276 G > T of the ADIPOQ gene were associated with obesity with odds ratios (OR, 95% confidence interval [CI]) of 2.5 (1.5-4.4), 2.5 (1.5-4.2), 2.0 (1.1-3.6) and 2.5 (1.4-5.0), respectively. Polymorphisms 455 T > C of APOC3 and rs738409 C > G of PNPLA3 were associated with NAFLD. Fasting insulin and triglycerides (TG) were higher in the adolescents with homozygous variant polymorphisms -1031 T > C of TNFA and 455 T > C of APOC3 genes, respectively. Conclusions Several polymorphisms were noted to have a significant association with obesity and NAFLD in Asian Indian adolescents.
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Affiliation(s)
- Vandana Jain
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Anil Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Nayeem Ahmad
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Brijesh Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Shivaram Shastri
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Oshima Jain
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Madhulika Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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22
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Prenissl J, Jaacks LM, Mohan V, Manne-Goehler J, Davies JI, Awasthi A, Bischops AC, Atun R, Bärnighausen T, Vollmer S, Geldsetzer P. Variation in health system performance for managing diabetes among states in India: a cross-sectional study of individuals aged 15 to 49 years. BMC Med 2019; 17:92. [PMID: 31084606 PMCID: PMC6515628 DOI: 10.1186/s12916-019-1325-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/15/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Understanding where adults with diabetes in India are lost in the diabetes care cascade is essential for the design of targeted health interventions and to monitor progress in health system performance for managing diabetes over time. This study aimed to determine (i) the proportion of adults with diabetes in India who have reached each step of the care cascade and (ii) the variation of these cascade indicators among states and socio-demographic groups. METHODS We used data from a population-based household survey carried out in 2015 and 2016 among women and men aged 15-49 years in all states of India. Diabetes was defined as a random blood glucose (RBG) ≥ 200 mg/dL or reporting to have diabetes. The care cascade-constructed among those with diabetes-consisted of the proportion who (i) reported having diabetes ("aware"), (ii) had sought treatment ("treated"), and (iii) had sought treatment and had a RBG < 200 mg/dL ("controlled"). The care cascade was disaggregated by state, rural-urban location, age, sex, household wealth quintile, education, and marital status. RESULTS This analysis included 729,829 participants. Among those with diabetes (19,453 participants), 52.5% (95% CI, 50.6-54.4%) were "aware", 40.5% (95% CI, 38.6-42.3%) "treated", and 24.8% (95% CI, 23.1-26.4%) "controlled". Living in a rural area, male sex, less household wealth, and lower education were associated with worse care cascade indicators. Adults with untreated diabetes constituted the highest percentage of the adult population (irrespective of diabetes status) aged 15 to 49 years in Goa (4.2%; 95% CI, 3.2-5.2%) and Tamil Nadu (3.8%; 95% CI, 3.4-4.1%). The highest absolute number of adults with untreated diabetes lived in Tamil Nadu (1,670,035; 95% CI, 1,519,130-1,812,278) and Uttar Pradesh (1,506,638; 95% CI, 1,419,466-1,589,832). CONCLUSIONS There are large losses to diabetes care at each step of the care cascade in India, with the greatest loss occurring at the awareness stage. While health system performance for managing diabetes varies greatly among India's states, improvements are particularly needed for rural areas, those with less household wealth and education, and men. Although such improvements will likely have the greatest benefits for population health in Goa and Tamil Nadu, large states with a low diabetes prevalence but a high absolute number of adults with untreated diabetes, such as Uttar Pradesh, should not be neglected.
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Affiliation(s)
- Jonas Prenissl
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany. .,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Public Health Foundation of India, New Delhi, Delhi NCR, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Jennifer Manne-Goehler
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine I Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Johannesburg, Gauteng, South Africa.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ashish Awasthi
- Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Anne Christine Bischops
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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23
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Enas EA, Varkey B, Dharmarajan TS, Pare G, Bahl VK. Lipoprotein(a): An underrecognized genetic risk factor for malignant coronary artery disease in young Indians. Indian Heart J 2019; 71:184-198. [PMID: 31543191 PMCID: PMC6796644 DOI: 10.1016/j.ihj.2019.04.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/14/2019] [Accepted: 04/26/2019] [Indexed: 02/06/2023] Open
Abstract
Malignant coronary artery disease (CAD) refers to a severe and extensive atherosclerotic process involving multiple coronary arteries in young individuals (aged <45 years in men and <50 years in women) with a low or no burden of established risk factors. Indians, in general, develop acute myocardial infarction (AMI) about 10 years earlier; AMI rates are threefold to fivefold higher in young Indians than in other populations. Although established CAD risk factors have a predictive value, they do not fully account for the excessive burden of CAD in young Indians. Lipoprotein(a) (Lp(a)) is increasingly recognized as the strongest known genetic risk factor for premature CAD, with high levels observed in Indians with malignant CAD. High Lp(a) levels confer a twofold to threefold risk of CAD-a risk similar to that of established risk factors, including diabetes. South Asians have the second highest Lp(a) levels and the highest risk of AMI from the elevated levels, more than double the risk observed in people of European descent. Approximately 25% of Indians and other South Asians have elevated Lp(a) levels (≥50 mg/dl), rendering Lp(a) a risk factor of great importance, similar to or surpassing diabetes. Lp(a) measurement is ready for clinical use and should be an essential part of all CAD research in Indians.
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Affiliation(s)
- Enas A Enas
- Coronary Artery Disease in Indians (CADI) Research Foundation, Lisle, IL, USA.
| | - Basil Varkey
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - Vinay K Bahl
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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24
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Ford CN, Weber MB, Staimez LR, Anjana RM, Lakshmi K, Mohan V, Narayan KMV, Harish R. Dietary changes in a diabetes prevention intervention among people with prediabetes: the Diabetes Community Lifestyle Improvement Program trial. Acta Diabetol 2019; 56:197-209. [PMID: 30426214 DOI: 10.1007/s00592-018-1249-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/29/2018] [Indexed: 01/02/2023]
Abstract
AIMS Diabetes prevention interventions have been less successful in Asian Indians compared to other populations, which may be due in part to dietary differences. The objective of this study was to determine the impact of a diabetes prevention intervention on diet and risk of diabetes in Asian Indians at high risk. METHODS Data were included from the Diabetes Community Lifestyle Improvement Program (D-CLIP), a randomized control trial to prevent diabetes in overweight/obese Asian Indian adults (20-65 years) with prediabetes. Respondents received standard treatment (control; n = 283) or a 6-month intervention (n = 295) that included education and support to reduce intakes of fat and total calories (kilocalories; kcal). Diet was ascertained using a food frequency questionnaire, and incident diabetes was determined from annual 2-h plasma glucose post-oral glucose tolerance test or biannual fasting plasma glucose. RESULTS There were 485 (control 240; intervention 245) respondents with complete diet data at baseline. At 6 months, the intervention was associated with decreased intake of total energy (- 185.6 kcal/day; 95% CI - 353.6, - 17.5 kcal/day) and refined cereals (- 7.2 g/1000 kcal; 95% CI - 12.7, - 1.7 g/1000 kcal), and increased intakes of fruits and vegetables (33.4 g/1000 kcal; 95% CI 16.0, 50.8 g/1000 kcal). The intervention group was half (HR 0.49; 95% CI 0.25, 0.94) as likely to develop diabetes at 1 year, and the hazard was significantly attenuated (12.2%; P = 0.015) with adjustment for fruits and vegetable intake. CONCLUSION The D-CLIP decreased the total energy intake and increased the intakes of fruits and vegetables, and reduced the 1-year incidence of diabetes by half. TRIAL REGISTRATION Clinicaltrails.gov # NCT01283308.
