Ranjit Mohan Anjana

Centre for IT Education, Bhubaneswar, Odisha, India

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Publications (89)230.14 Total impact

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    ABSTRACT: Measurement of physical activity in epidemiological studies requires tools which are reliable, valid and culturally relevant. We attempted to develop a physical activity questionnaire (PAQ) that would measure physical activity in various domains over a year and which would be valid for use in adults of different age groups with varying levels of activity in urban and rural settings in low and middle income countries like India. The present paper aims to assess the reliability and validity of this new PAQ- termed the Madras Diabetes Research Foundation- Physical Activity Questionnaire (MPAQ). The MPAQ was administered by trained interviewers to 543 individuals of either gender aged 20 years and above from urban and rural areas in 10 states of India from May to August 2011, followed by a repeat administration within a month for assessing reliability. Relative validity was performed against the Global Physical Activity Questionnaire (GPAQ). Construct validity was tested by plotting time spent in sitting and moderate and vigorous physical activity (MVPA) against body-mass index (BMI) and waist circumference. Criterion validity was assessed using the triaxial accelerometer, in a separate subset of 103 individuals. Bland and Altman plots were used to assess the agreement between MPAQ and accelerometer. The interclass correlation coefficients (ICC) for total energy expenditure and physical activity levels were 0.82 and 0.73 respectively, between baseline and 1st month. The ICC between GPAQ and the MPAQ was 0.40 overall. The construct validity of the MPAQ showed linear association between sitting and MVPA, and BMI and waist circumference independent of age and gender. The Spearman's correlation coefficients for sedentary activity, MVPA and overall PA for MPAQ against the accelerometer were 0.48 (95%CI-0.32-0.62), 0.44 (0.27-0.59) and 0.46 (0.29-0.60) respectively. Bland and Altman plots showed good agreement between MPAQ and accelerometer for sedentary behavior and fair agreement for MVPA. The MPAQ is an acceptable, reproducible and valid instrument, which captures data from multiple activity domains over the period of a year from adults of both genders and varying ages in various walks of life residing in urban and rural India.
    International Journal of Behavioral Nutrition and Physical Activity 12/2015; 12(1). DOI:10.1186/s12966-015-0196-2 · 3.68 Impact Factor
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    Goodarz Danaei, Saman Fahimi, Yuan Lu, Bin Zhou, Kaveh Hajifathalian, Mariachiara Di Cesare, Wei-Cheng Lo, Barbara Reis-Santos, Melanie J Cowan, Jonathan E Shaw, [...], Xiaoguang Yang, Xingwang Ye, Akihiro Yoshihara, Novie O Younger-Coleman, Sabina Zambon, Abdul Hamid Zargar, Tomasz Zdrojewski, Wenhua Zhao, Yingfeng Zheng, Majid Ezzati
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    ABSTRACT: Background Diabetes has been defined on the basis of different bio-markers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. Methods We used data from 96 population-based health examination surveys that had measured at least two of the bio-markers used for defining diabetes. Diabetes was defined using HbA1c (HbA1c ≥6·5% or history of diabetes diagnosis or using insulin or oral hypoglycemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG ≥7·0 mmol/L or 2hOGTT ≥11·1 mmol/L or history of diabetes or using insulin or oral hypoglycemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (i.e., excluding those with history of diabetes or using insulin or oral hypoglycemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0·98), but was higher by 2–6 percentage points at different prevalence levels. Prevalence based on HbA1c was lower than prevalence based on FPG in 42·8% of age–sex–survey groups and higher in another 41·6%; in the other 15·6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA1c-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, sub-national, or from specific communities. Diabetes defined as HbA1c 6·5% or more had a pooled sensitivity of 52·8% (95% CI 51·3–54·3%) and a pooled specificity of 99·74% (99·71–99·78%) compared with FPG 7·0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30·5% (28·7–32·3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA1c versus FPG. Interpretation Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA1c-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test.
