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Anjana RM. On the occasion of International Women's Day. Lancet Diabetes Endocrinol 2023; 11:312. [PMID: 36898397 DOI: 10.1016/s2213-8587(23)00067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Affiliation(s)
- R M Anjana
- Dr Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai 600 086, India.
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Lee CEC, Subramani P, Ananth P, Bhalraam U, Victor C, Venkatesan R, Prathiba V, Anjana RM, Palmer CNA, Struthers AD, Singh JS, Mordi IR, Mohan V, Lang CC. High prevalence of asymptomatic left ventricular diastolic dysfunction and its detection among South Asian patients with Type 2 Diabetes Mellitus compared with White Europeans. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is an important manifestation of Type 2 Diabetes (T2D). The development of HF in T2D may be preceded by Stage B HF. Asymptomatic left ventricular impairment, especially left ventricular diastolic dysfunction (LVDD), is a defining early feature of Stage B HF. Detection of Stage B HF is crucial as it provides an opportune target for intervention with cardio-protective therapy to prevent the development of symptomatic HF in T2D. The risk of T2DM is higher in South Asian populations resulting in increased risk of macrovascular and microvascular complications. The prevalence of Stage B HF in South Asian patients with T2DM is not known.
Purpose
(i) To compare the prevalence of Stage B HF in South Asians in India compared with White Europeans in Scotland; (ii) To test the role of NT-proBNP in identifying Stage B HF
Methods
This study involved the comparison between two independently conducted, cross-sectional studies. The patients were asymptomatic patients with T2DM with no prior history of cardiovascular disease from Chennai, India (n=246) and Tayside, Scotland (n=246). All patients underwent transthoracic echocardiogram (echo) examination to detect the presence of structural and functional echo features of Stage B HF: left atrial enlargement (LAE), left ventricular hypertrophy (LVH), LVDD and LV systolic dysfunction (LVSD). Receiver operating curves (ROC) were used to determine the predictive ability of NT-proBNP to predict LAE/LVDD/LVD/LVSD.
Results
The prevalence of Stage B HF was high in South-Asian patients with T2DM (median age of 55 [49, 62] with a high prevalence of LVDD (5% had LVH, 7.3% had LAE, 70% had LVDD and 0% had LVSD (Figure 1B). 10% of the South Asian patients had at least 2 factors contributing to Stage B HF and these patients had higher NT-proBNP titres (703.4 [500.0, 949.2] vs 423.7 [35.0, 754.2], p<0.001). ROC curves show that NT-proBNP can predict these participants with 2 or more echo features [Figure 2B, AUC: 0.7043 (0.6159, 0.7928) p<0.05]. The prevalence of Stage B HF among White Europeans (median age of 67 [61, 72].) was lower compared with South Asian patients: 15% had LVH, 13% had LAE, 19% had LVDD and 2% had LVSD (Figure 1A). 8% of White Europeans had at least 2 factors contributing to Stage B HF and these had higher NT-proBNP titres (368.9 [154.6, 1087.8] vs 186.8 [79.7, 411.5], p=0.02). ROC curves show that NT-proBNP can predict participants with 2 or more factors [Figure 2A, AUC: 0.6399 (0.5122, 0.7676) p<0.05].
Conclusion
Our study has shown that South Asian patients with T2DM have a high prevalence of Stage B HF compared with White Europeans and that the predominant Stage B HF feature is LVDD.
We also found that NTproBNP could potentially be used to detect Stage B HF and help identify at-risk patients for cardio-protective therapy such as SGLT2 inhibitor therapy that has been shown to prevent the development of future HF events.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C E C Lee
- University of Dundee, Division of Molecular and Clinical Medicine , Dundee , United Kingdom
| | - P Subramani
- Madras Diabetes Research Foundation , Chennai , India
| | - P Ananth
- Madras Diabetes Research Foundation , Chennai , India
| | - U Bhalraam
- University of Dundee, Division of Molecular and Clinical Medicine , Dundee , United Kingdom
| | - C Victor
- University of Dundee, Division of Molecular and Clinical Medicine , Dundee , United Kingdom
| | - R Venkatesan
- Madras Diabetes Research Foundation , Chennai , India
| | - V Prathiba
- Madras Diabetes Research Foundation , Chennai , India
| | - R M Anjana
- Madras Diabetes Research Foundation , Chennai , India
| | - C N A Palmer
- University of Dundee, Division of Molecular and Clinical Medicine , Dundee , United Kingdom
| | - A D Struthers
- University of Dundee, Division of Molecular and Clinical Medicine , Dundee , United Kingdom
| | - J S Singh
- University of Dundee, Division of Molecular and Clinical Medicine , Dundee , United Kingdom
| | - I R Mordi
- University of Dundee, Division of Molecular and Clinical Medicine , Dundee , United Kingdom
| | - V Mohan
- Madras Diabetes Research Foundation , Chennai , India
| | - C C Lang
- University of Dundee, Division of Molecular and Clinical Medicine , Dundee , United Kingdom
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Thirumoorthy C, Deepa M, Srikumar BN, Hannah W, Venkatesan U, Nikhil PJ, Hemavathy S, Binukumar B, Anjana RM, Ram U, Balasubramanyam M, Saravanan P, Mohan V, Gokulakrishnan K. Altered levels of neurobiological biomarkers at the interface of depression and gestational diabetes mellitus in Asian Indian women. Neuropeptides 2022; 93:102245. [PMID: 35461022 DOI: 10.1016/j.npep.2022.102245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/17/2022] [Accepted: 04/03/2022] [Indexed: 11/21/2022]
Abstract
AIM Gestational diabetes mellitus (GDM) might predispose the mothers to depression. Studies have reported the role of biomarkers either in GDM or depression, but very few have examined them in GDM with depression. The present study profiled the circulating levels of brain-derived neurotrophic factor (BDNF), Beta Endorphin (BE) and nesfatin-1 in women with GDM (with and without depression). METHODS 160 pregnant women at 24-28 weeks of pregnancy (NGT/GDM with & without depression, n = 40 each) were randomly selected from the ongoing STRiDE (STratification of Risk of Diabetes in Early pregnancy) study. Depression score was derived using PHQ-9 questionnaire and ELISA was used to quantify the biomarkers. RESULTS Circulatory levels of BDNF, BE and nesfatin-1 were lower in GDM women with or without depression compared to NGT without depression, however, nesfatin-1 levels were higher in NGT with depression. Notably, GDM with depression had the lowest levels of BDNF and BE. Both BDNF and BE levels were negatively correlated with depression, 1 h and 2 h plasma glucose. Regression analysis confirmed that each standard deviation decreases in BDNF and BE were independently associated with higher odds of GDM with or without depression even after adjusting for potential confounders. CONCLUSION Our study has identified altered levels of a panel of neurobiological biomarkers (BDNF/BE/nesfatin-1) in those with combined GDM and depression. BDNF/BE could be potential biomarkers to assess the higher risk of coexisting depression and GDM.
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Affiliation(s)
- C Thirumoorthy
- Department of Neurochemistry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India
| | - M Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - B N Srikumar
- Department of Neurophysiology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - W Hannah
- Department of Epidemiology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - U Venkatesan
- Department of Epidemiology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - P J Nikhil
- Department of Neurochemistry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India
| | - S Hemavathy
- Department of Epidemiology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - B Binukumar
- Department of Biostatistics, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - R M Anjana
- Department of Diabetology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - Uma Ram
- Seethapathy Clinic & Hospital, Chennai, India
| | - M Balasubramanyam
- Department of Cell & Molecular Biology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - P Saravanan
- Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, UK; Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton, UK
| | - V Mohan
- Department of Diabetology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - K Gokulakrishnan
- Department of Neurochemistry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India.
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Bhavadharini B, Anjana RM, Deepa M, Pradeepa R, Uma R, Saravanan P, Mohan V. Association between number of abnormal glucose values and severity of fasting plasma glucose in IADPSG criteria and maternal outcomes in women with gestational diabetes mellitus. Acta Diabetol 2022; 59:349-357. [PMID: 34705110 DOI: 10.1007/s00592-021-01815-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/21/2021] [Indexed: 12/17/2022]
Abstract
AIMS The International Association for Diabetes in Pregnancy Study Group (IADPSG) criteria recommend a single-step diagnostic oral glucose tolerance test (OGTT) for diagnosis of gestational diabetes mellitus (GDM). The aim of this study was to examine the association between the number of abnormal glucose values and levels of FPG with pregnancy outcomes. METHODS Pregnant women (n=1,044) were screened for GDM at maternity centers in South India using IADPSG criteria. OGTTs were classified based on the number of abnormal glucose values (any one value or more than one value high) and fasting plasma glucose (FPG) values (<92mg/dl,92-100mg/dl,>100mg/dl) and correlated with pregnancy outcomes. Odds ratio were adjusted for age, BMI, gestational week at diagnosis, family history of diabetes, previous history of GDM, gestational week at delivery and birth weight. For macrosomia and large for gestation age, birth weight was excluded from the model. RESULTS Risk of caesarean section was significantly higher in women with any one abnormal glucose value (OR: 1.49; 95%CI: 1.07-2.09). This further increased in those with >1 value (OR: 1.35; 95%CI: 0.87-2.10), when compared to women with all values normal. Risk of large for gestation age (LGA) was higher in women with FPG 92-100mg/dl (OR: 1.37; 95%CI: 0.80-2.35) and in those with FPG >100mg/dl (OR: 1.87; 95%CI: 1.04-3.35), compared to those with FPG <92mg/dl. CONCLUSIONS The risk for poor pregnancy outcomes starts in those with one abnormal value in the OGTT or with FPG >92mg/dl but becomes significantly higher in those with higher abnormal values.