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Affiliation(s)
- Christopher N Ford
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, CNR 7036, Atlanta, GA, 30322, USA
| | - Mary Beth Weber
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, CNR 7036, Atlanta, GA, 30322, USA.
| | - Lisa R Staimez
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, CNR 7036, Atlanta, GA, 30322, USA
| | - Ranjit M Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Karthikeyan Lakshmi
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, CNR 7036, Atlanta, GA, 30322, USA
| | - Ranjani Harish
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
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25
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Yaribeygi H, Butler AE, Sahebkar A. Aerobic exercise can modulate the underlying mechanisms involved in the development of diabetic complications. J Cell Physiol 2019; 234:12508-12515. [PMID: 30623433 DOI: 10.1002/jcp.28110] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 12/07/2018] [Indexed: 12/20/2022]
Abstract
Diabetes mellitus is a highly prevalent metabolic disorder that affects many molecular pathways, causing a shift from a physiologic to a pathophysiologic state. Alterations in the molecular pathways promote diabetic complications and, thus, many medical and nonmedical therapies have been directed at preventing these complications. Despite the beneficial effects on moderating glycemic control, medical therapies may also have unfavorable side effects. This makes nonmedical therapeutic approaches more attractive due to lower pharmacological side effects of these strategies compared to medical agents. Aerobic exercise is now considered as a major nonmedical strategy that can promote beneficial and protective effects to counteract the development of diabetic complications via attenuation of the major molecular mechanisms involved in diabetes.
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Affiliation(s)
- Habib Yaribeygi
- Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alexandra E Butler
- Diabetes Research Center, Qatar Biomedical Research Institute, Doha, Qatar
| | - Amirhossein Sahebkar
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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26
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Palaniappan L, Garg A, Enas E, Lewis H, Bari S, Gulati M, Flores C, Mathur A, Molina C, Narula J, Rahman S, Leng J, Gany F. South Asian Cardiovascular Disease & Cancer Risk: Genetics & Pathophysiology. J Community Health 2018; 43:1100-1114. [PMID: 29948525 PMCID: PMC6777562 DOI: 10.1007/s10900-018-0527-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
South Asians (SAs) are at heightened risk for cardiovascular disease as compared to other ethnic groups, facing premature and more severe coronary artery disease, and decreased insulin sensitivity. This disease burden can only be partially explained by conventional risk factors, suggesting the need for a specific cardiovascular risk profile for SAs. Current research, as explored through a comprehensive literature review, suggests the existence of population specific genetic risk factors such as lipoprotein(a), as well as population specific gene modulating factors. This review catalogues the available research on cardiovascular disease and genetics, anthropometry, and pathophysiology, and cancer genetics among SAs, with a geographical focus on the U.S. A tailored risk profile will hinge upon population customized classification and treatment guidelines, informed by continued research.
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Affiliation(s)
| | - Arun Garg
- Laboratory Medicine and Pathology, Fraser Health Authority, New Westminster, BC, Canada
| | - Enas Enas
- Coronary Artery Disease among Asian Indians (CADI) Research Foundation, Lisle, IL, USA
| | - Henrietta Lewis
- Rollins School of Public Health, Global Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Cristina Flores
- The Warren Alpert Medical School, The Brown Human Rights Asylum Clinic (BHRAC), Brown University, Providence, RI, USA
| | - Ashish Mathur
- South Asian Heart Center, El Camino Hospital, Mountain View, CA, USA
| | - Cesar Molina
- South Asian Heart Center, El Camino Hospital, Mountain View, CA, USA
| | | | - Shahid Rahman
- I-Say, Bangladeshi American Youth Association, Teach & Travel, New York, NY, USA
| | - Jennifer Leng
- Immigrant Health and Cancer Disparities Center, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Francesca Gany
- Immigrant Health and Cancer Disparities Center, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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27
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Iwamoto K, Kamo S, Takada Y, Ieda A, Yamashita T, Sato T, Zaima N, Moriyama T. Soyasapogenols reduce cellular triglyceride levels in 3T3-L1 mouse adipocyte cells by accelerating triglyceride lipolysis. Biochem Biophys Rep 2018; 16:44-49. [PMID: 30294680 PMCID: PMC6171538 DOI: 10.1016/j.bbrep.2018.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/27/2018] [Accepted: 09/18/2018] [Indexed: 01/07/2023] Open
Abstract
Soyasapogenol is a soyasaponin aglycone, which has been suggested to exert a more potent function than the glycoside form. In this study, the effect of soyasapogenol A and B on cultured adipocyte cell function was investigated using mouse 3T3-L1 adipocyte cells. 3T3-L1 cells were treated with insulin, dexamethasone, and 3-isobutyl-1-methylxanthine for differentiation to adipocytes, and the cells were then cultured in the presence of soyasapogenol A or B (6.25 or 12.5 µM). The media were harvested and refreshed every 2 d. After a 10 d culture, the cells were harvested and the triglyceride content of the cells was determined. The triglyceride content of soyasapogenol B-treated cells was significantly lower than those of vehicle-treated cells. Glycerol and free fatty acid levels in the soyasapogenol-treated cell media were higher than those in vehicle cells. However, there was no difference in the level of adipose triglyceride lipase among soyasapogenol A-, soyasapogenol B-, and vehicle-treated cells. The secreted adiponectin and resistin levels of soyasapogenol-treated cell media were also different compared with those of vehicle-treated cells. Especially, the secreted resistin level in soyasapogenol B-treated cell media was obviously reduced compared with that of vehicle-treated cells. Taken together, these results suggest that soyasapogenol B exerted an anti-obesity and anti-diabetic effect on adipocytes by lowering the cellular triglyceride level by accelerating triglyceride lipolysis with reduced resistin secretion. Soyasapogenol A and B exerted an influence on TG accumulation in adipocytes. Soyasapogenol B accelerated lipolysis in adipocyte cells. Soyasapogenol-treated adipocytes significantly decreased resistin secretion.
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Affiliation(s)
- Kazuko Iwamoto
- School of Agriculture, Kindai University, Naka-machi, Nara, Nara 631-8505, Japan
| | - Shuichi Kamo
- Product Development Laboratory, J-OIL MILLS, Inc., 7–41, Daikoku-cho, Tsurumi-ku, Yokohama-city, Kanagawa 230-0053, Japan
| | - Yuichi Takada
- School of Agriculture, Kindai University, Naka-machi, Nara, Nara 631-8505, Japan
| | - Ayana Ieda
- School of Agriculture, Kindai University, Naka-machi, Nara, Nara 631-8505, Japan
| | - Takatoshi Yamashita
- Product Development Laboratory, J-OIL MILLS, Inc., 7–41, Daikoku-cho, Tsurumi-ku, Yokohama-city, Kanagawa 230-0053, Japan
| | - Toshiro Sato
- Fundamental Research Laboratory, J-OIL MILLS, Inc., 7–41, Daikoku-cho, Tsurumi-ku, Yokohama-city, Kanagawa 230-0053, Japan
| | - Nobuhiro Zaima
- School of Agriculture, Kindai University, Naka-machi, Nara, Nara 631-8505, Japan
- KINDAI Research Institute for Agricultural Technology and Innovation, Naka-machi, Nara, Nara 631–8505, Japan
| | - Tatsuya Moriyama
- School of Agriculture, Kindai University, Naka-machi, Nara, Nara 631-8505, Japan
- KINDAI Research Institute for Agricultural Technology and Innovation, Naka-machi, Nara, Nara 631–8505, Japan
- Corresponding author at: School of Agriculture, Kindai University, Naka-machi, Nara, Nara 631-8505, Japan.