    The Lancet Diabetes & Endocrinology 06/2015; DOI:10.1016/S2213-8587(15)00129-1 · 9.19 Impact Factor
  • R M Anjana, A Amutha, V Mohan
    Acta Diabetologica 06/2015; DOI:10.1007/s00592-015-0758-4 · 3.68 Impact Factor
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    ABSTRACT: India has the second largest number of people with diabetes in the world following China. Evidence indicates that consumption of whole grains can reduce the risk of type 2 diabetes. This article describes the study design and methods of a trial in progress evaluating the effects of substituting whole grain brown rice for polished (refined) white rice on biomarkers of diabetes risk (glucose metabolism, dyslipidemia, inflammation). This is a randomized controlled clinical trial with a crossover design conducted in Chennai, India among overweight but otherwise healthy volunteers aged 25–65 y with a body mass index ≥23 kg/m2 and habitual rice consumption ≥200 g/day. The feasibility and cultural appropriateness of this type of intervention in the local environment will also be examined. If the intervention is efficacious, the findings can be incorporated into national-level policies which could include the provision of brown rice as an option or replacement for white rice in government institutions and food programs. This relatively simple dietary intervention has the potential to substantially diminish the burden of diabetes in Asia and elsewhere.
    International Journal of Food Sciences and Nutrition 05/2015; DOI:10.3109/09637486.2015.1038225 · 1.20 Impact Factor
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    Dataset: NAFLD
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    ABSTRACT: We sought to evaluate the contribution of various modifiable risk factors to the partial population attributable risk (PARp) for diabetes in an Asian Indian population. Of a cohort of 3589 individuals, representative of Chennai, India, followed up after a period of ten years, we analyzed data from 1376 individuals who were free of diabetes at baseline. A diet risk score was computed incorporating intake of refined cereals, fruits and vegetables, dairy products, and monounsaturated fatty acid. Abdominal obesity was found to contribute the most to incident diabetes [Relative Risk (RR) 1.63(95%CI 1.21-2.20)]; (PARp 41.1% (95%CI 28.1-52.6)]. The risk for diabetes increased with increasing quartiles of the diet risk score [highest quartile RR 2.14(95% CI 1.26-3.63)] and time spent viewing television [(RR 1.84(95%CI 1.36-2.49] and sitting [(RR 2.09(95%CI 1.42-3.05)]. The combination of five risk factors (obesity, physical inactivity, unfavorable diet risk score, hypertriglyceridemia and low HDL cholesterol) could explain 80.7% of all incident diabetes (95%CI 53.8-92.7). Modifying these easily identifiable risk factors could therefore prevent the majority of cases of incident diabetes in the Asian Indian population. Translation of these findings into public health practice will go a long way in arresting the progress of the diabetes epidemic in this region. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Diabetes research and clinical practice 05/2015; DOI:10.1016/j.diabres.2015.05.039 · 2.54 Impact Factor
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    ABSTRACT: To investigate insulin sensitivity and insulin secretion patterns among Asian Indian youth without and with type 2 diabetes (T2DM-y defined as onset of diabetes at or below 25years) with normal and high visceral fat (VF) levels. We recruited 74 T2DM-y individuals, within 18 months of diagnosis and compared them to 77 age-matched controls with normal glucose tolerance (NGT). Using L4/L5 abdominal CT images, VF levels were categorized as normal or high according to their median values. Oral glucose tolerance tests (glucose and insulin measures) were used to derive Matsuda index, insulin resistance (HOMA-IR) and oral disposition index (DIo). Relationships between measures of insulin sensitivity and secretion and T2DM-y by VF level were assessed using standardized multinomial regression models. Participants were categorized into four groups: NGT-normal VF; NGT-high VF; T2DM-normal VF, and T2DM-high VF. Among NGTs, those with high VF had significantly lower insulin sensitivity (0.013 vs.0.019pM(-1)) and Matsuda index (10.2 vs.13.8), than