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Affiliation(s)
| | - R M Anjana
- Dr. Mohan's Diabetes Specialities Centre, IDF Centre of Excellence in Diabetes Care, Madras Diabetes Research Foundation, ICMR Center for Advanced Research On Diabetes, Conran Smith Road, No:6B, Gopalapuram, Chennai, Pin: 600086, India
| | - M Deepa
- Dr. Mohan's Diabetes Specialities Centre, IDF Centre of Excellence in Diabetes Care, Madras Diabetes Research Foundation, ICMR Center for Advanced Research On Diabetes, Conran Smith Road, No:6B, Gopalapuram, Chennai, Pin: 600086, India
| | - R Pradeepa
- Dr. Mohan's Diabetes Specialities Centre, IDF Centre of Excellence in Diabetes Care, Madras Diabetes Research Foundation, ICMR Center for Advanced Research On Diabetes, Conran Smith Road, No:6B, Gopalapuram, Chennai, Pin: 600086, India
| | - R Uma
- Seethapathy Hospital and Clinic, Chennai, India
| | - P Saravanan
- Population, Evidence and Technologies, Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, UK
- Academic Department of Diabetes, Endocrinology & Metabolism, George Eliot Hospital, Nuneaton, UK
| | - V Mohan
- Dr. Mohan's Diabetes Specialities Centre, IDF Centre of Excellence in Diabetes Care, Madras Diabetes Research Foundation, ICMR Center for Advanced Research On Diabetes, Conran Smith Road, No:6B, Gopalapuram, Chennai, Pin: 600086, India.
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Sundararajan S, Jayachandran I, Subramanian SC, Anjana RM, Balasubramanyam M, Mohan V, Venkatesan B, Manickam N. Decreased Sestrin levels in patients with type 2 diabetes and dyslipidemia and their association with the severity of atherogenic index. J Endocrinol Invest 2021; 44:1395-1405. [PMID: 33048307 DOI: 10.1007/s40618-020-01429-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 09/16/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE We earlier reported that Sestrin2 regulates monocyte activation and atherogenic events through AMPK-mTOR nexus under high-glucose and dyslipidemic conditions. However, the statuses of Sestrins in diabetes and dyslipidemia are not known. We report here on the status of Sestrins and their association with diabetic dyslipidemia and atherosclerosis. METHODS Individuals with normal glucose tolerance (NGT) (n = 46), dyslipidemia (n = 42), and patients with Type 2 diabetes with (n = 41) and without dyslipidemia (n = 40) were recruited from a tertiary diabetes centre, Chennai, India to study the mRNA expression levels of Sestrins (1, 2, and 3) in monocytes by RT-qPCR. Serum levels of Sestrins were measured using ELISA. Atherogenic index of plasma was calculated as log (triglyceride/HDL). RESULTS mRNA expressions of Sestrin1 and Sestrin3 were significantly reduced in monocytes under dyslipidemic conditions but not in diabetes condition. Interestingly, Sestrin2 mRNA expression was significantly reduced in all disease conditions including dyslipidemia, and diabetes with and without dyslipidemia. Sestrin2 mRNA levels were negatively correlated with glycemic and lipid parameters and plasma atherogenic index. Furthermore, circulatory Sestrin2 was also found to be significantly decreased in dyslipidemia (415.2 ± 44.7 pg/ml), diabetes (375 ± 45 pg/ml), and diabetes with dyslipidemia (319.2 ± 26.3 pg/ml) compared to NGT (706.3 ± 77 pg/ml) and negatively correlated with glycemic, lipid parameters, and plasma atherogenic index. CONCLUSION We report for the first time that Sestrins levels are significantly decreased in diabetes and dyslipidemic conditions. More strikingly, Sestrin2 had a strong association with atherogenic risk factors and severity of atherogenic index and we suggest that Sestrin2 may be used as a biomarker for assessing atherogenesis.
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Affiliation(s)
- S Sundararajan
- Department of Vascular Biology, Madras Diabetes Research Foundation and ICMR Centre for Advanced Research On Diabetes, Chennai, India
| | - I Jayachandran
- Department of Vascular Biology, Madras Diabetes Research Foundation and ICMR Centre for Advanced Research On Diabetes, Chennai, India
| | - S C Subramanian
- Clinical Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - R M Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Who Collaborating Centre for Non-Communicable Diseases Prevention and Control, Chennai, India
| | - M Balasubramanyam
- Department of Cell and Molecular Biology, Madras Diabetes Research Foundation, Chennai, India
| | - V Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Who Collaborating Centre for Non-Communicable Diseases Prevention and Control, Chennai, India
| | - B Venkatesan
- Department of Vascular Biology, Madras Diabetes Research Foundation and ICMR Centre for Advanced Research On Diabetes, Chennai, India.
- Science and Engineering Research Board, New Delhi, India.
| | - N Manickam
- Department of Vascular Biology, Madras Diabetes Research Foundation and ICMR Centre for Advanced Research On Diabetes, Chennai, India.
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Srivastava BK, Anjana RM, Singla A, Jebarani S, Viswanathan M. Combination Therapy With Premixed & Basal Insulin Analogues in Asian Indians With Type 2 Diabetes. J Endocr Soc 2021. [PMCID: PMC8090128 DOI: 10.1210/jendso/bvab048.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Many individuals with type 2 diabetes (T2DM) eventually need insulin for better glycaemic control. Different insulin regimens like basal, premixed, basal plus, split mixed and basal bolus are used in T2DM management. There is not much literature on a combination of premixed insulin in the morning along with basal insulin at night. Such a regimen is preferred by people with T2DM, who do not want to take an afternoon insulin dose due to inconvenience. To study the effect of a premixed insulin given in the morning and long acting basal insulin analogue given at night in T2DM subjects, we looked into this combination. We performed a retrospective study to look into the effects of premixed and basal insulin analogue combination in patients with T2DM (in addition to oral antidiabetic agents). From the diabetes electronic medical records of a tertiary care hospital for diabetes at Chennai in South India, 648 patients on premixed and basal insulin analogue combination, who came for a follow-up visit were included in the final analysis. Baseline characteristics included body weight, BMI, blood pressure, fasting lipid profile, fasting and post prandial plasma glucose and HbA1c were analysed at baseline, and a change in the parameters was studied at the first follow up visit between 5 to 7 months. Mean age of the study population was 60.7± 13.1 years with mean diabetes duration of 20.5 ± 8.0 years. Out of 648 patients included, three fifths were male. Statistically significant improvement was observed in body weight, BMI, HbA1c, systolic blood pressure, lipid profile, fasting blood sugars (P < 0.001) and post prandial blood sugars (P= 0.005) in comparison to baseline values. Significant reduction in HbA1c (1.7 %, p < 0.0001) was observed in those with in the highest tertile of HbA1c (11.3 ± 1.0 %) in comparison to the baseline values. At follow up, nearly a third of study subjects achieved a HbA1c target of < 8% (30.1 % vs 18.4 0%, p =0.0005) in comparison to the baseline values. 28.7 % patients on combination therapy achieved a fasting blood sugar value of < 130 mg/dl at follow up compared to 18.2 % patients at baseline (p <.0001). Similarly, 22 % of the patients on combination therapy also achieved post prandial blood sugars of <180 mg/dl at follow up, compared to 12.2 % (P<.0001) at baseline. This study shows that in T2DM subjects, a simple regimen of premixed and basal insulin analogue combination helps in improving the glycaemic control.
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Affiliation(s)
| | - R M Anjana
- Dr Mohans Diabetes Specialities Centre, Chennai, India
| | - Amit Singla
- Dr Mohans Diabetes Specialities Centre, Chennai, India
| | - S Jebarani
- Dr Mohans Diabetes Specialities Centre, Chennai, India
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Ford CN, Do WL, Weber MB, Narayan KMV, Ranjani H, Anjana RM. Moderate-to-vigorous physical activity changes in a diabetes prevention intervention randomized trial among South Asians with prediabetes - The D-CLIP trial. Diabetes Res Clin Pract 2021; 174:108727. [PMID: 33662491 DOI: 10.1016/j.diabres.2021.108727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/02/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
AIMS The Diabetes Community Lifestyle Improvement Program (D-CLIP) was a lifestyle education program to prevent diabetes in South Asians with prediabetes. This paper examines the impact of the D-CLIP intervention on moderate-to-vigorous intensity physical activity (MVPA). METHODS This randomized controlled trial to prevent diabetes included 573 individuals with prediabetes from Chennai, India. The intervention was designed to increase MVPA to ≥150 minutes per week. MVPA was measured by questionnaire at baseline, six, 12, 18, 24, 30 and 36 months of follow-up. Random effects models were used to examine the relationship between treatment group and odds of reporting ≥150 weekly minutes of MVPA and to examine the impact of the intervention on weekly MVPA. RESULTS With the exception of the proportion of respondents at baseline with a high waist circumference, selected sample characteristics did not differ at baseline between the intervention and control groups. The intervention significantly (p < 0.05) increased the proportion of respondents who reported ≥150 weekly minutes of MVPA by 28.5%, 13.6% and 14.0% at six, 12 and 18 months respectively. Mean minutes of weekly MVPA significantly (p < 0.05) increased by an additional 56.7, 34.3, 23.6 and 24.3 minutes/week at six, 12, 18, and 24 months, respectively. CONCLUSION The D-CLIP intervention significantly increased MVPA at six, 12 and 18 months of follow-up. Interventions to prevent diabetes in South Asians with prediabetes can significantly increase MVPA in this population.