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28
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Penkler M, Müller R. [Not Available]. BERICHTE ZUR WISSENSCHAFTSGESCHICHTE 2018; 41:258-278. [PMID: 32495359 DOI: 10.1002/bewi.201801902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Michael Penkler
- Munich Center for Technology in Society, Technische Universität München, Arcisstraße 21, D-, 80333, München
| | - Ruth Müller
- Munich Center for Technology in Society, Technische Universität München, Arcisstraße 21, D-, 80333, München
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29
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Commodore-Mensah Y, Selvin E, Aboagye J, Turkson-Ocran RA, Li X, Himmelfarb CD, Ahima RS, Cooper LA. Hypertension, overweight/obesity, and diabetes among immigrants in the United States: an analysis of the 2010-2016 National Health Interview Survey. BMC Public Health 2018; 18:773. [PMID: 29925352 PMCID: PMC6011357 DOI: 10.1186/s12889-018-5683-3] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/08/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Ethnic minority populations in the United States (US) are disproportionately affected by cardiovascular disease (CVD) risk factors, including hypertension, overweight/obesity, and diabetes. The size and diversity of ethnic minority immigrant populations in the US have increased substantially over the past three decades. However, most studies on immigrants in the US are limited to Asians and Hispanics; only a few have examined the prevalence of CVD risk factors across diverse immigrant populations. The prevalence of diagnosed hypertension, overweight/obesity, and diagnosed diabetes was examined and contrasted among a socioeconomically diverse sample of immigrants. It was hypothesized that considerable variability would exist in the prevalence of hypertension, overweight and diabetes. METHODS A cross-sectional analysis of the 2010-2016 National Health Interview Survey (NHIS) was conducted among 41,717 immigrants born in Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, Indian subcontinent, Asia and Southeast Asia. The outcomes were the prevalence of diagnosed hypertension, overweight/obesity, and diagnosed diabetes. RESULTS The highest multivariable adjusted prevalence of diagnosed hypertension was observed in Russian (24.2%) and Southeast Asian immigrants (23.5%). Immigrants from Mexico/Central America/Caribbean and the Indian subcontinent had the highest prevalence of overweight/obesity (71.5 and 73.4%, respectively) and diagnosed diabetes (9.6 and 10.1%, respectively). Compared to European immigrants, immigrants from Mexico/Central America/Caribbean and the Indian subcontinent respectively had higher prevalence of overweight/obesity (Prevalence Ratio (PR): 1.19[95% CI, 1.13-1.24]) and (PR: 1.22[95% CI, 1.14-1.29]), and diabetes (PR: 1.70[95% CI, 1.42-2.03]) and (PR: 1.78[95% CI, 1.36-2.32]). African immigrants and Middle Eastern immigrants had a higher prevalence of diabetes (PR: 1.41[95% CI, 1.01-1.96]) and PR: 1.57(95% CI: 1.09-2.25), respectively, than European immigrants -without a corresponding higher prevalence of overweight/obesity. CONCLUSIONS Immigrants from Mexico/Central America/Caribbean and the Indian subcontinent bore the highest burden of overweight/obesity and diabetes while those from Southeast Asia and Russia bore the highest burden of hypertension.
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Affiliation(s)
- Yvonne Commodore-Mensah
- Department of Community-Public Health, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Room 419, Baltimore, MD 21205 USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Suite 2-600, Baltimore, MD 21287 USA
| | - Jonathan Aboagye
- School of Medicine, Johns Hopkins University, 733 N Broadway, Baltimore, MD 21205 USA
| | | | - Ximin Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Cheryl Dennison Himmelfarb
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Rexford S. Ahima
- Department of Community-Public Health, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Room 419, Baltimore, MD 21205 USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Suite 2-600, Baltimore, MD 21287 USA
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 333, Baltimore, MD 21287 USA
| | - Lisa A. Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Suite #2-500, Baltimore, MD 21287 USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St, Suite 2-500, Baltimore, MD 21287 USA
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30
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Barik A, Das K, Chowdhury A, Rai RK. Metabolic syndrome among rural Indian adults. Clin Nutr ESPEN 2018; 23:129-135. [DOI: 10.1016/j.clnesp.2017.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/24/2017] [Accepted: 11/14/2017] [Indexed: 11/30/2022]
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31
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Babu GR, Murthy GVS, Ana Y, Patel P, Deepa R, Benjamin-Neelon SE, Kinra S, Reddy KS. Association of obesity with hypertension and type 2 diabetes mellitus in India: A meta-analysis of observational studies. World J Diabetes 2018; 9:40-52. [PMID: 29359028 PMCID: PMC5763039 DOI: 10.4239/wjd.v9.i1.40] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/09/2017] [Accepted: 11/20/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To perform a meta-analysis of the association of obesity with hypertension and type 2 diabetes mellitus (T2DM) in India among adults.
METHODS To conduct meta-analysis, we performed comprehensive, electronic literature search in the PubMed, CINAHL Plus, and Google Scholar. We restricted the analysis to studies with documentation of some measure of obesity namely; body mass index, waist-hip ratio, waist circumference and diagnosis of hypertension or diagnosis of T2DM. By obtaining summary estimates of all included studies, the meta-analysis was performed using both RevMan version 5 and “metan” command STATA version 11. Heterogeneity was measured by I2 statistic. Funnel plot analysis has been done to assess the study publication bias.
RESULTS Of the 956 studies screened, 18 met the eligibility criteria. The pooled odds ratio between obesity and hypertension was 3.82 (95%CI: 3.39 to 4.25). The heterogeneity around this estimate (I2 statistic) was 0%, indicating low variability. The pooled odds ratio from the included studies showed a statistically significant association between obesity and T2DM (OR = 1.14, 95%CI: 1.04 to 1.24) with a high degree of variability.
CONCLUSION Despite methodological differences, obesity showed significant, potentially plausible association with hypertension and T2DM in studies conducted in India. Being a modifiable risk factor, our study informs setting policy priority and intervention efforts to prevent debilitating complications.