normal VF. When compared, T2DM-high VF had lowest insulin sensitivity (0.009 vs.0.019, 0.013, 0.012pM-1; p<0.001), Matsuda index (6.4 vs. 13.8, 10.2, 8.6; p<0.001), OGIS120 (305 vs. 396, 382, 316; p<0.001) and DIo (0.48 vs. 3.75, 3.20, 0.55mmol/L; p<0.001). At every category of 2h PG values, NGT-high VF had lower DIo than NGT-normal VF participants. In standardized multinomial models, that included DIo and Matsuda index adjusted for age, gender, BMI, and leptin, DIo (Odds ratio: 0.001; 95%Confidence interval: 0.000-0.020), matsuda index (0.26; 0.07-0.93), age (2.92; 1.18-7.19) and leptin (3.17; 1.12-8.99) were associated with high VF among T2DM. Lower DIo and Matsuda index, younger age and higher leptin were independently associated with high visceral fat among T2DM participants. Also, lower DIo was seen with increasing 2h PG values even among normal glucose tolerant individuals. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Diabetes research and clinical practice 05/2015; DOI:10.1016/j.diabres.2015.05.018 · 2.54 Impact Factor
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    ABSTRACT: Reduced muscular strength, as measured by grip strength, has been associated with an increased risk of all-cause and cardiovascular mortality. Grip strength is appealing as a simple, quick, and inexpensive means of stratifying an individual's risk of cardiovascular death. However, the prognostic value of grip strength with respect to the number and range of populations and confounders is unknown. The aim of this study was to assess the independent prognostic importance of grip strength measurement in socioculturally and economically diverse countries. The Prospective Urban-Rural Epidemiology (PURE) study is a large, longitudinal population study done in 17 countries of varying incomes and sociocultural settings. We enrolled an unbiased sample of households, which were eligible if at least one household member was aged 35-70 years and if household members intended to stay at that address for another 4 years. Participants were assessed for grip strength, measured using a Jamar dynamometer. During a median follow-up of 4·0 years (IQR 2·9-5·1), we assessed all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, myocardial infarction, stroke, diabetes, cancer, pneumonia, hospital admission for pneumonia or chronic obstructive pulmonary disease (COPD), hospital admission for any respiratory disease (including COPD, asthma, tuberculosis, and pneumonia), injury due to fall, and fracture. Study outcomes were adjudicated using source documents by a local investigator, and a subset were adjudicated centrally. Between January, 2003, and December, 2009, a total of 142 861 participants were enrolled in the PURE study, of whom 139 691 with known vital status were included in the analysis. During a median follow-up of 4·0 years (IQR 2·9-5·1), 3379 (2%) of 139 691 participants died. After adjustment, the association between grip strength and each outcome, with the exceptions of cancer and hospital admission due to respiratory illness, was similar across country-income strata. Grip strength was inversely associated with all-cause mortality (hazard ratio per 5 kg reduction in grip strength 1·16, 95% CI 1·13-1·20; p<0·0001), cardiovascular mortality (1·17, 1·11-1·24; p<0·0001), non-cardiovascular mortality (1·17, 1·12-1·21; p<0·0001), myocardial infarction (1·07, 1·02-1·11; p=0·002), and stroke (1·09, 1·05-1·15; p<0·0001). Grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure. We found no significant association between grip strength and incident diabetes, risk of hospital admission for pneumonia or COPD, injury from fall, or fracture. In high-income countries, the risk of cancer and grip strength were positively associated (0·916, 0·880-0·953; p<0·0001), but this association was not found in middle-income and low-income countries. This study suggests that measurement of grip strength is a simple, inexpensive risk-stratifying method for all-cause death, cardiovascular death, and cardiovascular disease. Further research is needed to identify determinants of muscular strength and to test whether improvement in strength reduces mortality and cardiovascular disease. Full funding sources listed at end of paper (see Acknowledgments). Copyright © 2015 Elsevier Ltd. All rights reserved.