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Affiliation(s)
- Christopher N Ford
- Department of Internal Medicine, Rush Institute for Health Aging (Section of Community Epidemiology), Rush University Medical Center, Chicago, IL, USA.
| | - Whitney L Do
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Mary Beth Weber
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Harish Ranjani
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - R M Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, Chennai, India
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Mohan V, Amutha A, Dhakshayani R, Dharmarajan P, Suresh E, Periyandavar I, Shanmugam A, Seshiah V, Viswanathan V, Ramachandran A, Anjana RM, Vijayakumar G, Paneerselvam A, Srivatsa A, Nallaperumal S, Vasanthi T, Moses A, Roy S. Clinical profile and types of youth-onset diabetes in Chennai: The indian council of medical research registry of youth-onset diabetes in india – chennai centres. J Diabetol 2021. [DOI: 10.4103/jod.jod_76_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
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Mehreen TS, Kamalesh R, Pandiyan D, Kumar DS, Anjana RM, Mohan V, Ranjani H. Incidence and Predictors of Dysglycemia and Regression to Normoglycemia in Indian Adolescents and Young Adults: 10-Year Follow-Up of the ORANGE Study. Diabetes Technol Ther 2020; 22:875-882. [PMID: 32349530 DOI: 10.1089/dia.2020.0109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: The prevalence of diabetes in youth is increasing worldwide in parallel with the obesity epidemic. This study aimed to determine the incidence rates of dysglycemia (diabetes or prediabetes) and evaluate the predictors of its progression or regression to normal glucose tolerance (NGT) in a cohort of children and adolescents studied in Chennai, South India. Methods: A longitudinal follow-up of the Obesity Reduction and Awareness of Noncommunicable Diseases through Group Education (ORANGE) cohort was performed after a median of 7.1 years (n = 845; 5928 person-years of follow-up). To determine their diabetes status at follow-up, participants underwent an oral glucose tolerance test (n = 811 with NGT and 34 with prediabetes at baseline), excluding those with diabetes at baseline. Incidence rates for dysglycemia were reported per 1000 person-years of follow-up. Cox proportional hazards model was used to estimate the predictors of progression and regression. Results: Out of 811 individuals with NGT at baseline, 115 developed dysglycemia giving an incidence rate of 20.2 per 1000 person-years (95% confidence interval: 16.8-24.2). Among those with prediabetes at baseline, 70.6% of the individuals converted to NGT and the remaining 29.4% either got converted to diabetes or remained as prediabetes. Higher age, body mass index, fasting plasma glucose, 2-hour plasma glucose (2-h PG), positive family history of diabetes, and systolic blood pressure (BP) were independent predictors of incident dysglycemia, whereas lower age, waist circumference, 2-h PG, systolic BP, and triglycerides predicted regression to normoglycemia. Conclusions: This study highlights the growing burden of dysglycemia in Asian Indian youth and emphasizes the need for targeted preventive actions.
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Affiliation(s)
- T S Mehreen
- Department of Translational Research, Madras Diabetes Research Foundation, Chennai, India
| | - R Kamalesh
- Department of Research Operations, Madras Diabetes Research Foundation, Chennai, India
| | - D Pandiyan
- Department of Translational Research, Madras Diabetes Research Foundation, Chennai, India
| | - D Sathish Kumar
- Department of Translational Research, Madras Diabetes Research Foundation, Chennai, India
| | - R M Anjana
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, India
| | - V Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, India
| | - H Ranjani
- Department of Translational Research, Madras Diabetes Research Foundation, Chennai, India
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Chetan MR, Miksza JK, Lawrence I, Anjana RM, Unnikrishnan R, Amutha A, Shanthi Rani CS, Jebarani S, Mohan V, Khunti K, Narendran P. The increased risk of microvascular complications in South Asians with type 1 diabetes is influenced by migration. Diabet Med 2020; 37:2136-2142. [PMID: 31721280 DOI: 10.1111/dme.14184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2019] [Indexed: 11/28/2022]
Abstract
AIM We aimed to explore the association between South Asian ethnicity and complications of type 1 diabetes, and whether this is affected by migration. METHODS In this retrospective cohort study, data on diabetes control and complications were obtained for South Asians in India (South AsiansIndia , n = 2592) and the UK (South AsiansUK , n = 221) and white Europeans in the UK (n = 1431). Multivariable logistic regression was used to identify associations between ethnicity and diabetic kidney disease, retinopathy and neuropathy adjusting for age, sex, BMI, disease duration, HbA1c , blood pressure (BP) and cholesterol. RESULTS South AsiansIndia had significantly greater adjusted odds of diabetic kidney disease [odds ratio (OR) 5.0, 95% confidence intervals (CI) 3.6-7.1] and retinopathy (OR 1.8, 95% CI 1.2-2.5), but lower odds of neuropathy (OR 0.5, 95% CI 0.4-0.6) than white Europeans. South AsiansIndia had significantly greater adjusted odds of diabetic kidney disease (OR 3.0, 95% 1.8-5.3) than South AsiansUK , but there was no significant difference in the odds of other complications. CONCLUSIONS In this hypothesis-generating study, we report that South Asian ethnicity is associated with greater risk of diabetic kidney disease and retinopathy, and lower risk of neuropathy than white European ethnicity. Part of the excess diabetic kidney disease risk is reduced in South AsiansUK . These associations cannot be accounted for by differences in vascular risk factors. Our findings in South Asians with type 1 diabetes mirror previous findings in type 2 diabetes and now need to be validated in a study of the effect of ethnicity on type 1 diabetes complications where healthcare is provided in the same setting.
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Affiliation(s)
- M R Chetan
- College of Medical and Dental Sciences, Birmingham, UK
| | - J K Miksza
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - I Lawrence
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - R M Anjana
- Madras Diabetes Research Foundation, Chennai, India
| | | | - A Amutha
- Madras Diabetes Research Foundation, Chennai, India
| | | | - S Jebarani
- Madras Diabetes Research Foundation, Chennai, India
| | - V Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - P Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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11
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Kapoor D, Iqbal R, Singh K, Jaacks LM, Shivashankar R, Sudha V, Anjana RM, Kadir M, Mohan V, Ali MK, Narayan KM, Tandon N, Prabhakaran D, Merchant AT. Association of dietary patterns and dietary diversity with cardiometabolic disease risk factors among adults in South Asia: The CARRS study. Asia Pac J Clin Nutr 2019; 27:1332-1343. [PMID: 30485933 DOI: 10.6133/apjcn.201811_27(6).0021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate the association of dietary patterns and dietary diversity with cardiometabolic disease risk factors among South Asians. METHODS AND STUDY DESIGN In a population based study conducted in 2010-11, we recruited 16,287 adults aged >20 years residing in Delhi, Chennai, and Karachi. Diet was assessed using an interviewer-administered 26-item food frequency questionnaire. Principal component analysis identified three dietary patterns: Prudent, Indian, and Non-Vegetarian. We also computed a dietary diversity score. Multinomial and binary logistic regressions were used to calculate adjusted prevalence (95% confidence intervals) of cardio-metabolic disease risk factors across quartiles of dietary pattern and dietary diversity scores. RESULTS The adjusted prevalence of diagnosed diabetes was lower among participants in the highest versus lowest quartile of the Prudent Pattern (4.7% [3.8-5.6] versus 10.3% [8.5-12.0]), and the Indian Pattern (4.8% [3.7-5.9] versus 8.7% [6.7-10.6] in highest versus lowest quartile, respectively). Participants following the Indian Pattern also had lower adjusted prevalence of diagnosed hypertension (7.0% [5.4-8.5] versus 10.6% [8.6-12.5] in highest versus lowest quartile, respectively). Participants in the highest versus lowest quartile of the dietary diversity score had a lower adjusted prevalence of diagnosed diabetes (4.1% [3.0-5.2] versus 8.2% [7.1-9.3]), diagnosed hypertension (6.7% [5.3-8.1] versus 10.3% [9.1-11.5]), and undiagnosed hypertension (14.2% [12.0-16.4] versus 18.5% [16.9-20.1]). CONCLUSIONS High dietary diversity appears to be protective against cardio-metabolic disease risk factors in this urban cohort of South Asian adults. Further investigation to understand the underlying mechanism of this observation is warranted.
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Affiliation(s)
| | | | | | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard University, Boston, MA, USA
| | - Roopa Shivashankar
- Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, India
| | | | - R M Anjana
- Madras Diabetes Research Foundation, Chennai, India
| | | | | | - Mohammed K Ali
- Department of Global Health, Emory University, Atlanta, GA, USA
| | - K Mv Narayan
- Department of Global Health, Emory University, Atlanta, GA, USA
| | | | - Dorairaj Prabhakaran
- Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, India
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
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12
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Gujral UP, Prabhakaran D, Pradeepa R, Kandula NR, Kondal D, Deepa M, Zakai NA, Anjana RM, Rautela G, Mohan V, Narayan KMV, Tandon N, Kanaya AM. Isolated HbA1c identifies a different subgroup of individuals with type 2 diabetes compared to fasting or post-challenge glucose in Asian Indians: The CARRS and MASALA studies. Diabetes Res Clin Pract 2019; 153:93-102. [PMID: 31150721 PMCID: PMC6635041 DOI: 10.1016/j.diabres.2019.05.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 12/26/2022]
Abstract
AIMS Guidelines recommend hemoglobin A1c (HbA1c) as a diagnostic test for type 2 diabetes, but its accuracy may differ in certain ethnic groups. METHODS The prevalence of type 2 diabetes by HbA1c, fasting glucose, and 2 h glucose was compared in 3016 participants from Chennai and Delhi, India from the CARRS-2 Study to 757 Indians in the U.S. from the MASALA Study. Type 2 diabetes was defined as fasting glucose ≥ 7.0 mmol/L, 2-h glucose ≥ 11.1 mmol/L, or HbA1c ≥ 6.5%. Isolated HbA1c diabetes was defined as HbA1c ≥ 6.5% with fasting glucose < 7.0 mmol/L and 2 h glucose < 11.1 mmol/L. RESULTS The age, sex, and BMI adjusted prevalence of diabetes by isolated HbA1c was 2.9% (95% CI: 2.2-4.0), 3.1% (95% CI: 2.3-4.1), and 0.8% (95% CI: 0.4-1.8) in CARRS-Chennai, CARRS-Delhi, and MASALA, respectively. The proportion of diabetes diagnosed by isolated HbA1c was 19.4%, 26.8%, and 10.8% in CARRS-Chennai, CARRS-Delhi, and MASALA respectively. In CARRS-2, individuals with type 2 diabetes by isolated HbA1c milder cardio-metabolic risk than those diagnosed by fasting or 2-h measures. CONCLUSIONS In Asian Indians, the use of HbA1c for type 2 diabetes diagnosis could result in a higher prevalence. HbA1c may identify a subset of individuals with milder glucose intolerance.