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Affiliation(s)
- Giridhara R Babu
- Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, Bangalore 560023, India
| | - G V S Murthy
- Indian Institute of Public Health-Hyderabad, Plot # 1, A.N.V.Arcade, Amar Co-op Society, Kavuri Hills, Madhapur, Hyderabad 500033, India
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Yamuna Ana
- Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, Bangalore 560023, India
| | - Prital Patel
- Indian School of Business, Hyderabad 500111, India
| | - R Deepa
- Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, Bangalore 560023, India
| | | | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine and University College London Hospital, London WC1E 7HT, United Kingdom
| | - K Srinath Reddy
- Public Health Foundation of India, ISID Campus, 4 Institutional Area Vasant Kunj, New Delhi 110070, India
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32
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Psychosocial Factors Associated with Subclinical Atherosclerosis in South Asians: The MASALA Study. J Immigr Minor Health 2018; 18:1317-1327. [PMID: 26897179 DOI: 10.1007/s10903-016-0367-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
South Asians have the highest rates of premature atherosclerotic cardiovascular disease amongst all ethnic groups in the world; however this risk cannot be fully explained by traditional risk factors. Participants from the Mediators of Atherosclerosis in South Asians Living in America Study were included in this cross-sectional analysis. The purpose of this study was to investigate the association of psychosocial factors (including anger, anxiety, depressive symptoms, current and chronic stress, and everyday hassles) with carotid intima-media thickness (CIMT). Three multivariate models were examined to evaluate the association between the psychosocial factors and CIMT. Findings suggest that the impact of psychosocial factors on subclinical atherosclerosis is differential for South Asian men and women. For men, anxiety and depression were associated; while for women, stress was associated with common carotid intima media thickness, independent of traditional CVD risk factors, diet and physical activity.
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33
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Abstract
Metabolic syndrome is characterized by hypertension; hyperglycemia; hypertriglyceridemia; reduced high-density lipoprotein cholesterol levels and abdominal obesity. Abundant data suggest that, compared with other people, patients meeting these diagnostic criteria have a greater risk of having substantial clinical consequences, the two most prominent of which are the development of diabetes mellitus and coronary heart disease. The metabolic syndrome is a health issue of epidemic proportions. Its prevalence in the world continues to increase, hand in hand with that of obesity. Protein, on the other hand, is the foundation of cell-building, especially in muscle tissue. The body needs protein to build not only muscle cells, but the cells of major organs, skin and red blood cells. For people with metabolic syndrome, one of the other functions of protein is to slow down the absorption of carbohydrates. When proteins are consumed with carbohydrates, it takes longer for the digestive system to break down that meal. This means that the sugar created from those carbohydrates is released at a slower rate, preventing spikes in both blood sugar and insulin. As the understanding of the metabolic syndrome evolves, it is likely that more comprehensive therapeutic options will become available.
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Affiliation(s)
- Neetu Miglani
- a Department of Food and Nutrition , Punjab Agricultural University , Ludhiana , India
| | - Kiran Bains
- a Department of Food and Nutrition , Punjab Agricultural University , Ludhiana , India
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Gupta SS, Teede H, Aroni R. Spicing up your advice for South Asian and Anglo-Australians with type 2 diabetes and CVD: Do cultural constructions of diet matter? Appetite 2018; 120:679-697. [DOI: 10.1016/j.appet.2017.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/29/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
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35
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Misra R, Balagopal P, Raj S, Patel TG. Vegetarian Diet and Cardiometabolic Risk among Asian Indians in the United States. J Diabetes Res 2018; 2018:1675369. [PMID: 29670913 PMCID: PMC5835256 DOI: 10.1155/2018/1675369] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/22/2017] [Indexed: 02/07/2023] Open
Abstract
Research studies have shown that plant-based diets confer cardiovascular and metabolic health benefits. Asian Indians (AIs) in the US (who have often followed plant-based diets) have elevated risk for chronic diseases such as diabetes, metabolic syndrome, and obesity suggesting ethnic vulnerability that imply genetic and/or lifestyle causative links. This study explored the association between this ethnic group and diabetes, obesity, and metabolic syndrome after controlling for demographics, acculturation, family history of diabetes, and lifestyle and clinical risk factors. The sample comprised of 1038 randomly selected adult AIs in seven US sites. Prevalence and metabolic syndrome was estimated, and obesity was calculated using the WHO Asian criteria. Multivariate analysis included multinomial logistic regression. The mean age and length of residency in the US were 47 and 18.5 years, respectively. The majority of respondents were vegetarians (62%) and educated. A vegetarian lifestyle was associated with females, food label users, respondents with poor/fair current health status, less acculturated, and those who reported their diet had not changed after coming to the US. Vegetarian status was a protective factor and lowered the risk for diabetes but not for metabolic syndrome and obesity in the regression model. Results provide a firm basis for educational programs.
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Affiliation(s)
- Ranjita Misra
- WVU Public Health Training Center, 3313A, Robert C. Byrd Health Science Center, West Virginia University, Morgantown, WV 26506-9190, USA
| | - Padmini Balagopal
- Clinical Nutritionist, Early Intervention, 1901 JFK Blvd, Philadelphia, PA 19103, USA
| | - Sudha Raj
- Department of Public Health, Food Studies and Nutrition, 562 Falk College, Syracuse, NY 13244, USA
| | - Thakor G. Patel
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Sluyter JD, Hughes AD, Camargo CA, Lowe A, Scragg RKR. Relations of Demographic and Clinical Factors With Cardiovascular Autonomic Function in a Population-Based Study: An Assessment By Quantile Regression. Am J Hypertens 2017; 31:53-62. [PMID: 28992049 DOI: 10.1093/ajh/hpx134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/15/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The relationships of many factors with cardiovascular autonomic function (CVAF) outcome parameters may not be uniform across the entire distribution of the outcome. We examined how demographic and clinical factors varied with different subgroups of CVAF parameters. METHODS Quantile regression was applied to a cross-sectional analysis of 4,167 adults (56% male; age range, 50-84 years) from 4 ethnic groups (3,419 New Zealand European, 303 Pacific, 227 Maori, and 218 South Asian) and without diagnosed cardiac arrhythmia. Pulse rate variability (root mean square of successive differences (RMSSD) and SD of pulse intervals) and baroreflex sensitivity were response variables. Independent variables were age, sex, ethnicity, brachial and aortic blood pressure (BP) variables, body mass index (BMI), and diabetes. RESULTS Ordinary linear regression showed that age, sex, Pacific and Maori ethnicity, BP variables, BMI, and diabetes were associated with CVAF parameters. But quantile regression revealed that, across CVAF percentiles, the slopes for these relationships: (i) varied by more than 10-fold in several cases and sometimes changed direction and (ii) noticeably differed in magnitude often (by >3-fold in several cases) compared to ordinary linear regression coefficients. For instance, age was inversely associated with RMSSD at the 10th percentile of this parameter (β = -0.12 ms/year, 95% confidence interval = -0.18 to -0.09 ms/year) but had a positive relationship at the 90th percentile (β = 3.17 ms/year, 95% confidence interval = 2.50 to 4.04 ms/year). CONCLUSIONS The relationships of demographic and clinical factors with CVAF parameters are, in many cases, not uniform. Quantile regression provides an improved assessment of these associations.