    The Lancet 05/2015; DOI:10.1016/S0140-6736(14)62000-6 · 45.22 Impact Factor
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    ABSTRACT: Betatrophin is emerging as a marker for compensatory beta cell proliferation. While betatrophin has been mainly investigated in adults, there is a lack of data on betatrophin levels in youth-onset type 2 diabetes mellitus (T2DM-Y). The aim of this study was to determine levels of betatrophin and its association with T2DM-Y in Asian Indian participants. We recruited 100 individuals with normal glucose tolerance (NGT; n=50) and newly-diagnosed cases (within 18 months of first diagnosis) of T2DM-Y (n=50) with onset between 12 and 24 years of age from a large tertiary diabetes center in Chennai in southern India. Insulin resistance was measured by homeostatic model (HOMA-IR) and insulin secretion by oral disposition index (DIO). Betatrophin levels were measured by enzyme-linked immunosorbent assay. Betatrophin levels were significantly lower in the T2DM-Y group compared with the NGT group (803 vs 1104pg/ml, p<0.001). Betatrophin showed a significant inverse correlation with waist circumference (p=0.035), HOMA-IR (p<0.001), fasting and 2h postprandial glucose (p<0.01), glycated hemoglobin (p=0.019) and a positive correlation with fasting C-peptide (p<0.001) and DIO (p=0.012). In regression analysis, betatrophin was independently associated with T2DM-Y even after adjustment for age, gender, and waist circumference (OR per standard deviation: 0.562, 95% CI: 0.342-0.899, p=0.019). However, the association was lost when HOMA-IR was included in the model (OR: 1.141, 95% CI: 0.574-2.249; p=0.646). Betatrophin levels are lower in T2DM-Y and this association is likely mediated through insulin resistance. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Diabetes research and clinical practice 05/2015; DOI:10.1016/j.diabres.2015.04.028 · 2.54 Impact Factor
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    ABSTRACT: The aim of the study was to evaluate usefulness of capillary blood glucose (CBG) for diagnosis of gestational diabetes mellitus (GDM) in resource-constrained settings where venous plasma glucose (VPG) estimations may be impossible. Consecutive pregnant women (n = 1031) attending antenatal clinics in southern India underwent 75-g oral glucose tolerance test (OGTT). Fasting, 1- and 2-h VPG (AU2700 Beckman, Fullerton, CA) and CBG (One Touch Ultra-II, LifeScan) were simultaneously measured. Sensitivity and specificity were estimated for different CBG cut points using the International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria for the diagnosis of GDM as gold standard. Bland-Altman plots were drawn to look at the agreement between CBG and VPG. Correlation and regression equation analysis were also derived for CBG values. Pearson's correlation between VPG and CBG for fasting was r = 0.433 [intraclass correlation coefficient (ICC) = 0.596, p < 0.001], for 1H, it was r = 0.653 (ICC = 0.776, p < 0.001), and for 2H, r = 0.784 (ICC = 0.834, p < 0.001). Comparing a single CBG 2-h cut point of 140 mg/dl (7.8 mmol/l) with the IADPSG criteria, the sensitivity and specificity were 62.3 and 80.7 %, respectively. If CBG cut points of 120 mg/dl (6.6 mmol/l) or 110 mg/dl (6.1 mmol/l) were used, the sensitivity improves to 78.3 and 92.5 %, respectively. In settings where VPG estimations are not possible, CBG can be used as an initial screening test for GDM, using lower 2H CBG cut points to maximize the sensitivity. Those who screen positive can be referred to higher centers for definitive testing, using VPG.
    Acta Diabetologica 04/2015; DOI:10.1007/s00592-015-0761-9 · 3.68 Impact Factor
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    ABSTRACT: There is little data on the incidence rates of diabetes and prediabetes (dysglycemia) in Asian Indians. This article presents the incidence of diabetes and prediabetes and the predictors of progression in a population-based Asian Indian cohort. Data on progression to diabetes and prediabetes from 1,376 individuals, a subset of 2,207 of the Chennai Urban Rural Epidemiology Study (CURES) cohort with normal glucose tolerance (NGT) or prediabetes at baseline, who were followed for a median of 9.1 years (11,629 person-years), are presented. During follow-up, 534 died and 1,077 with NGT and 299 with prediabetes at baseline were reinvestigated in a 10-year follow-up study. Diabetes and prediabetes were diagnosed based on the American Diabetes Association criteria. Incidence rates were calculated and predictors of progression to prediabetes and/or diabetes were estimated using the Cox proportional hazards model. The incidence of diabetes, prediabetes, and "any dysglycemia" were 22.2, 29.5, and 51.7 per 1,000 person-years, respectively. Among those with NGT, 19.4% converted to diabetes and 25.7% to prediabetes, giving an overall conversion rate to dysglycemia of 45.1%. Among those with prediabetes, 58.9% converted to diabetes. Predictors of progression to dysglycemia were advancing age, family history of diabetes, 2-h plasma glucose, glycated hemoglobin (HbA1c), low HDL cholesterol, and physical inactivity. Asian Indians have one of the highest incidence rates of diabetes, with rapid conversion from normoglycemia to dysglycemia. Public health interventions should target modifiable risk factors to slow down the diabetes epidemic in this population. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