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Affiliation(s)
- U P Gujral
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Road NE, Room 7040 N, Emory University, Atlanta, GA, USA.
| | - D Prabhakaran
- Public Health Foundation of India, Unit No. 316 Situated on 3rd Floor, Rectangle-1 Building, Plot No. D-4, District Centre Saket, New Delhi, India; London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom.
| | - R Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - N R Kandula
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 6th Floor, Chicago, IL, USA.
| | - D Kondal
- Public Health Foundation of India, Unit No. 316 Situated on 3rd Floor, Rectangle-1 Building, Plot No. D-4, District Centre Saket, New Delhi, India.
| | - M Deepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - N A Zakai
- Department of Medicine, Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, 89 Beaumont Avenue, Courtyard at Given S269, Burlington, VT, USA.
| | - R M Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, ICMR Centre for Advanced Research on Diabetes, Chennai, India.
| | - G Rautela
- Public Health Foundation of India, Unit No. 316 Situated on 3rd Floor, Rectangle-1 Building, Plot No. D-4, District Centre Saket, New Delhi, India.
| | - V Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, ICMR Centre for Advanced Research on Diabetes, Chennai, India.
| | - K M V Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Road NE, Room 7040 N, Emory University, Atlanta, GA, USA; Department of Medicine, School of Medicine, 201 Dowman Drive Emory University, Atlanta, GA, USA.
| | - N Tandon
- Public Health Foundation of India, Unit No. 316 Situated on 3rd Floor, Rectangle-1 Building, Plot No. D-4, District Centre Saket, New Delhi, India; Department of Endocrinology and Metabolism, All Indian Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - A M Kanaya
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
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13
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Mohan V, Unnikrishnan R, Shobana S, Malavika M, Anjana RM, Sudha V. Are excess carbohydrates the main link to diabetes & its complications in Asians? Indian J Med Res 2019; 148:531-538. [PMID: 30666980 PMCID: PMC6366262 DOI: 10.4103/ijmr.ijmr_1698_18] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Dietary carbohydrates form the major source of energy in Asian diets. The carbohydrate quantity and quality play a vital function in the prevention and management of diabetes. High glycaemic index foods elicit higher glycaemic and insulinaemic responses and promote insulin resistance and type 2 diabetes (T2D) through beta-cell exhaustion. This article reviews the evidence associating dietary carbohydrates to the prevalence and incidence of T2D and metabolic syndrome (MS) in control of diabetes and their role in the complications of diabetes. Cross-sectional and longitudinal studies show that higher carbohydrate diets are linked to higher prevalence and incidence of T2D. However, the association seems to be stronger in Asian-Indians consuming diets high in carbohydrates and more marked on a background of obesity. There is also evidence for high carbohydrate diets and risk for MS and cardiovascular disease (CVD). However, the quality of carbohydrates is also equally important. Complex carbohydrates such as brown rice, whole wheat bread, legumes, pulses and green leafy vegetables are good carbs. Conversely, highly polished rice or refined wheat, sugar, glucose, highly processed foods such as cookies and pastries, fruit juice and sweetened beverages and fried potatoes or French fries are obviously ‘bad’ carbs. Ultimately, it is all a matter of balance and moderation in diet. For Indians who currently consume about 65-75 per cent of calories from carbohydrates, reducing this to 50-55 per cent and adding enough protein (20-25%) especially from vegetable sources and the rest from fat (20-30%) by including monounsaturated fats (e.g. groundnut or mustard oil, nuts and seeds) along with a plenty of green leafy vegetables, would be the best diet prescription for the prevention and management of non-communicable diseases such as T2D and CVD.
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Affiliation(s)
- Viswanathan Mohan
- Department of Diabetology, Dr Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - Ranjit Unnikrishnan
- Department of Diabetology, Dr Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - S Shobana
- Department of Foods Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, India
| | - M Malavika
- Department of Foods Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, India
| | - R M Anjana
- Department of Diabetology, Dr Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - V Sudha
- Department of Foods Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, India
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14
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Balakrishnan K, Dey S, Gupta T, Dhaliwal RS, Brauer M, Cohen AJ, Stanaway JD, Beig G, Joshi TK, Aggarwal AN, Sabde Y, Sadhu H, Frostad J, Causey K, Godwin W, Shukla DK, Kumar GA, Varghese CM, Muraleedharan P, Agrawal A, Anjana RM, Bhansali A, Bhardwaj D, Burkart K, Cercy K, Chakma JK, Chowdhury S, Christopher DJ, Dutta E, Furtado M, Ghosh S, Ghoshal AG, Glenn SD, Guleria R, Gupta R, Jeemon P, Kant R, Kant S, Kaur T, Koul PA, Krish V, Krishna B, Larson SL, Madhipatla K, Mahesh PA, Mohan V, Mukhopadhyay S, Mutreja P, Naik N, Nair S, Nguyen G, Odell CM, Pandian JD, Prabhakaran D, Prabhakaran P, Roy A, Salvi S, Sambandam S, Saraf D, Sharma M, Shrivastava A, Singh V, Tandon N, Thomas NJ, Torre A, Xavier D, Yadav G, Singh S, Shekhar C, Vos T, Dandona R, Reddy KS, Lim SS, Murray CJL, Venkatesh S, Dandona L. The impact of air pollution on deaths, disease burden, and life expectancy across the states of India: the Global Burden of Disease Study 2017. Lancet Planet Health 2019; 3:e26-e39. [PMID: 30528905 PMCID: PMC6358127 DOI: 10.1016/s2542-5196(18)30261-4] [Citation(s) in RCA: 260] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 10/18/2018] [Accepted: 11/02/2018] [Indexed: 05/19/2023]
Abstract
BACKGROUND Air pollution is a major planetary health risk, with India estimated to have some of the worst levels globally. To inform action at subnational levels in India, we estimated the exposure to air pollution and its impact on deaths, disease burden, and life expectancy in every state of India in 2017. METHODS We estimated exposure to air pollution, including ambient particulate matter pollution, defined as the annual average gridded concentration of PM2.5, and household air pollution, defined as percentage of households using solid cooking fuels and the corresponding exposure to PM2.5, across the states of India using accessible data from multiple sources as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The states were categorised into three Socio-demographic Index (SDI) levels as calculated by GBD 2017 on the basis of lag-distributed per-capita income, mean education in people aged 15 years or older, and total fertility rate in people younger than 25 years. We estimated deaths and disability-adjusted life-years (DALYs) attributable to air pollution exposure, on the basis of exposure-response relationships from the published literature, as assessed in GBD 2017; the proportion of total global air pollution DALYs in India; and what the life expectancy would have been in each state of India if air pollution levels had been less than the minimum level causing health loss. FINDINGS The annual population-weighted mean exposure to ambient particulate matter PM2·5 in India was 89·9 μg/m3 (95% uncertainty interval [UI] 67·0-112·0) in 2017. Most states, and 76·8% of the population of India, were exposed to annual population-weighted mean PM2·5 greater than 40 μg/m3, which is the limit recommended by the National Ambient Air Quality Standards in India. Delhi had the highest annual population-weighted mean PM2·5 in 2017, followed by Uttar Pradesh, Bihar, and Haryana in north India, all with mean values greater than 125 μg/m3. The proportion of population using solid fuels in India was 55·5% (54·8-56·2) in 2017, which exceeded 75% in the low SDI states of Bihar, Jharkhand, and Odisha. 1·24 million (1·09-1·39) deaths in India in 2017, which were 12·5% of the total deaths, were attributable to air pollution, including 0·67 million (0·55-0·79) from ambient particulate matter pollution and 0·48 million (0·39-0·58) from household air pollution. Of these deaths attributable to air pollution, 51·4% were in people younger than 70 years. India contributed 18·1% of the global population but had 26·2% of the global air pollution DALYs in 2017. The ambient particulate matter pollution DALY rate was highest in the north Indian states of Uttar Pradesh, Haryana, Delhi, Punjab, and Rajasthan, spread across the three SDI state groups, and the household air pollution DALY rate was highest in the low SDI states of Chhattisgarh, Rajasthan, Madhya Pradesh, and Assam in north and northeast India. We estimated that if the air pollution level in India were less than the minimum causing health loss, the average life expectancy in 2017 would have been higher by 1·7 years (1·6-1·9), with this increase exceeding 2 years in the north Indian states of Rajasthan, Uttar Pradesh, and Haryana. INTERPRETATION India has disproportionately high mortality and disease burden due to air pollution. This burden is generally highest in the low SDI states of north India. Reducing the substantial avoidable deaths and disease burden from this major environmental risk is dependent on rapid deployment of effective multisectoral policies throughout India that are commensurate with the magnitude of air pollution in each state. FUNDING Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
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15
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Lear SA, Hu W, Rangarajan S, Gasevic D, Leong D, Iqbal R, Casanova A, Swaminathan S, Anjana RM, Kumar R, Rosengren A, Wei L, Yang W, Chuangshi W, Huaxing L, Nair S, Diaz R, Swidon H, Gupta R, Mohammadifard N, Lopez-Jaramillo P, Oguz A, Zatonska K, Seron P, Avezum A, Poirier P, Teo K, Yusuf S. The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet 2017; 390:2643-2654. [PMID: 28943267 DOI: 10.1016/s0140-6736(17)31634-3] [Citation(s) in RCA: 685] [Impact Index Per Article: 97.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 05/27/2017] [Accepted: 05/31/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Physical activity has a protective effect against cardiovascular disease (CVD) in high-income countries, where physical activity is mainly recreational, but it is not known if this is also observed in lower-income countries, where physical activity is mainly non-recreational. We examined whether different amounts and types of physical activity are associated with lower mortality and CVD in countries at different economic levels. METHODS In this prospective cohort study, we recruited participants from 17 countries (Canada, Sweden, United Arab Emirates, Argentina, Brazil, Chile, Poland, Turkey, Malaysia, South Africa, China, Colombia, Iran, Bangladesh, India, Pakistan, and Zimbabwe). Within each country, urban and rural areas in and around selected cities and towns were identified to reflect the geographical diversity. Within these communities, we invited individuals aged between 35 and 70 years who intended to live at their current address for at least another 4 years. Total physical activity was assessed using the International Physical Activity Questionnaire (IPQA). Participants with pre-existing CVD were excluded from the analyses. Mortality and CVD were recorded during a mean of 6·9 years of follow-up. Primary clinical outcomes during follow-up were mortality plus major CVD (CVD mortality, incident myocardial infarction, stroke, or heart failure), either as a composite or separately. The effects of physical activity on mortality and CVD were adjusted for sociodemographic factors and other risk factors taking into account household, community, and country clustering. FINDINGS Between Jan 1, 2003, and Dec 31, 2010, 168 916 participants were enrolled, of whom 141 945 completed the IPAQ. Analyses were limited to the 130 843 participants without pre-existing CVD. Compared with low physical activity (<600 metabolic equivalents [MET] × minutes per week or <150 minutes per week of moderate intensity physical activity), moderate (600-3000 MET × minutes or 150-750 minutes per week) and high physical activity (>3000 MET × minutes or >750 minutes per week) were associated with graded reduction in mortality (hazard ratio 0·80, 95% CI 0·74-0·87 and 0·65, 0·60-0·71; p<0·0001 for trend), and major CVD (0·86, 0·78-0·93; p<0·001 for trend). Higher physical activity was associated with lower risk of CVD and mortality in high-income, middle-income, and low-income countries. The adjusted population attributable fraction for not meeting the physical activity guidelines was 8·0% for mortality and 4·6% for major CVD, and for not meeting high physical activity was 13·0% for mortality and 9·5% for major CVD. Both recreational and non-recreational physical activity were associated with benefits. INTERPRETATION Higher recreational and non-recreational physical activity was associated with a lower risk of mortality and CVD events in individuals from low-income, middle-income, and high-income countries. Increasing physical activity is a simple, widely applicable, low cost global strategy that could reduce deaths and CVD in middle age. FUNDING Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Ontario SPOR Support Unit, Ontario Ministry of Health and Long-Term Care, AstraZeneca, Sanofi-Aventis, Boehringer Ingelheim, Servier, GSK, Novartis, King Pharma, and national and local organisations in participating countries that are listed at the end of the Article.
