Gupta Vp

Prevalence of diabetes, impaired fasting glucose and insulin resistance syndrome in an urban Indian population

OBJECTIVE Epidemiological study among urban subjects in western India to determine prevalence of diabetes, insulin resistance syndrome (IRS) and their risk factors. METHODS Randomly selected adults > or =20 years were studied using stratified sampling. Target sample was 1,800 (men 960, women 840). 1123 subjects (response 62.4%) were evaluated and blood samples were available in 532 men and 559 women (n=1091, 60.6%). Measurement of anthropometric variables, blood pressure, fasting blood glucose and lipids was performed. Atherosclerosis risk factors were determined using current guidelines. Diabetes was diagnosed when the subject was a known diabetic or fasting blood glucose was > or =126 mg/dl, impaired fasting glucose (IFG) diagnosed when fasting glucose was 110-125 mg/dl. IRS was diagnosed when any three of-IFG, high triglycerides >150 mg/dl, low HDL cholesterol (men<40 mg/dl, women<50 mg/dl), central obesity (men>102 cm, women>88 cm), or high normal blood pressure (>130/>85 mmHg) or hypertension-were present. RESULTS Diabetes was present in 70 men (13.2%) and 64 women (11.5%). Age-adjusted prevalence of diabetes was 9.3% in men (95% confidence intervals (CI) 6.7-11.8), 8.1% in women (CI 5.8-10.4) and 8.6% overall (CI 6.9-10.3). IFG was in 28 men (5.3%) and 29 women (5.2%). IRS was present in 52 men (9.8%) and 114 women (20.4%) with age-adjusted prevalence of 7.9% in men (CI 6.7-9.1) and 17.5% in women (CI 14.4-20.6) with an overall prevalence of 12.8% (CI 10.8-14.8). Other metabolic abnormalities of IRS in men and women were high triglycerides in 32.1 and 28.6%, low HDL cholesterol in 54.9 and 90.2%; central obesity in 21.8 and 44.0%, and high normal blood pressure or hypertension in 35.5 and 32.4%. IFG subjects had similar atherosclerosis risk factor profile as normal subjects while those with IRS and diabetes had significantly greater prevalence of obesity, central obesity, hypertension, high triglycerides and low HDL (P<0.01). CONCLUSIONS There is s significant prevalence of diabetes and IRS in this urban Indian population. Subjects with diabetes as well as IRS have greater prevalence of obesity, central obesity, hypertension, hypertriglyceridemia and low HDL as compared with normal subjects.

Educational status, coronary heart disease, and coronary risk factor prevalence in a rural population of India

Abstract Objective: To define the association between educational level and prevalence of coronary heart disease and coronary risk factors in India. Design - Total community cross sectional survey with a doctor administered questionnaire, physical examination, and electrocardiography. Setting: A cluster of three villages in rural Rajasthan, Western India. Subjects: 3148 residents aged over 20 (1982 men, 1166 women) divided into various groups according to years of formal schooling. Results - Illiteracy and low educational levels were associated with less prestigious occupations (agricultural and farm labouring) and inferior housing. There was an inverse correlation of educational level with age (rank correlation: men -045, women -0.49). The prevalence of coronary heart disease (diagnosed by electrocardiography) was significantly higher among uneducated and less educated people and showed an inverse relation with education in both sexes. Among uneducated and less educated people there was a higher prevalence of the coronary risk factors smoking and hypertension. Educational level showed a significant inverse correlation with systolic and diastolic blood pressure. Logistic regression analysis with adjustment for age showed that educational level had an inverse relation with prevalence of electrocardiographically diagnosed coronary heart disease (odds ratio: men 0.82, women 0.53), hypertension (men 0.88, women 0.56), and smoking (men 0.73, women 0.65) but not with hypercholesterolaemia and obesity. The inverse relation of coronary heart disease with educational level abated after adustment for smoking, physical activity, body mass index, and blood pressure (odds ratio: men 0.98, women 0.78). Conclusion: Uneducated and less educated people in rural India have a higher prevalence of coronary heart disease and of the coronary risk factors smoking and hypertension.

Prevalence and determinants of hypertension in the urban population of Jaipur in western India.