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Affiliation(s)
- John D Sluyter
- Epidemiology and Biostatistics Section, School of Population Health, University of Auckland, New Zealand
| | - Alun D Hughes
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Sciences, University College London, UK
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, USA
| | - Andrew Lowe
- Institute for Biomedical Technologies, Auckland University of Technology, New Zealand
| | - Robert K R Scragg
- Epidemiology and Biostatistics Section, School of Population Health, University of Auckland, New Zealand
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Hiremath R, Ibrahim J, Prasanthi K, Reddy HT, Shah RS, Haritha C. Comparative Study of Ultrasonographic and Anthropometric Measurements of Regional Adiposity in Metabolic Syndrome. J Clin Diagn Res 2017; 11:TC01-TC05. [PMID: 28969236 DOI: 10.7860/jcdr/2017/26386.10352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/29/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Metabolic syndrome is complex disorder unifying dyslipidemia, insulin resistance and hyper insulinemia. Rising global epidemic of obesity has tremendous impact on metabolic syndrome. Ultrasound is becoming widely utilized modality for measuring the visceral adiposity. AIM To determine the usefulness of ultrasonographic measurements in the estimation of regional adiposity and to compare them with anthropometric measurements and to correlate ultrasonographic measurements of regional adiposity and metabolic syndrome. MATERIALS AND METHODS A cross-sectional study was conducted to compare anthropometry and ultrasonography in assessing the regional adiposity in metabolic syndrome. A total of 105 consecutive participants were included in the study after scrutinizing them for various definable factors of metabolic syndrome. Body Mass Index (BMI) of all participants was calculated and their available serological investigations were gathered. Primarily participants were subjected for anthropometric measurements like waist circumference and hip circumference, further waist/hip ratio was calculated. Following which all participants underwent sonological examination and sonographic indices like intraabdominal fat thickness, preperitoneal fat thickness, minimum and maximum subcutaneous fat thicknesses were measured. Abdominal wall fat index was calculated as ratio of maximum preperitoneal fat thickness to minimum subcutaneous fat thickness. Statistical analysis was performed using SPSS (Statistical Package Social Science, version-10.0.5) software. A p-value was calculated and values <0.05 were considered as statistically significant. RESULTS Significant correlation was established between the BMI and waist and hip circumferences. Mild positive correlation was obtained between BMI and sonographic indices like IAF, SCF and PPF with Pearson correlation (r) values of 0.324, 0.585 and 0.211 respectively. Anthropometric measurements showed higher r-values (WC- 0.624 and HC- 0.825) than sonographic indices; indicating anthropometry is better in assessing the regional adiposity than the sonography. CONCLUSION Sonography can be considered as one of the reliable imaging modality for assessing the regional adiposity but not as better as waist or hip circumferences.
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Affiliation(s)
- Rudresh Hiremath
- Professor, Department of Radiodiagnosis, K V G Medical College and Hospital, Sullia, Dakshina Kannada, Karnataka, India
| | - Jebin Ibrahim
- Senior Resident, Department of Radiodiagnosis, K V G Medical College and Hospital, Sullia, Dakshina Kannada, Karnataka, India
| | - Krishna Prasanthi
- Senior Resident, Department of Radiodiagnosis, K V G Medical College and Hospital, Sullia, Dakshina Kannada, Karnataka, India
| | - Harish T Reddy
- Senior Resident, Department of Radiodiagnosis, K V G Medical College and Hospital, Sullia, Dakshina Kannada, Karnataka, India
| | - Rushit Sandeep Shah
- Senior Resident, Department of Radiodiagnosis, K V G Medical College and Hospital, Sullia, Dakshina Kannada, Karnataka, India
| | - Ch Haritha
- Senior Resident, Department of Radiodiagnosis, K V G Medical College and Hospital, Sullia, Dakshina Kannada, Karnataka, India
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Salunke AS, Nagargoje MV, Belgaumkar VA, Tolat SN, Chavan RB. Association of Metabolic Syndrome in Chronic Plaque Psoriasis Patients and their Correlation with Disease Severity, Duration and Age: A Case Control Study from Western Maharashtra. J Clin Diagn Res 2017; 11:WC06-WC10. [PMID: 28969252 DOI: 10.7860/jcdr/2017/24390.10348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/24/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Psoriasis is a chronic systemic inflammatory disease where the skin and the joints are the primary targets. Despite the fact that psoriasis carries minimal risk of mortality, it is associated with significant morbidity which may have a significant impact on quality of life of patients. Globally, psoriasis has been reported to be associated with Metabolic Syndrome (MS) including obesity, dyslipidemia, diabetes and hypertension. Association of MS and its various components with psoriasis has been consistently reported in various studies, but there is a paucity of data on this association from the Indian subcontinent. AIM To compare the prevalence of MS in patients with psoriasis and controls and to determine association of MS with age of patient, severity and duration of psoriasis. MATERIALS AND METHODS A hospital based case control study on 95 psoriasis patients and 95 age and sex matched controls. MS was diagnosed by the presence of three or more of the South Asian Modified National Cholesterol Education Program's Adult Panel III SAM-NCEP criteria. Clinical, biometric and necessary laboratory evaluations were performed. Statistical analysis was performed by using Statistical Package for the Social Sciences (SPSS version 16.0). Data was compared between cases and controls using unpaired t-test and chi-square test and odds ratio with 95% confidence interval. RESULTS MS was significantly more common in psoriatic patients than in controls (38.9%vs 21.05%, odds ratio 2.39, 95% confidence interval, 1.26-4.55; p-value=0.007). Psoriatic patients had higher prevalence of hypertriglyceridemia (45.2%vs.11.5%), decreased HDL cholesterol (27.3%vs.4.2%), abdominal obesity (32.6% vs.15.7%) and elevated blood pressure (18.9%vs.5.2%) whereas no association observed for elevated blood sugar level (12.6%vs.5.2%). MS was present in psoriasis cohort irrespective of severity and duration of psoriasis. (p-value 0.123, 0.596 respectively). MS was more prevalent in elderly individuals with psoriasis (51.1%vs.28% p-value=0.008; Odds ratio 3.12, 95% confidence interval 1.32-7.35). CONCLUSION Significant association between psoriasis and MS was noted and it was independent of disease duration and severity. Elderly psoriatic patients were more prone for developing MS. We suggest that all patients of psoriasis, irrespective of disease, duration and severity, should be screened for MS to prevent significant morbidity and mortality associated with it.
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Affiliation(s)
- Aarti Sudam Salunke
- Assistant Professor, Department of Skin and V.D., B.J.G.M.C. and Sassoon General Hospital, Pune, Maharashtra, India
| | - Mahendra Vinayak Nagargoje
- Assistant Professor, Department of Skin and V.D., B.K.L. Walawalkar Rural Medical College, Dervan, Maharashtra, India
| | - Vasudha Abhijit Belgaumkar
- Associate Professor, Department of Skin and V.D., B.J.G.M.C. and Sassoon General Hospital, Pune, Maharashtra, India
| | - Sunil Narayan Tolat
- Associate Professor, Department of Skin and V.D., B.J.G.M.C. and Sassoon General Hospital, Pune, Maharashtra, India
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Presence of coronary artery disease in diabetic and non diabetic South Asian immigrants. Indian Heart J 2017; 70:50-55. [PMID: 29455788 PMCID: PMC5902822 DOI: 10.1016/j.ihj.2017.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 05/28/2017] [Accepted: 07/17/2017] [Indexed: 12/17/2022] Open
Abstract
Introduction South Asian Immigrants (SAIs) are the second fastest growing Asian immigrant population in the US, and at a higher risk of type 2 diabetes (diabetes) and coronary artery disease (CAD) than the general US population. Objectives: We sought to determine in SAIs the; 1) the prevalence of CAD risk factors in diabetics and non-diabetics; and b) the high possibility of CAD in diabetic SAIs. We also assessed the prevalence of sub-clinical CAD in both diabetics and non-diabetics SAIs using common carotid artery Intima-media thickness (CIMT) as a surrogate marker for atherosclerosis. Methods In a cross-sectional study design, 213 first generation SAIs were recruited and based on the history, and fasting glucose levels were divided into two subgroups; 35 diabetics and 178 non-diabetics. 12-hour fasting blood samples were collected for glucose and total cholesterol levels. Exercise Tolerance Test (ETT) was performed to determine the possibility of CAD. Results Both diabetics and non-diabetics SAIs in general, share a significant burden of CAD risk factors. The prevalence of hypertension (p = 0.003), total cholesterol ≥ 200 mg/dl (p < 0.0001) and family history of diabetes (p < 0.0001) was significantly was significantly higher in diabetics compared to non-diabetics. Of the 22/29 diabetic participants without known history of CAD, 45% had positive ETT (p < 0.001). Similarly, 63.1% of diabetics and 51.8 % of non-diabetics were positive for sub-clinical CAD using CIMT as a marker. Conclusion The susceptibility to diabetes amongst SAIs promotes an adverse CAD risk, as evident by this small study. Further research, including larger longitudinal prospective studies, is required to validate the current small study findings with investigation of the temporal association.