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Affiliation(s)
- Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby and Division of Cardiology, Providence Health Care, Vancouver, BC, Canada.
| | - Weihong Hu
- Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, ON, Canada
| | - Danijela Gasevic
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Darryl Leong
- Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, ON, Canada
| | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Amparo Casanova
- Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, ON, Canada
| | - Sumathi Swaminathan
- St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India
| | - R M Anjana
- Madras Diabetes Research Foundation, Chennai, India
| | - Rajesh Kumar
- School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Li Wei
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
| | - Wang Yang
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
| | - Wang Chuangshi
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
| | - Liu Huaxing
- Center for Disease Control & Prevention, Mengla County, Xishuangbanna Prefecture, Yunnan Province, China
| | | | - Rafael Diaz
- Estudios Clinicos Latinoamerica ECLA, Rosario, Santa Fe, Argentina
| | - Hany Swidon
- Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Mount Sinai New York Affiliate, Jaipur, India
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Aytekin Oguz
- Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Katarzyna Zatonska
- Department of Social Medicine, Medical University of Wroclaw, Wroclaw, Poland
| | | | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec City, QC, Canada
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, ON, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, ON, Canada
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16
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Kowalski AJ, Poongothai S, Chwastiak L, Hutcheson M, Tandon N, Khadgawat R, Sridhar GR, Aravind SR, Sosale B, Anjana RM, Rao D, Sagar R, Mehta N, Narayan KMV, Unutzer J, Katon W, Mohan V, Ali MK. The INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) study: Design and methods to address mental healthcare gaps in India. Contemp Clin Trials 2017. [PMID: 28642211 DOI: 10.1016/j.cct.2017.06.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Depression and diabetes are highly prevalent worldwide and often co-exist, worsening outcomes for each condition. Barriers to diagnosis and treatment are exacerbated in low and middle-income countries with limited health infrastructure and access to mental health treatment. The INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) study tests the sustained effectiveness and cost-effectiveness of a multi-component care model for individuals with poorly-controlled diabetes and depression in diabetes clinics in India. MATERIALS AND METHODS Adults with diabetes, depressive symptoms (Patient Health Questionnaire-9 score≥10), and ≥1 poorly-controlled cardiometabolic indicator (either HbA1c≥8.0%, SBP≥140mmHg, and/or LDL≥130mg/dl) were enrolled and randomized to the intervention or usual care. The intervention combined collaborative care, decision-support, and population health management. The primary outcome is the between-arm difference in the proportion of participants achieving combined depression response (≥50% reduction in Symptom Checklist score from baseline) AND one or more of: ≥0.5% reduction in HbA1c, ≥5mmHg reduction in SBP, or ≥10mg/dl reduction in LDL-c at 24months (12-month intervention; 12-month observational follow-up). Other outcomes include control of individual parameters, patient-centered measures (i.e. treatment satisfaction), and cost-effectiveness. RESULTS The study trained seven care coordinators. Participant recruitment is complete - 940 adults were screened, with 483 eligible, and 404 randomized (196 to intervention; 208 to usual care). Randomization was balanced across clinic sites. CONCLUSIONS The INDEPENDENT model aims to increase access to mental health care and improve depression and cardiometabolic disease outcomes among complex patients with diabetes by leveraging the care provided in diabetes clinics in India (clinicaltrials.gov number: NCT02022111).
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Affiliation(s)
- A J Kowalski
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - S Poongothai
- Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, 4, Conran Smith Road, Gopalapuram, Chennai 600 086, Tamil Nadu, India
| | - L Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - M Hutcheson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - N Tandon
- All India Institute of Medical Sciences, Department of Endocrinology & Metabolism, Biotechnology Block, 3rd Floor, Rm #312, Ansari Nagar, New Delhi 110 029, India
| | - R Khadgawat
- All India Institute of Medical Sciences, Department of Endocrinology & Metabolism, Biotechnology Block, 3rd Floor, Rm #312, Ansari Nagar, New Delhi 110 029, India
| | - G R Sridhar
- Endocrine and Diabetes Centre, Visakhapatnam, Andhra Pradesh, India
| | - S R Aravind
- Diacon Hospital, Diabetes Care and Research Center, Rajajinagar, Bangalore 560 010, Karantaka, India
| | - B Sosale
- Diacon Hospital, Diabetes Care and Research Center, Rajajinagar, Bangalore 560 010, Karantaka, India
| | - R M Anjana
- Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, 4, Conran Smith Road, Gopalapuram, Chennai 600 086, Tamil Nadu, India
| | - D Rao
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States; Department of Global Health, University of Washington, Seattle, WA, United States
| | - R Sagar
- All India Institute of Medical Sciences, Department of Psychiatry, Ansari Nagar, New Delhi 110 029, India
| | - N Mehta
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - K M V Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - J Unutzer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - W Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - V Mohan
- Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, 4, Conran Smith Road, Gopalapuram, Chennai 600 086, Tamil Nadu, India
| | - M K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States.
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17
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Amutha A, Pradeepa R, Chella KS, Anjana RM, Unnikrishnan R, Mohan V. Lipid Profile in Childhood-and Youth-Onset Type 2 Diabetes and their Association with Microvascular Complications. J Assoc Physicians India 2017; 65:42-47. [PMID: 28782313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To assess the lipid profiles in childhood and youth onset type 2 diabetes (T2DM) and study their association with microvascular complications. METHODS Clinical details of individuals with childhood and youth onset T2DM, age at diagnosis between 10 and 25 yrs (n=1340) were retrieved from electronic medical records. Lipid abnormalities were classified based on the NCEP (ATP III) guidelines and management of dyslipidemia in children and adolescents with diabetes. Retinopathy was assessed by retinal photography; nephropathy, if albumin excretion was ≥300 mg/g of creatinine or if the 24 hour protein excretion was >500 mg and neuropathy by elevated vibration perception threshold (≥20 V) on biothesiometry. RESULTS Out of 1,340 individuals with childhood and youth with T2DM, 53.3% of them were male. The mean age and duration of diabetes were 28.4 ± 10.4 and 7.4 ± 9.5 years respectively. Overall, the prevalence of dyslipidemia was 82.1%. Prevalence of hypercholesterolemia, hypertriglyceridemia, low HDL-C and high LDL-C were 40.7%, 52.8%, 59.1 % and 64.5% respectively. In logistic regression, both in unadjusted and adjusted model, hypercholesterolemia, and hypertriglyceridemia were associated with diabetic retinopathy [OR:1.8, CI:1.4-2.4, p<0.001 and 1.7, 1.3-2.2, p<0.001] and nephropathy [OR:1.7, CI:1.1-2.5, p=0.015 and 1.8, 1.2-2.8, p=0.007]. Additionally, hypercholesterolemia was associated with neuropathy, even after adjusting for age at diagnosis of diabetes and glycated hemoglobin [OR1.6, 1.0-2.5, p=0.041]. CONCLUSIONS Lipid abnormalities are common and associated with microvascular complications among these T2DM individuals. This underscores the need for effective control of lipids among childhood and youth onset T2DM.