    Diabetes care 04/2015; DOI:10.2337/dc14-2814 · 8.57 Impact Factor
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    ABSTRACT: To assess the prevalence of diabetes and prediabetes and the associated risk factors in two Asian Indian populations living in different environments. We performed cross-sectional analyses, using representative samples of 2,305 Asian Indians aged 40-84 years living in Chennai, India, from the Centre for cArdiometabolic Risk Reduction in South-Asia study (CARRS) (2010-2011), and 757 Asian Indians aged 40-84 years living in the greater San Francisco and Chicago areas from the U.S. Mediators of Atherosclerosis in South Asians Living in America (MASALA) study (2010-2013). Diabetes was defined as self-reported use of glucose-lowering medication, fasting glucose ≥126 mg/dL, or 2-h glucose ≥200 mg/dL. Prediabetes was defined as fasting glucose 100-125 mg/dL and/or 2-h glucose 140-199 mg/dL. Age-adjusted diabetes prevalence was higher in India (38% [95% CI 36-40]) than in the U.S. (24% [95% CI 21-27]) Age-adjusted prediabetes prevalence was lower in India (24% [95% CI 22-26]) than the U.S. (33% [95% CI 30-36]). After adjustment for age, sex, waist circumference, and systolic blood pressure, living in the U.S. was associated with an increased odds for prediabetes (odds ratio 1.2 [95% CI 9.9-1.5]) and a decreased odds for diabetes (odds ratio 0.5 [95% CI 0.4-0.6]). These findings indicate possible changes in the relationship between migration and diabetes risk and highlight the growing burden of disease in urban India. Additionally, these results call for longitudinal studies to better identify the gene-environment-lifestyle exposures that underlie the elevated risk for type 2 diabetes development in Asian Indians. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
    Diabetes care 04/2015; DOI:10.2337/dc15-0032 · 8.57 Impact Factor
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    ABSTRACT: To assess the prevalence of metabolic syndrome (MetS) among patients with type 1 diabetes mellitus(T1DM) and to look at prevalence of diabetes complications in T1DM with and without MetS. We studied 451 T1DM patients attending a tertiary diabetes centre in Chennai, South India. T1DM was diagnosed based on absence of beta cell reserve and requirement of insulin from the time of diagnosis. Data on clinical and biochemical characteristics as well as complications details to study the prevalence were also extracted from electronic records. T1DM patients were divided into those with and without MetS[diagnosed according to the harmonizing the metabolic syndrome criteria(IDF/NHLBI/AHA/WHF/IAS/IASO)]. The overall prevalence of MetS among T1DM was 22.2%(100/451). Patients with MetS were older, had longer diabetes duration, acanthosis nigricans, and increased serum cholesterol. In the unadjusted logistic regression analysis, retinopathy, nephropathy and neuropathy were associated with MetS. However after adjustment for age, gender, diabetes duration, HbA1C and BMI significant association was seen only between MetS and retinopathy [odds ratio (OR) 2.82, 95% CI 1.18-6.74, p=0.020] and nephropathy [OR 4.92, 95% CI 2.59-9.33, p<0.001]. Prevalence of MetS is high among Asian Indian T1DM patients, and its presence is associated with increased risk of diabetic retinopathy and nephropathy. Copyright © 2015. Published by Elsevier Inc.
    Journal of Diabetes and its Complications 04/2015; 29(5). DOI:10.1016/j.jdiacomp.2015.03.014 · 1.93 Impact Factor
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    ABSTRACT: Background: This study examined the association in a South Indian population with gestational diabetes mellitus (GDM) of type 2 diabetes risk variants that have previously conferred susceptibility to GDM in other populations. Subjects and Methods: The study groups comprised 518 women with GDM and 910 pregnant women with normal glucose tolerance (NGT). Women with GDM were recruited from a tertiary diabetes center in Chennai, in south India, and NGT women were selected from antenatal clinics also in Chennai. Genomic DNA was isolated from whole blood using the phenol chloroform method. Twelve previously reported GDM-associated single nucleotide polymorphisms (SNPs) in or near nine loci were genotyped using the MassARRAY™ system (Sequenom, San Diego, CA). Results: Among the 12 SNPs genotyped, 11 SNPs were in Hardy-Weinberg equilibrium and had a call rate of >95%. Of the 11 SNPs previously associated with GDM in other populations, significant association was observed only with the rs7754840 and rs7756992 SNPs of the CDK5 regulatory subunit associated protein 1-like 1 (CDKAL1) gene in this population. The minor alleles of the SNPs rs7754840 and rs7756992 showed significant susceptibility to GDM with an odds ratio of 1.34 (95% confidence interval, 1.12-1.60; P=0.0013) and 1.45 (95% confidence interval, 1.21-1.72; P=0.00004), respectively. Conclusions: The rs7754840 and rs7756992 SNPs of the CDKAL1 gene were found to be associated with GDM in this south Indian population. This is the first study describing genetic susceptibility of GDM in Asian Indians.