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Girisha BS, Thomas N. Metabolic Syndrome in Psoriasis among Urban South Indians: A Case Control Study Using SAM-NCEP Criteria. J Clin Diagn Res 2017; 11:WC01-WC04. [PMID: 28384966 DOI: 10.7860/jcdr/2017/24717.9376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/19/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Psoriasis is a chronic inflammatory disease of the skin associated with increased cardiovascular morbidity. Metabolic syndrome is a significant forecaster of cardiovascular events. AIM To assess the association of metabolic syndrome and its components in patients with psoriasis and to compare it with the age and sex matched control group. MATERIALS AND METHODS We conducted a hospital based case-control study on 156 adult patients with chronic plaque psoriasis and 156 patients with skin diseases other than psoriasis. Height, weight, BMI, blood pressure and waist circumference were documented in all the subjects. Fasting levels of serum glucose, serum triglycerides and serum HDL were estimated by automated clinical chemistry analyzer. The South Asian modified NCEP ATP criterion was used for the diagnosis of metabolic syndrome. Statistical analysis of the data was done using statistical processing software (SPSS-17). RESULTS Metabolic syndrome was significantly more common in psoriatic patients than in controls (28.8% vs 16.7%, p=0.01). Hypertriglyceridemia was significantly more prevalent in cases than in controls (34% vs 20.5%, p=0.008). The reduced HDL levels also showed a significantly high occurrence among cases (27.6% vs 13.5%, p=0.002). Moderate increase of blood pressure was seen among cases as compared to controls but the difference was not statistically significant (p=0.1). Impaired blood glucose and abdominal obesity were similar in both groups. Smoking and alcoholism did not influence the association of metabolic syndrome with psoriasis. There was no correlation of metabolic syndrome with severity and duration of psoriasis. CONCLUSION Our findings suggest that metabolic syndrome as well as dyslipidemia is common in psoriasis patients among urban South Indians. This study highlights the need for screening at diagnosis and regular follow up of the metabolic aspects of the disease along with the skin lesions.
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Affiliation(s)
- Banavasi S Girisha
- Professor and Head, Department of Dermatology, K.S Hegde Medical Academy , Mangalore, Karnataka, India
| | - Neetha Thomas
- Junior Resident, Department of Dermatology, K.S Hegde Medical Academy , Mangalore, Karnataka, India
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Patel SA, Shivashankar R, Ali MK, Anjana RM, Deepa M, Kapoor D, Kondal D, Rautela G, Mohan V, Narayan KMV, Kadir MM, Fatmi Z, Prabhakaran D, Tandon N. Is the "South Asian Phenotype" Unique to South Asians?: Comparing Cardiometabolic Risk Factors in the CARRS and NHANES Studies. Glob Heart 2017; 11:89-96.e3. [PMID: 27102026 DOI: 10.1016/j.gheart.2015.12.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 12/17/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In the context of rising obesity in South Asia, it is unclear whether the "South Asian phenotype"(described as high glucose, low high-density lipoprotein cholesterol, and high triglycerides at normal ranges of body weight) continues to be disproportionately exhibited by contemporary South Asians relative to other race/ethnic groups. OBJECTIVES We assessed the distinctiveness of the South Asian cardiometabolic profile by comparing the prevalence of combined high glucose, high triglycerides, and low high-density lipoprotein cholesterol (combined dysglycemia and dyslipidemia) in resident South Asians with 4 race/ethnic groups in the United States (Asians, black persons, Hispanics, and white persons) overall and by body mass index (BMI) category. METHODS South Asian data were from the 2010 to 2011 Center for Cardiometabolic Risk Reduction in South Asia Study, representative of Chennai and New Delhi, India and Karachi, Pakistan. U.S. data were from the 2011 to 2012 National Health and Nutrition Examination Survey, representative of the U.S. POPULATION Combined dysglycemia and dyslipidemia was defined as fasting blood glucose ≥126 mg/dl and triglyceride/high-density lipoprotein cholesterol ratio >4. Logistic regression was used to estimate the relative odds and 95% confidence intervals of combined dysglycemia and dyslipidemia associated with each race/ethnic group (referent, U.S. white persons). Models were estimated among adults aged 20 to 79 years by sex and BMI category and accounted for age, education, and tobacco use. Data from 8,448 resident South Asians, 274 U.S. Asians, 404 U.S. black persons, 308 U.S. Hispanics, and 703 U.S. white persons without previously known diabetes were analyzed. RESULTS In the normal body weight range of BMI 18.5 to 24.9 kg/m(2), the prevalence of combined dysglycemia and dyslipidemia among men and women, respectively, was 33% and 11% in resident South Asians, 15% and 1% in U.S. Asians, 5% and 2% in U.S. black persons, 11% and 2% in U.S. Hispanics, and 8% and 2% in U.S. white persons. Compared with U.S. whites persons, South Asians were more likely to present with combined dysglycemia and dyslipidemia at all categories of BMI for men and at BMI 18.5 to 29.9 for women in adjusted models. The most pronounced difference between South Asians and U.S. white persons was observed at normal weight (adjusted odds ratio: 4.98; 95% confidence interval: 2.46 to 10.07 for men) (adjusted odds ratio: 9.09; 95% confidence interval: 2.48 to 33.29 for women). CONCLUSIONS Between 8% and 15% of U.S. men and 1% and 2% of U.S. women of diverse race/ethnic backgrounds exhibited dysglycemia and dyslipidemia at levels of body weight considered "healthy," consistent with the cardiometabolic profile described as the "South Asian Phenotype." Urban South Asians, however, were 5 to 9 times more likely to exhibit dysglycemia and dyslipidemia in the "healthy" BMI range compared with any other U.S. race/ethnic group.