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Affiliation(s)
- A Amutha
- Scientist, Madras Diabetes Research Foundation, Chennai, Tamil Nadu
| | - R Pradeepa
- Senior Scientist,Madras Diabetes Research Foundation, Chennai, Tamil Nadu
| | - K S Chella
- Senior Research Officer,Madras Diabetes Research Foundation, Chennai, Tamil Nadu
| | - R M Anjana
- Vice President and Managing Director, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu
| | - R Unnikrishnan
- Vice Chairman, Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu
| | - V Mohan
- President, Madras Diabetes Research Foundation and Chairman, Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu
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Ayyappa KA, Shatwan I, Bodhini D, Bramwell LR, Ramya K, Sudha V, Anjana RM, Lovegrove JA, Mohan V, Radha V, Vimaleswaran KS. High fat diet modifies the association of lipoprotein lipase gene polymorphism with high density lipoprotein cholesterol in an Asian Indian population. Nutr Metab (Lond) 2017; 14:8. [PMID: 28115978 PMCID: PMC5247808 DOI: 10.1186/s12986-016-0155-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/17/2016] [Indexed: 01/11/2023] Open
Abstract
Background Single nucleotide polymorphisms (SNPs) in lipoprotein lipase gene (LPL) have been shown to influence metabolism related to lipid phenotypes. Dietary factors have been shown to modify the association between LPL SNPs and lipids; however, to date, there are no studies in South Asians. Hence, we tested for the association of four common LPL SNPs with plasma lipids and examined the interactions between the SNPs and dietary factors on lipids in 1,845 Asian Indians. Methods The analysis was performed in 788 Type 2 diabetes cases and 1,057 controls randomly chosen from the cross-sectional Chennai Urban Rural Epidemiological Study. Serum triacylglycerol (TAG), serum total cholesterol, and high-density lipoprotein cholesterol (HDL-C) were measured using a Hitachi-912 autoanalyzer (Roche Diagnostics GmbH, Mannheim, Germany). Dietary intake was assessed using a semi-quantitative food frequency questionnaire. The SNPs (rs1121923, rs328, rs4922115 and rs285) were genotyped by polymerase chain reaction followed by restriction enzyme digestion and 20% of samples were sequenced to validate the genotypes obtained. Statistical Package for Social Sciences for Windows version 22.0 (SPSS, Chicago, IL) was used for statistical analysis. Results After correction for multiple testing and adjusting for potential confounders, SNPs rs328 and rs285 showed association with HDL-C (P = 0.0004) and serum TAG (P = 1×10−5), respectively. The interaction between SNP rs1121923 and fat intake (energy %) on HDL-C (P = 0.003) was also significant, where, among those who consumed a high fat diet (28.4 ± 2.5%), the T allele carriers (TT + XT) had significantly higher HDL-C concentrations (P = 0.0002) and 30% reduced risk of low HDL-C levels compared to the CC homozygotes. None of the interactions on other lipid traits were statistically significant. Conclusion Our findings suggest that individuals carrying T allele of the SNP rs1121923 have increased HDL-C levels when consuming a high fat diet compared to CC homozygotes. Our finding warrants confirmation in prospective studies and randomized controlled trials. Electronic supplementary material The online version of this article (doi:10.1186/s12986-016-0155-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K A Ayyappa
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Kallam Anji Reddy Centre, Plot no. 20, Golden Jubilee Biotech Park for Women Society, SIPCOT-IT PARK, Siruseri, Chennai 603 103 India.,Present Address: Department of Biotechnology, School of Chemical & Biotechnology, SASTRA University, Tanjore, India
| | - I Shatwan
- Department of Food and Nutritional Sciences, Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), University of Reading, Whiteknights, PO Box 226, Reading, RG6 6AP UK.,Food and Nutrition Department, Faculty of Home Economics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - D Bodhini
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Kallam Anji Reddy Centre, Plot no. 20, Golden Jubilee Biotech Park for Women Society, SIPCOT-IT PARK, Siruseri, Chennai 603 103 India
| | - L R Bramwell
- Department of Food and Nutritional Sciences, Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), University of Reading, Whiteknights, PO Box 226, Reading, RG6 6AP UK
| | - K Ramya
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Kallam Anji Reddy Centre, Plot no. 20, Golden Jubilee Biotech Park for Women Society, SIPCOT-IT PARK, Siruseri, Chennai 603 103 India
| | - V Sudha
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, India
| | - R M Anjana
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, India.,Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, Chennai, India
| | - J A Lovegrove
- Department of Food and Nutritional Sciences, Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), University of Reading, Whiteknights, PO Box 226, Reading, RG6 6AP UK
| | - V Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, India.,Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, Chennai, India
| | - V Radha
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Kallam Anji Reddy Centre, Plot no. 20, Golden Jubilee Biotech Park for Women Society, SIPCOT-IT PARK, Siruseri, Chennai 603 103 India
| | - K S Vimaleswaran
- Department of Food and Nutritional Sciences, Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), University of Reading, Whiteknights, PO Box 226, Reading, RG6 6AP UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Vimaleswaran KS, Bodhini D, Lakshmipriya N, Ramya K, Anjana RM, Sudha V, Lovegrove JA, Kinra S, Mohan V, Radha V. Erratum to: Interaction between FTO gene variants and lifestyle factors on metabolic traits in an Asian Indian population. Nutr Metab (Lond) 2016; 13:41. [PMID: 27303438 PMCID: PMC4906905 DOI: 10.1186/s12986-016-0100-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Karani S Vimaleswaran
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading, Reading, UK
| | - Dhanasekaran Bodhini
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India
| | - N Lakshmipriya
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, India
| | - K Ramya
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India
| | - R Mohan Anjana
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India ; Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, India ; Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, Chennai, India
| | - Vasudevan Sudha
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, India
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading, Reading, UK
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Viswanathan Mohan
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India ; Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, India ; Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, Chennai, India
| | - Venkatesan Radha
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India
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Vimaleswaran KS, Bodhini D, Lakshmipriya N, Ramya K, Anjana RM, Sudha V, Lovegrove JA, Kinra S, Mohan V, Radha V. Interaction between FTO gene variants and lifestyle factors on metabolic traits in an Asian Indian population. Nutr Metab (Lond) 2016; 13:39. [PMID: 27274759 PMCID: PMC4891824 DOI: 10.1186/s12986-016-0098-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/11/2016] [Indexed: 11/27/2022] Open
Abstract
Background Lifestyle factors such as diet and physical activity have been shown to modify the association between fat mass and obesity–associated (FTO) gene variants and metabolic traits in several populations; however, there are no gene-lifestyle interaction studies, to date, among Asian Indians living in India. In this study, we examined whether dietary factors and physical activity modified the association between two FTO single nucleotide polymorphisms (rs8050136 and rs11076023) (SNPs) and obesity traits and type 2 diabetes (T2D). Methods The study included 734 unrelated T2D and 884 normal glucose-tolerant (NGT) participants randomly selected from the urban component of the Chennai Urban Rural Epidemiology Study (CURES). Dietary intakes were assessed using a validated interviewer administered semi-quantitative food frequency questionnaire (FFQ). Physical activity was based upon the self-report. Interaction analyses were performed by including the interaction terms in the linear/logistic regression model. Results There was a significant interaction between SNP rs8050136 and carbohydrate intake (% energy) (Pinteraction = 0.04), where the ‘A’ allele carriers had 2.46 times increased risk of obesity than those with ‘CC’ genotype (P = 3.0 × 10−5) among individuals in the highest tertile of carbohydrate intake (% energy, 71 %). A significant interaction was also observed between SNP rs11076023 and dietary fibre intake (Pinteraction = 0.0008), where individuals with AA genotype who are in the 3rd tertile of dietary fibre intake had 1.62 cm lower waist circumference than those with ‘T’ allele carriers (P = 0.02). Furthermore, among those who were physically inactive, the ‘A’ allele carriers of the SNP rs8050136 had 1.89 times increased risk of obesity than those with ‘CC’ genotype (P = 4.0 × 10−5). Conclusions This is the first study to provide evidence for a gene-diet and gene-physical activity interaction on obesity and T2D in an Asian Indian population. Our findings suggest that the association between FTO SNPs and obesity might be influenced by carbohydrate and dietary fibre intake and physical inactivity. Further understanding of how FTO gene influences obesity and T2D through dietary and exercise interventions is warranted to advance the development of behavioral intervention and personalised lifestyle strategies, which could reduce the risk of metabolic diseases in this Asian Indian population. Electronic supplementary material The online version of this article (doi:10.1186/s12986-016-0098-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karani S Vimaleswaran
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading, Reading, UK
| | - Dhanasekaran Bodhini
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India
| | - N Lakshmipriya
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, India
| | - K Ramya
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India
| | - R Mohan Anjana
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India ; Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, India ; Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, Chennai, India
| | - Vasudevan Sudha
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, India
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading, Reading, UK
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Viswanathan Mohan
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India ; Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, India ; Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, Chennai, India
| | - Venkatesan Radha
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India
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Anjana RM, Amutha A, Mohan V. Regularity of follow-up, glycemic burden, and risk of microvascular complications in patients with type 2 diabetes: a 9-year follow-up study : Reply to Dr. Tasci et al. Acta Diabetol 2016; 53:131-2. [PMID: 26063175 DOI: 10.1007/s00592-015-0758-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 04/12/2015] [Indexed: 01/21/2023]
Affiliation(s)
- R M Anjana
- Madras Diabetes Research Foundation, Chennai, India
| | - A Amutha
- Madras Diabetes Research Foundation, Chennai, India
| | - V Mohan
- Madras Diabetes Research Foundation, Chennai, India.
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Ranjani H, Weber MB, Anjana RM, Lakshmi N, Narayan KMV, Mohan V. Recruitment challenges in a diabetes prevention trial in a low- and middle-income setting. Diabetes Res Clin Pract 2015; 110:51-59. [PMID: 26321102 DOI: 10.1016/j.diabres.2015.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/02/2015] [Accepted: 07/27/2015] [Indexed: 11/28/2022]
Abstract
AIM To describe recruitment challenges in a randomized controlled translational trial (RCTT) of diabetes prevention in India. METHODS The Diabetes Community Lifestyle Improvement Program (D-CLIP) is a RCTT, comparing standard of care to a step-wise model of diabetes prevention. Overweight adults with prediabetes were identified through a two-step screening process (1) field-based screening: minimal testing with a random capillary glucose measurement and (2) clinic-based screening including an Oral Glucose Tolerance Test (OGTT). RESULTS Individuals from the community (n=19377) were screened at residential locations, offices, educational institutions, places of worship, parks and beaches. Of these, 3535 (18.2%) 'high-risk' participants based on capillary glucose values were eligible for step 2 screening with OGTT. However, only 21.5% participated. An additional 521 participants directly entered step 2 via direct referrals from our clinical/research databases, study participant referrals and targeted advertisements. Of the 1285 individuals who underwent an OGTT, 710 (55.3%) were eligible for randomization, and 602 (84.8%) were randomized into the trial. The ratio of participants entering from step 1 to step 2 was 25:1 (3.9%) and from step 2 to randomization 2:1 (47%). Average staff time for recruitment was 350 h per week for an 11-person team. CONCLUSIONS Nearly 55 people needed to be screened with a questionnaire plus capillary glucose test to randomize one participant with prediabetes. Using a 2-step strategy requires additional staff time, but considerably reduces the need for OGTT's, thereby minimizing participant burden and study costs.