    Diabetes Technology &amp Therapeutics 02/2015; DOI:10.1089/dia.2014.0349 · 2.29 Impact Factor
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    ABSTRACT: Adiposity is an important diabetes risk factor, and Asian Indians have elevated diabetes risk. This analysis assessed the relationship between behavioral and psychosocial factors and adiposity among Asian Indians to better understand factors driving elevated weight/waist circumference in this population. This study used screening data (N=1285) from the D-CLIP study, a randomized controlled diabetes prevention trial in Chennai, India. Correlation tests and linear regression models were done to describe relationships among exposure variables (weight loss/exercise self-efficacy, fruit/vegetable intake, weekly exercise, past weight loss experience) and between these exposures and BMI or waist circumference. Exercise and weight loss self-efficacy were positively correlated with average minutes per week exercising (R=0.26, p<0.0001) and fruit (R=0.07, p<0.05) and vegetable intake (R=0.12, p<0.0001). Weekly fruit consumption, past weight loss experience, and weight loss self-efficacy, along with sex, age, and marital status, explained 13.6% and 25.9% in the variation in BMI and waist circumference, respectively. Low fruit consumption, unsuccessful past weight loss attempts, and low self-efficacy for weight loss are associated with higher BMI and waist circumference in this population. Understanding factors related to adiposity is important for preventing and treating weight gain. Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
    Primary Care Diabetes 02/2015; DOI:10.1016/j.pcd.2015.01.012 · 1.29 Impact Factor
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    ABSTRACT: To assess the relationship between regularity of follow-up and risk of complications in patients with type 2 diabetes (T2DM) followed up for 9 years at a tertiary diabetes center in India. We compared glycemic burden [cumulative time spent above a HbA1c of 53 mmol/mol (7 %)] and incidence of diabetes complications (retinopathy, neuropathy, nephropathy, peripheral arterial disease, coronary heart disease) between 1,783 T2DM patients with "regular follow-up" (minimum of three visits and two HbA1c tests every year from 2003 to 2012), and 1,798 patients with "irregular follow-up" (two visits or less and one HbA1c or less per year during the same time period), retrospectively identified from medical records. Cox proportional hazards models were used to estimate risk associated with diabetes complications. Compared to those with regular follow-up, the irregular follow-up group had significantly higher mean fasting and postprandial plasma glucose, HbA1c, glycemic burden, total and LDL cholesterol, and triglycerides at every time point during the 9 years of follow-up. Those with irregular follow-up had double the total and mean monthly glycemic burden and 1.98 times higher risk of retinopathy (95 % CI 1.62, 2.42) and 2.11 times higher risk of nephropathy (95 % CI 1.73, 2.58) compared to those with regular follow-up, even after adjusting for time-varying confounding variables. Complications tended to develop significantly earlier and were more severe in those with irregular follow-up. Among patients with type 2 diabetes, regular follow-up was associated with significantly lower glycemic burden and lower incidence of retinopathy and nephropathy over a 9-year period.
    Acta Diabetologica 12/2014; 52(3). DOI:10.1007/s00592-014-0701-0 · 3.68 Impact Factor
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    ABSTRACT: Abstract Aim: This study looked at the association of adipokines, inflammatory and oxidative stress markers in subjects with the following phenotypes: metabolically healthy, nonobese (MHNO), metabolically healthy, obese (MHO), metabolically obese, nonobese (MONO), and metabolically obese, obese (MOO). Materials and Methods: Subjects with MHNO (n=462), MHO (n=192), MONO (n=315), and MOO (n=335) were randomly selected from the Chennai Urban Rural Epidemiology Study. Adiponectin, visfatin, resistin, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), oxidized low-density lipoprotein (LDL), and monocyte chemoattractant protein-1 (MCP-1) were measured by enzyme-linked immunosorbent assay. Results: Levels of adiponectin were lowest in the MOO group, followed by the MONO, MHO, and the MHNO groups (P=0.042), whereas the levels of visfatin (P=0.042) and resistin (P=0.043) were highest in the MOO group, followed by the MONO, MHO, and the MHNO groups. Levels of hs-CRP (P=0.029), TNF-α (P=0.036), IL-6 (P=0.042), oxidized LDL (P=0.036), and MCP-1 (P=0.039) increased from the MHNO to MHO to MONO to MOO phenotypes. Linear regression analysis of the parameters with body mass index (BMI) and metabolic syndrome components showed that adiponectin is negatively associated with abdominal obesity (β=-0.060; P=0.039) and BMI (β=-0.076; P=0.009) and that TNF-α is negatively associated with high-density lipoprotein levels (β=0.114, P=0.049) even after adjusting for age and gender. hs-CRP (β=0.112, P=0.020) and oxidized LDL (β=0.114, P=0.050) showed a positive association with systolic blood pressure even after adjusting for age and gender. Conclusions: The metabolically obese phenotype is characterized by altered adipokine and inflammatory profiles, which could make this phenotype at high risk for type 2 diabetes mellitus and cardiovascular diseases.