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Affiliation(s)
- Shivani A Patel
- Centre for Control of Chronic Conditions, New Delhi, India; Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Roopa Shivashankar
- Centre for Control of Chronic Conditions, New Delhi, India; Public Health Foundation of India, New Delhi, India; Centre for Chronic Disease Control, New Delhi, India
| | - Mohammed K Ali
- Centre for Control of Chronic Conditions, New Delhi, India; Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - R M Anjana
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, India
| | - M Deepa
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, India; Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - Deksha Kapoor
- Centre for Control of Chronic Conditions, New Delhi, India; Centre for Chronic Disease Control, New Delhi, India
| | - Dimple Kondal
- Centre for Control of Chronic Conditions, New Delhi, India; Public Health Foundation of India, New Delhi, India; Centre for Chronic Disease Control, New Delhi, India
| | - Garima Rautela
- Centre for Control of Chronic Conditions, New Delhi, India; Public Health Foundation of India, New Delhi, India
| | - V Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, India
| | - K M Venkat Narayan
- Centre for Control of Chronic Conditions, New Delhi, India; Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Dorairaj Prabhakaran
- Centre for Control of Chronic Conditions, New Delhi, India; Public Health Foundation of India, New Delhi, India; Centre for Chronic Disease Control, New Delhi, India
| | - Nikhil Tandon
- Centre for Control of Chronic Conditions, New Delhi, India; Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Arterial waveform parameters in a large, population-based sample of adults: relationships with ethnicity and lifestyle factors. J Hum Hypertens 2016; 31:305-312. [PMID: 28004730 PMCID: PMC5383734 DOI: 10.1038/jhh.2016.78] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/02/2016] [Accepted: 09/26/2016] [Indexed: 01/09/2023]
Abstract
Little is known about how aortic waveform parameters vary with ethnicity and lifestyle factors. We investigated these issues in a large, population-based sample. We carried out a cross-sectional analysis of 4798 men and women, aged 50-84 years from Auckland, New Zealand. Participants were 3961 European, 321 Pacific, 266 Maori and 250 South Asian people. We assessed modifiable lifestyle factors via questionnaires, and measured body mass index (BMI) and brachial blood pressure (BP). Suprasystolic oscillometry was used to derive aortic pressure, from which several haemodynamic parameters were calculated. Heavy alcohol consumption and BMI were positively related to most waveform parameters. Current smokers had higher levels of aortic augmentation index than non-smokers (difference=3.7%, P<0.0001). Aortic waveform parameters, controlling for demographics, antihypertensives, diabetes and cardiovascular disease (CVD), were higher in non-Europeans than in Europeans. Further adjustment for brachial BP or lifestyle factors (particularly BMI) reduced many differences but several remained. Despite even further adjustment for mean arterial pressure, pulse rate, height and total:high-density lipoprotein cholesterol, compared with Europeans, South Asians had higher levels of all measured aortic waveform parameters (for example, for backward pressure amplitude: β=1.5 mm Hg; P<0.0001), whereas Pacific people had 9% higher loge (excess pressure integral) (P<0.0001). In conclusion, aortic waveform parameters varied with ethnicity in line with the greater prevalence of CVD among non-white populations. Generally, this was true even after accounting for brachial BP, suggesting that waveform parameters may have increased usefulness in capturing ethnic variations in cardiovascular risk. Heavy alcohol consumption, smoking and especially BMI may partially contribute to elevated levels of these parameters.
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Surendar J, Indulekha K, Mohan V, Pradeepa R. Association of neutrophil-lymphocyte ratio with metabolic syndrome and its components in Asian Indians (CURES-143). J Diabetes Complications 2016; 30:1525-1529. [PMID: 27615666 DOI: 10.1016/j.jdiacomp.2016.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/05/2016] [Accepted: 08/06/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Metabolic syndrome (MS) is the state of chronic low grade inflammation. This study looks at the relationship of neutrophil-lymphocyte ratio (NLR) in subjects with and without MS in Asian Indians. METHODS Study subjects (n=754) were recruited from the Chennai Urban Rural Epidemiology Study. MS was defined using the National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) III criteria modified for waist according to World Health Organization Asia Pacific guidelines. A complete hemogram was done in all subjects using a five-part hematology analyzer (model SF-3000; Sysmex, Kobe, Japan). The NLR was calculated as the ratio between counts for neutrophils and total lymphocytes in subjects with (n=422) and without (n332) MS and correlated with number of metabolic abnormalities in those with MS. RESULTS Subjects with five metabolic abnormalities had the highest NLR, and with decreasing number of metabolic abnormalities, the NLR decreased linearly (p for trend <0.001). Logistic regression analysis revealed that even after adjusting for age, gender and body mass index, MS was strongly associated with NLR (p<0.001). CONCLUSION Among Asian Indians, NLR is correlated with MS and also with the number of metabolic abnormalities.
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Affiliation(s)
- Jayagopi Surendar
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention & Control, Gopalapuram, Chennai, India
| | - Karunakaran Indulekha
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention & Control, Gopalapuram, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention & Control, Gopalapuram, Chennai, India.
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention & Control, Gopalapuram, Chennai, India
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Joshi H, Shah K, Patel P, Prajapati J, Parmar M, Doshi D, Chaurushia S. Novel indexes for diagnosing metabolic syndrome in apparently healthy Gujarati Asian Indians: a cross-sectional study. QJM 2016; 109:717-722. [PMID: 27083984 DOI: 10.1093/qjmed/hcw056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/17/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We aimed to compare the diagnostic accuracy of four novel indexes-triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio, weight height ratio (WHtR), lipid accumulation product (LAP) and visceral adiposity index (VAI) with conventional components of metabolic syndrome (MetS) in order to identify a single index for the diagnosis of MetS in Gujarati Indian population. METHODS This observational and cross sectional study involved a total of 3329 healthy adults of 18-79 years of age. Demographic and clinical data such as body mass index, waist circumference, blood pressure were measured along with the levels of lipids and fasting blood glucose. RESULTS The overall prevalence of MetS was 34.32%, which was almost double in older individuals (45.5% vs. 20.8%) and slightly higher in males (37% vs. 31.2%). In comparison to individual components of MetS, three novel indexes-VAI, LAP and TG/HDL-C ratio showed superior diagnostic efficacy yielding an area under curve of 0.856, 0.821 and 0.821 respectively. The optimal cut-offs for VAI, LAP and TG/HDL Ratios for male, females, young and old population are (79.71, 88.12, 75.42, 87.4), (35.62, 34.73, 35.88, 34.7) and (2.249, 3.16, 2.49, 2.79) respectively. The diagnostic effectiveness of novel markers was unaffected by the age and gender of an individual. However, the efficacy of WHtR was comparable with the other conventional markers. CONCLUSION Three novel markers-LAP, VAI and TG/HDL-C ratio could be effectively used as a single 'Surrogate marker' for screening of asymptomatic Gujarati Asian Indians with MetS.