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Affiliation(s)
- H Ranjani
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India.
| | - M B Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - R M Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - N Lakshmi
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - V Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
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Anjana RM, Ranjani H, Unnikrishnan R, Weber MB, Mohan V, Narayan KMV. Exercise patterns and behaviour in Asian Indians: data from the baseline survey of the Diabetes Community Lifestyle Improvement Program (D-CLIP). Diabetes Res Clin Pract 2015; 107:77-84. [PMID: 25458336 DOI: 10.1016/j.diabres.2014.09.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 08/06/2014] [Accepted: 09/16/2014] [Indexed: 12/01/2022]
Abstract
AIMS This paper attempts to describe the patterns of exercise and the perceived benefits and barriers to exercise in an urban south Indian population. METHODS Study participants were recruited from the baseline survey of the D-CLIP (Diabetes Community Lifestyle Improvement Program). Frequency, duration, type and location of exercise were assessed using a questionnaire, while a Likert type scale was used to assess perceived benefits of and barriers to exercise. Quality of life was measured using the EQ-5D. RESULTS Out of 1281 participants (63.7% males), 24.1% reported doing ≥150min of exercise/week ("exercisers") compared to 75.9% "non-exercisers". Exercisers were significantly older (47 vs. 43 years), better educated (68.8% vs. 60%), had a higher monthly income (41% vs. 29.2%), consumed more fruits (38.2% vs. 25.6%) and vegetables (84.1% vs. 77.7%) and had better perceived state of health (81.1% vs. 76.8%), compared to non-exercisers. Exercisers had significantly lower HOMA-IR, higher Matsuda index and lower prevalence of low HDL cholesterol compared to non-exercisers. However, there were no significant differences in cardio-metabolic risk factors like diabetes, hypertension and obesity between the two groups. Walking was the most common type of exercise. Both exercisers and non-exercisers perceived the benefits of exercising, but barriers weighed more heavily on exercise behaviour. CONCLUSIONS Urgent steps are needed to improve overall exercise levels in India by addressing barriers and improving the quality of exercise performed so as to enhance overall metabolic health.
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Affiliation(s)
- R M Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India.
| | - H Ranjani
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - R Unnikrishnan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - M B Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - V Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Pradeepa R, Surendar J, Indulekha K, Chella S, Anjana RM, Mohan V. Association of serum adiponectin with diabetic microvascular complications among south Indian type 2 diabetic subjects - (CURES-133). Clin Biochem 2014; 48:33-8. [PMID: 25445230 DOI: 10.1016/j.clinbiochem.2014.10.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/20/2014] [Accepted: 10/23/2014] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To assess the association of serum adiponectin and microvascular complications of diabetes in an urban south Indian type 2 diabetic population. DESIGN AND METHODS Diabetic subjects [n=487] were included from Chennai Urban Rural Epidemiology Study (CURES). Four-field stereo retinal color photography was done and diabetic retinopathy (DR) was classified as non-proliferative DR (NPDR) or proliferative DR (PDR) according to the Early Treatment Diabetic Retinopathy Study grading system. Sight threatening DR (STDR) was defined as the presence of NPDR with diabetic macular edema, and/or PDR. Neuropathy was diagnosed if vibratory perception threshold of the great toe using biothesiometry exceeded ≥20V. Nephropathy was diagnosed if urinary albumin excretion (UAE) was ≥30μg/mg creatinine. Serum total adiponectin levels were measured by radioimmunoassay. RESULTS Subjects with any microvascular complications had significantly higher levels of adiponectin levels compared to those without the complications (geometric mean: 6.1 vs. 5.3μg/mL, p=0.004). The adiponectin level was significantly higher in subjects with DR (6.8 vs. 5.5μg/mL, p=0.004) and neuropathy (5.6 vs. 6.5μg/mL, p=0.024) compared to those without. Adiponectin levels were not significantly different in subjects with and without nephropathy. Serum adiponectin levels increased with the severity of DR [No DR - 5.5μg/mL; NPDR without DME - 6.5μg/mL; STDR - 8.3μg/mL, p=0.001]. Regression analysis revealed adiponectin to be associated with microvascular disease (presence of neuropathy and/or retinopathy and/or nephropathy) (OR: 1.44, 95% CI: 1.01-2.06, p=0.049) even after adjusting for age, gender, BMI, HbA1c, diabetes of duration, serum cholesterol and triglycerides, hypertension and medication status. CONCLUSION In Asian Indians with type 2 diabetes, serum adiponectin levels are associated with microvascular complications and also with the severity of retinopathy.
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Affiliation(s)
- R Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention & Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - J Surendar
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention & Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - K Indulekha
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention & Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - S Chella
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention & Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - R M Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention & Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - V Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention & Control, IDF Centre of Education, Gopalapuram, Chennai, India.
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Kesavadev J, Sadikot S, Wangnoo S, Kannampilly J, Saboo B, Aravind SR, Kalra S, Makkar BM, Maji D, Saikia M, Anjana RM, Rajput R, Singh SK, Shah S, Dhruv U, Vishwanathan V. Consensus guidelines for glycemic monitoring in type 1/type 2 & GDM. Diabetes Metab Syndr 2014; 8:187-195. [PMID: 25200925 DOI: 10.1016/j.dsx.2014.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Stringent monitoring of blood glucose in diabetes plays an important role as the treatment of the disease itself. Blood glucose monitoring (BGM) strategies such as measurement of Hb1Ac, Self-Monitoring of Blood Glucose (SMBG) and Continuous Glucose Monitoring (CGM) plays a vital role in achieving the important goal of preventing long term complications of diabetes. Although the use of BGM is recommended by various international guidelines in T1DM and T2DM, there is no consensus on the utility of BGM in India. So, there is a need to develop a guidance for uniform monitoring mechanism among the care givers taking into account the variations and challenges that are unique to Indian population. A committee was established that comprised of physicians, researchers and other healthcare professionals having expertise in diabetes treatment to oversee the formulation of guidelines on different monitoring and treatment aspects of diabetes. Extensive literature searches were conducted to identify and analyze the evidence available on BGM. An initial draft of BGM guidelines was presented to core members who discussed the subject matter and presented their opinion. This was then taken to wider expert audience to invite their comments that were incorporated in the initial draft. The first compilation was presented at a conference attended by nearly 200 experts. Again, their opinion was sought and the next version was prepared which was sent to core committee members for the final inputs. The Indian consensus guideline on BGM using Hb1Ac, SMBG and CGM as the primary tools was then finalized.
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Indulekha K, Surendar J, Anjana RM, Gokulakrishnan K, Balasubramanyam M, Aravindhan V, Mohan V. Circulating levels of high molecular weight (HMW) adiponectin and total adiponectin in relation to fat distribution, oxidative stress and inflammation in Asian Indians. Dis Markers 2013; 33:185-92. [PMID: 22960344 PMCID: PMC3810689 DOI: 10.3233/dma-2012-0924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: To look at the association of total and high molecular weight (HMW) adiponectin with markers of fat distribution, oxidative stress and inflammation in Asian Indians. Methods: A total of 120 subjects were chosen randomly from Chennai Urban Rural Epidemiological Study. Fasting HMW adiponectin levels, TNF-alpha and oxidized LDL were measured using ELISA. High sensitivity C reactive protein (hsCRP) was measured by a high sensitive nephelometric assay. Lipid peroxidation was measured by Tbars assay and protein carbonyl content was assessed by DNPH assay. Visceral and subcutaneous fat areas were assessed by computed tomography (CT) scan. When stratified based on the tertiles of visceral fat, the levels of total (p = 0.03) and HMW adiponectin (p = 0.007) were highest in the first tertile followed by tertiles 2 and 3 whereas in tertiles of subcutaneous fat, there was no such trend. With increasing tertiles of Tbars, the levels of total (p = 0.03) and HMW adiponectin decreased (p = 0.002). The levels of HMW (p < 0.001) but not total adiponectin was also found to decrease with increasing tertiles of Protein carbonyl content. The levels of Total (p = 0.02) and HMW adiponectin (p = 0.004) were highest in the first tertile of oxidized LDL followed by tertile 2 and tertile 3. With increasing tertiles of TNF-alpha total (p = 0.01) and HMW adiponectin (p = 0.004) was found to decrease. With increasing tertiles of hs-CRP, Total (p = 0.005) and HMWadiponectin (p = 0.007)was found to decrease. Conclusion: Oxidative stress markers, visceral but not subcutaneous fat and inflammation are associated with total and HMW adiponectin levles in Asian Indians.
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Affiliation(s)
- K Indulekha
- Madras Diabetes Research Foundation and Dr.\ Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control, International Diabetes Federation Centre for Education, Gopalapuram, Chennai, India
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Shobana S, Krishnaswamy K, Sudha V, Malleshi NG, Anjana RM, Palaniappan L, Mohan V. Finger millet (Ragi, Eleusine coracana L.): a review of its nutritional properties, processing, and plausible health benefits. Adv Food Nutr Res 2013; 69:1-39. [PMID: 23522794 DOI: 10.1016/b978-0-12-410540-9.00001-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Finger millet or ragi is one of the ancient millets in India (2300 BC), and this review focuses on its antiquity, consumption, nutrient composition, processing, and health benefits. Of all the cereals and millets, finger millet has the highest amount of calcium (344mg%) and potassium (408mg%). It has higher dietary fiber, minerals, and sulfur containing amino acids compared to white rice, the current major staple in India. Despite finger millet's rich nutrient profile, recent studies indicate lower consumption of millets in general by urban Indians. Finger millet is processed by milling, malting, fermentation, popping, and decortication. Noodles, vermicilli, pasta, Indian sweet (halwa) mixes, papads, soups, and bakery products from finger millet are also emerging. In vitro and in vivo (animal) studies indicated the blood glucose lowering, cholesterol lowering, antiulcerative, wound healing properties, etc., of finger millet. However, appropriate intervention or randomized clinical trials are lacking on these health effects. Glycemic index (GI) studies on finger millet preparations indicate low to high values, but most of the studies were conducted with outdated methodology. Hence, appropriate GI testing of finger millet preparations and short- and long-term human intervention trials may be helpful to establish evidence-based health benefits.