    Diabetes Technology &amp Therapeutics 12/2014; 17(2). DOI:10.1089/dia.2014.0202 · 2.29 Impact Factor
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    ABSTRACT: Background: Rapid economic development and rural-to-urban migration in low- and middle-income countries has coincided with a growth in non-communicable diseases, such as hypertension. Exposure to the urban milieu may increase the risk of hypertension through changes in diet, physical activity, and tobacco consumption. Migrants, who are exposed to both rural and urban environments, may have a different prevalence of risk factors relative to urban-born residents. Aims: This study investigates the associations between migrant status and hypertension risk factors and prevalence in Chennai, India. Methods: We surveyed 546 adults from the Center for Cardiometabolic Risk Reduction in South-Asia Surveillance study in Chennai, India. We linked individuals' migration histories with clinical and sociodemographic data. Blinder-Oaxaca regression decomposition was used to evaluate the contribution of individual risk factors to the migrant/non-migrant difference in hypertension prevalence. Results: Migrants had an 8.5% greater prevalence of hypertension than non-migrants (p=0.085). Migrants older than 50 had greater age-specific hypertension prevalences relative to non-migrants. 65.4% of the migrant/non-migrant difference in hypertension could be explained by differences in the distribution of the risk factors in our model (p=0.037); the remaining 34.6% is attributable to an unexplained "migrant effect." Implications: The higher prevalence of hypertension in migrants is not purely due to differences in known risk factors. Compared to urban-born, migrants may face different, unknown, risks for hypertension. As the share of migrants in urban India grows, further research is required to investigate causes underlying the differences in hypertension prevalence between urban-born and migrant populations.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Abstract Objectives: This study assessed the relationship between diabetic retinopathy (DR) and coronary artery diseases (CAD) in Asian Indians, who are known to be at high risk of CAD and diabetes but have lower prevalence of DR. Subjects and Methods: Type 2 diabetes subjects (n=1,736) were selected from the urban component of the population-based Chennai Urban Rural Epidemiology Study Eye Study. Four-field stereo retinal color photography was done, and DR when present was classified according to the Early Treatment Diabetic Retinopathy Study grading system. Among the 1,723 subjects with gradable fundus photographs, 12-lead electrocardiogram (ECG) was performed in 1,602 individuals, and analysis was restricted to this group. CAD was diagnosed based on documented medical history of CAD or Minnesota coding of ECGs. Results: The prevalence of CAD was significantly higher among subjects with DR compared with those without (11.3% vs. 6.7%; P=0.007). A significant association was observed between DR and CAD in subjects with glycated hemoglobin (HbA1c) levels >7% (P=0.002). After controlling for age and gender, only hard exudates were associated with CAD (P=0.032). Logistic regression analysis revealed that even after adjusting for age, gender, HbA1c, mean arterial blood pressure, smoking, serum cholesterol, triglyceride, and low-density lipoprotein cholesterol levels, DR was significantly associated with CAD among the study subjects (odds ratio [OR]=1.58; 95% confidence interval [CI], 1.00-2.49; P=0.049) and those subjects with duration of diabetes >10 years (OR=4.06; 95% CI, 1.55-10.60; P=0.004). Conclusions: This cross-sectional study shows a significant association between DR and CAD in South Indian subjects with type 2 diabetes.
    Diabetes Technology &amp Therapeutics 11/2014; 17(2). DOI:10.1089/dia.2014.0141 · 2.29 Impact Factor