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Affiliation(s)
| | - Komal Shah
- Department of Research, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Asarwa, Ahmedabad 380016, India
| | - Priyanka Patel
- Department of Research, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Asarwa, Ahmedabad 380016, India
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Aseri R, Garg R, Kajal K, Sarker G, Pal R. Association and pattern of diastolic dysfunction in metabolic syndrome: Potential for diagnosis and prognosis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2016. [DOI: 10.1016/j.cegh.2015.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pramodkumar TA, Priya M, Jebarani S, Anjana RM, Mohan V, Pradeepa R. Metabolic profile of normal glucose-tolerant subjects with elevated 1-h plasma glucose values. Indian J Endocrinol Metab 2016; 20:612-618. [PMID: 27730069 PMCID: PMC5040039 DOI: 10.4103/2230-8210.190532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIM The aim of this study was to compare the metabolic profiles of subjects with normal glucose tolerance (NGT) with and without elevated 1-h postglucose (1HrPG) values during an oral glucose tolerance test (OGTT). METHODOLOGY The study group comprised 996 subjects without known diabetes seen at tertiary diabetes center between 2010 and 2014. NGT was defined as fasting plasma glucose <100 mg/dl (5.5 mmol/L) and 2-h plasma glucose <140 mg/dl (7.8 mmol/L) after an 82.5 g oral glucose (equivalent to 75 g of anhydrous glucose) OGTT. Anthropometric measurements and biochemical investigations were done using standardized methods. The prevalence rate of generalized and central obesity, hypertension, dyslipidemia, and metabolic syndrome (MS) was determined among the NGT subjects stratified based on their 1HrPG values as <143 mg/dl, ≥143-<155 mg/dl, and ≥155 mg/dl, after adjusting for age, sex, body mass index (BMI), waist circumference, alcohol consumption, smoking, and family history of diabetes. RESULTS The mean age of the 996 NGT subjects was 48 ± 12 years and 53.5% were male. The mean glycated hemoglobin for subjects with 1HrPG <143 mg/dl was 5.5%, for those with 1HrPG ≥143-<155 mg/dl, 5.6% and for those with 1HrPG ≥155 mg/dl, 5.7%. NGT subjects with 1HrPG ≥143-<155 mg/dl and ≥155 mg/dl had significantly higher BMI, waist circumference, systolic and diastolic blood pressure, triglyceride, total cholesterol/high-density lipoprotein (HDL) ratio, triglyceride/HDL ratio, leukocyte count, and gamma glutamyl aminotransferase (P < 0.05) compared to subjects with 1HrPG <143 mg/dl. The odds ratio for MS for subjects with 1HrPG ≥143 mg/dl was 1.84 times higher compared to subjects with 1HrPG <143 mg/dl taken as the reference. CONCLUSION NGT subjects with elevated 1HrPG values have a worse metabolic profile than those with normal 1HrPG during an OGTT.
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Affiliation(s)
| | - Miranda Priya
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Saravanan Jebarani
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
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Venkatesh S, Conner T, Song WO, Olson BH, Weatherspoon LJ. The Relationship Between Dietary Acculturation and Type 2 Diabetes Risk Among Asian Indians in the U.S. J Immigr Minor Health 2016; 19:294-301. [DOI: 10.1007/s10903-016-0482-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Wells JCK, Pomeroy E, Walimbe SR, Popkin BM, Yajnik CS. The Elevated Susceptibility to Diabetes in India: An Evolutionary Perspective. Front Public Health 2016; 4:145. [PMID: 27458578 PMCID: PMC4935697 DOI: 10.3389/fpubh.2016.00145] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 06/24/2016] [Indexed: 01/11/2023] Open
Abstract
India has rapidly become a "diabetes capital" of the world, despite maintaining high rates of under-nutrition. Indians develop diabetes at younger age and at lower body weights than other populations. Here, we interpret these characteristics in terms of a "capacity-load" model of glucose homeostasis. Specifically, we assume that glycemic control depends on whether the body's "metabolic capacity," referring to traits, such as pancreatic insulin production and muscle glucose clearance, is able to resolve the "metabolic load" generated by high levels of body fat, high dietary glycemic load, and sedentary behavior. We employ data from modern cohorts to support the model and the interpretation that elevated diabetic risk among Indian populations results from the high metabolic load imposed by westernized lifestyles acting on a baseline of low metabolic capacity. We attribute this low metabolic capacity to the low birth weight characteristic of Indian populations, which is associated with short stature and low lean mass in adult life. Using stature as a marker of metabolic capacity, we review archeological and historical evidence to highlight long-term declines in Indian stature associated with adaptation to several ecological stresses. Underlying causes may include increasing population density following the emergence of agriculture, the spread of vegetarian diets, regular famines induced by monsoon failure, and the undermining of agricultural security during the colonial period. The reduced growth and thin physique that characterize Indian populations elevate susceptibility to truncal obesity, and increase the metabolic penalties arising from sedentary behavior and high glycemic diets. Improving metabolic capacity may require multiple generations; in the meantime, efforts to reduce the metabolic load will help ameliorate the situation.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health , London , UK
| | - Emma Pomeroy
- McDonald Institute for Archaeological Research, University of Cambridge , Cambridge , UK
| | | | - Barry M Popkin
- Nutrition Department, Gillings Global School of Public Health, University of North Carolina School of Public Health , Chapel Hill, NC , USA
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Abstract
India is one of the epicentres of the global diabetes mellitus pandemic. Rapid socioeconomic development and demographic changes, along with increased susceptibility for Indian individuals, have led to the explosive increase in the prevalence of diabetes mellitus in India over the past four decades. Type 2 diabetes mellitus in Asian Indian people is characterized by a young age of onset and occurrence at low levels of BMI. Available data also suggest that the susceptibility of Asian Indian people to the complications of diabetes mellitus differs from that of white populations. Management of this disease in India faces multiple challenges, such as low levels of awareness, paucity of trained medical and paramedical staff and unaffordability of medications and services. Novel interventions using readily available resources and technology promise to revolutionise the care of patients with diabetes mellitus in India. As many of these challenges are common to most developing countries of the world, the lessons learnt from India's experience with diabetes mellitus are likely to be of immense global relevance. In this Review, we discuss the epidemiology of diabetes mellitus and its complications in India and outline the advances made in the country to ensure adequate care. We make specific references to novel, cost-effective interventions, which might be of relevance to other low-income and middle-income countries of the world.
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Affiliation(s)
- Ranjit Unnikrishnan
- Madras Diabetes Research Foundation &Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, IDF Centre of Education, No. 6 Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation &Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, IDF Centre of Education, No. 6 Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation &Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, IDF Centre of Education, No. 6 Conran Smith Road, Gopalapuram, Chennai, 600 086, India
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Abstract
Diabetes is among the biggest of the 21st-century global health challenges. In the U.S. and other high-income countries, thanks to investments in science, dedication to implementing these findings, and measurement of quality of care, there have been improvements in diabetes management and declines in rate of diabetes complications and mortality. This good news, however, is overshadowed by the ever-increasing absolute numbers of people with diabetes and its complications and the unprecedented growth of diabetes in low- and middle-income countries of the world. To comprehensively win the war against diabetes requires 1) concerted attention to prevention and 2) expansion of global research to better inform population-level policies to curb diabetes but also to better understand individual- and population-level variations in pathophysiology and phenotypes globally so that prevention and treatment can be tailored. For example, preliminary data show that thin people in low- and middle-income countries such as India commonly experience type 2 diabetes. Global studies comparing these thin Asian Indians with other high-risk groups such as Pima Indians, a population with a high mean BMI, suggest that type 2 diabetes may not be a single pathophysiological entity. Pima Indians may represent the well-studied phenotype of poor insulin action (type 2A), whereas Asian Indians represent the grossly understudied phenotype of poor insulin secretion (type 2B). This has major implications for diagnosis, prevention, and treatment and highlights the mismatch between where diabetes burdens occur (i.e., low- and middle-income countries) and where research happens (i.e., high-income countries). Correcting this imbalance will advance our knowledge and arsenal to win the global war against diabetes.
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Affiliation(s)
- K M Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, and Department of Medicine, School of Medicine, Emory University, Atlanta, GA
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