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Affiliation(s)
- S Shobana
- Madras Diabetes Research Foundation, Gopalapuram, Chennai, India.
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Anjana RM. Reducing the risk of development of diabetes: do we have an answer? Natl Med J India 2012; 25:221-222. [PMID: 23278780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- R M Anjana
- Dr Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Gopalapuram, Chennai, Tamil Nadu
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Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, Bhansali A, Joshi SR, Joshi PP, Yajnik CS, Dhandhania VK, Nath LM, Das AK, Rao PV, Madhu SV, Shukla DK, Kaur T, Priya M, Nirmal E, Parvathi SJ, Subhashini S, Subashini R, Ali MK, Mohan V. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia 2011; 54:3022-7. [PMID: 21959957 DOI: 10.1007/s00125-011-2291-5] [Citation(s) in RCA: 457] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 07/28/2011] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS This study reports the results of the first phase of a national study to determine the prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in India. METHODS A total of 363 primary sampling units (188 urban, 175 rural), in three states (Tamilnadu, Maharashtra and Jharkhand) and one union territory (Chandigarh) of India were sampled using a stratified multistage sampling design to survey individuals aged ≥ 20 years. The prevalence rates of diabetes and prediabetes were assessed by measurement of fasting and 2 h post glucose load capillary blood glucose. RESULTS Of the 16,607 individuals selected for the study, 14,277 (86%) participated, of whom 13,055 gave blood samples. The weighted prevalence of diabetes (both known and newly diagnosed) was 10.4% in Tamilnadu, 8.4% in Maharashtra, 5.3% in Jharkhand, and 13.6% in Chandigarh. The prevalences of prediabetes (impaired fasting glucose and/or impaired glucose tolerance) were 8.3%, 12.8%, 8.1% and 14.6% respectively. Multiple logistic regression analysis showed that age, male sex, family history of diabetes, urban residence, abdominal obesity, generalised obesity, hypertension and income status were significantly associated with diabetes. Significant risk factors for prediabetes were age, family history of diabetes, abdominal obesity, hypertension and income status. CONCLUSIONS/INTERPRETATIONS We estimate that, in 2011, Maharashtra will have 6 million individuals with diabetes and 9.2 million with prediabetes, Tamilnadu will have 4.8 million with diabetes and 3.9 million with prediabetes, Jharkhand will have 0.96 million with diabetes and 1.5 million with prediabetes, and Chandigarh will have 0.12 million with diabetes and 0.13 million with prediabetes. Projections for the whole of India would be 62.4 million people with diabetes and 77.2 million people with prediabetes.
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Affiliation(s)
- R M Anjana
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, IDF Centre for Education, 4, Conran Smith Road, Gopalapuram, Chennai 600 086, India
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Shobana S, Kokila A, Lakshmipriya N, Subhashini S, Ramya Bai M, Mohan V, Malleshi NG, Anjana RM, Henry CJK, Sudha V. Glycaemic index of three Indian rice varieties. Int J Food Sci Nutr 2011; 63:178-83. [PMID: 21916534 DOI: 10.3109/09637486.2011.615300] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Three commonly consumed Indian rice varieties (Sona Masuri, Ponni and Surti Kolam) were tested for their glycaemic index (GI). Healthy volunteers were recruited and after an overnight fast were given a 50 g available carbohydrate portion of glucose (reference food) or different varieties of cooked rice (test foods) on separate occasions. The fasting as well as postprandial capillary blood glucose response was determined over 2 h, and the incremental area under the curve (IAUC) was calculated. The GI was calculated as the IAUC of the test food/IAUC of the reference food (glucose) × 100. The differences between the GI values for Sona Masuri (72.0 ± 4.5), Ponni (70.2 ± 3.6) and Surti Kolam (77.0 ± 4.0) rice varieties were non-significant (p = 0.606) and are all classified as high GI varieties of rice. There is an urgent need to study the GI of other commonly consumed rice varieties and to develop rice of a lower GI value.
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Affiliation(s)
- S Shobana
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-Communicable Diseases, International Diabetes Federation (IDF) Centre of Education, Gopalapuram, Chennai, India
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Ranjit Unnikrishnan I, Anjana RM, Mohan V. Importance of controlling diabetes early--the concept of metabolic memory, legacy effect and the case for early insulinisation. J Assoc Physicians India 2011; 59 Suppl:8-12. [PMID: 21818992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Most of the microvascular complications of diabetes are related to the degree and the length of exposure to hyperglycaemia. New data from the follow-up studies of the Diabetes Control and Complications Trial-the Epidemiology of Diabetes Intervention and Complications Study (DCCT-EDIC), and the United Kingdom Prospective Diabetes Study (UKPDS) emphasize the role of glycemic control early in the course of the disorder and its value in prevention of later complications. The phenomenon of ongoing beneficial effects on diabetic complications after a period of improved glycemic control even if followed by a return to usual (often poorer) metabolic control has been described as representing "metabolic memory" by the DCCT/EDIC investigators and as a "legacy effect" by the UKPDS investigators. This article reviews these concepts and explores the role of early use of insulin as a tool to achieve good glycemic control in type 2 diabetes.
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Affiliation(s)
- I Ranjit Unnikrishnan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, Prevention and Control, IDF Centre of Education, Chennai-600 086
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Gokulakrishnan K, Anjana RM, Indulekha K, Anuradha S, Mohan V. Association of hypoadiponectinemia with non-alcoholic fatty liver disease in urban south Indians--(CURES - 81). Indian J Med Res 2010; 132:271-277. [PMID: 20847373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND & OBJECTIVES Association between adiponectin and non-alcoholic fatty liver disease (NAFLD) has been reported in west. Studies in Indian population are lacking. This study was undertaken to assess the association of hypoadiponectinemia with NAFLD in Asian Indians. METHOD In this cross-sectional study, subjects were randomly selected from Phase 5 of the Chennai Urban Rural Epidemiology Study (CURES), an epidemiological study based on a representative population of Chennai in south India. One hundred twenty one subjects without NAFLD and 72 subjects with NAFLD were selected. NAFLD was diagnosed by ultrasonography. Serum adiponectin levels were measured using radioimmunoassay. Insulin resistance was calculated using Homeostasis Assessment model (HOMA-IR). RESULTS Serum adiponectin values were significantly lower in subjects with NAFLD compared to those without [5.6 μg/ml (95% Confidence Interval (CI) 5.0 - 6.3 μg/ml] vs 7.4 μg/ml (95% CI: 6.7 - 8.1 μg/ml, P<0.01). Adiponectin levels decreased with increasing severity of NAFLD. Subjects with moderate to severe steatosis had significantly lower adiponectin levels (5.1μg/ml, 95% CI: 4.1- 6.4 μg/ml) compared to subjects with mild steatosis (5.9 μg/ml, 95% CI: 5.0 - 6.9 μg/ml; P<0.001) and subjects without NAFLD (7.3 μg/ml, 95% CI: 6.6 - 8.0 μg/ml; P<0.01). Multiple logistic regression analysis revealed adiponectin to be negatively associated with NAFLD [Odds Ratio (OR): 0.865, 95% Confidence Interval (CI): 0.792- 0.944, P=0.001]. This remained statistically significant even after adjusting for confounding factors age, gender, body mass index, insulin resistance, waist circumference, total cholesterol, triglycerides and glucose intolerance (OR: 0.873, 95% CI: 0.793 - 0.961; P=0.005). INTERPRETATION & CONCLUSION NAFLD is associated with lower serum adiponectin levels independent of conventional cardiovascular risk factors in Asian Indians known to have high prevalence of diabetes and coronary artery disease.
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Affiliation(s)
- K Gokulakrishnan
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention & Control, Chennai, India
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Mohan V, Deepa M, Anjana RM, Lanthorn H, Deepa R. Incidence of diabetes and pre-diabetes in a selected urban south Indian population (CUPS-19). J Assoc Physicians India 2008; 56:152-157. [PMID: 18697630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Several cross-sectional studies have reported on the prevalence of diabetes in India. However, there are virtually no longitudinal population-based studies on the incidence of diabetes from India. The aim of the study was to determine the incidence of diabetes and prediabetes in an urban south Indian population. METHODS The Chennai Urban Population Study [CUPS], an ongoing epidemiological study in two residential colonies in Chennai [the largest city in southern India, formerly called Madras] was launched in 1996; the baseline study was completed in 1997. Follow-up examination was performed after a mean period of 8 years. At follow-up, 501 [47.0%] subjects had moved out of this colonies and were lost to follow-up. Of the remaining 564 individuals, 513 [90.9%] provided blood samples for biochemical analysis. Regression analysis was done using incident diabetes as dependant variable to identify factors associated with development of diabetes or pre-diabetes. RESULTS Among subjects with normal glucose tolerance (NGT) at baseline [n=476], 64 (13.4%) developed diabetes and 48 (10.1%) developed pre-diabetes (IGT or IFG). The incidence rate of diabetes was 20.2 per 1000 person years and that of pre-diabetes was 13.1 per 1000 person years among subjects with NGT. Of the 37 individuals who were pre-diabetic at baseline, 15 (40.5%) developed diabetes [incidence rate: 64.8 per 1000 person years], 16 (43.2%) remained as pre-diabetic and 6 (16.2%) reverted to normal during the follow-up period. Regression analysis revealed obesity [Odds Ratio (OR): 2.1, p=0.001], abdominal obesity [OR: 2.23, p<0.001] and hypertension [OR: 2.57, p<0.001] to be significantly associated with incident diabetes. The Indian Diabetes Risk Score (IDRS) showed the strongest association with incident diabetes [OR: 5.14, p<0.001]. CONCLUSION The study shows that the incidence of diabetes is very high among urban south Indians. While obesity, abdominal obesity and hypertension were associated with incident diabetes, IDRS was the strongest predictor of incident of diabetes in this population.
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Affiliation(s)
- V Mohan
- Madras Diabetes Research Foundation, India
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