Objectives: To determine age-specific blood pressure levels and prevalence of hypertension in an urban Indian population. Design and setting: A cross-sectional survey in six randomly selected municipal blocks in Jaipur city, India. Subjects and methods: There were 2122 subjects (1415 male, 797 female) aged 20 years or more. Evaluation was by physician-administered questionnaire, physical examination and electrocardiography. Diagnosis of hypertension used World Health Organization (WHO) and USA Fifth Joint National Committee (JNC-V) guidelines. Hypertension was subclassified according to the Framingham Study criteria. Results: The mean±SD blood pressures (mmHg) were 125±19 systolic and 81 ±24 diastolic in men and 126±20 systolic and 81 ±12 diastolic in women. A significant correlation of blood pressure with increasing age groups was seen. The prevalence of hypertension according to the JNC-V criteria was 30% in men and 33% in women; by WHO criteria it was 11% in men and 12% in women and increased with age in all subjects. In the JNC-V hypertensive group borderline isolated systolic hypertension was present in 13% of men and 17% of women, definite isolated systolic hypertension was present in 7% of men and 2% of women, isolated diastolic hypertension was present in 65% of men and 57% of women and definite hypertension was present in 16% of men and 24% of women. Multivariate analysis revealed that age, smoking and higher body mass index were independently associated with higher prevalence of hypertension both in men and in women. Conclusions: A high prevalence of JNC-V-defined hypertension was found in an Indian urban population. Isolated diastolic hypertension was the commonest subtype. Significant determinants of hypertension were age, smoking and body mass index.

Prevalence and determinants of coronary heart disease in a rural population of India

BACKGROUND The prevalence and determinants of coronary heart disease (CHD) have been inadequately studied in rural areas of developing countries. METHODS Entire communities were surveyed in randomly selected villages in Rajasthan, India. A physician-administered questionnaire, physical examination, and electrocardiogram (ECG) were performed on 3148 adults > or = 20 years of age (1982 males, 1166 females). Fasting blood samples for determination of lipids were obtained from 202 males and 98 females. Prevalence of coronary risk factors--smoking, hypertension, sedentary life-style, obesity, and hypercholesterolemia--was determined. CHD was diagnosed on basis of past documentation, response to WHO-Rose questionnaire, or changes in ECG. Three methods were used: (a) documentation, history, and ECG criteria, (b) ECG-Q, ST, or T changes, and (c) presence of Q waves. RESULTS Coronary risk factors: smoking was present in 51% males and 5% females, hypertension (> or = 140/90 mmHg) in 24% males and 17% females, hypercholesterolemia (> 200 mg/dl) in 22%, diabetes history in 0.2%, and irregular physical activity or sedentary habits in 85%. Other risk factors were lack of formal education in 44%, obesity (body-mass index > or = 27 kg/m2) in 6% and truncal obesity (waist-hip ratio > or = 0.95) in 5%. The prevalence of CHD (clinical + ECG criteria) was 3.4% in males and 3.7% in females. According to ECG criteria only, it was 2.8% in males and 3.3% in females and according to Q-waves only, it was 1.6% in males and 0.9% in females. Multivariate logistic regression analysis showed that age and smoking in males and age and systolic blood pressure in females were associated with higher prevalence of Q-wave CHD. In males, higher educational level and prayer habit were associated with lower prevalence. CONCLUSIONS Prevalence of CHD in this rural community is higher than in previously reported Indian studies. Smoking, hypertension, and sedentary lifestyle have high prevalence. Significant determinants of CHD are increasing age and smoking while education and prayer-habit are protective.

Lipoprotein Lipids and the Prevalence of Hyperlipidaemia in Rural India

Background: The prevalence of hyperlipidaemias has been inadequately studied in rural populations of developing countries. No significant data exist on the population levels of serum cholesterol, cholesterol subclasses or triglycerides in these countries. Methods: We studied fasting blood samples of 300 apparently healthy adults (202 men and 98 women, age range 20–73 years) randomly selected from a larger sample of 3148 individuals during a comprehensive cardiovascular risk-factor survey in Rajasthan, India. Levels of serum total cholesterol, its subfractions [low-density-lipoprotein (LDL) cholesterol, very-low-density-lipoprotein cholesterol and high-density-lipoprotein (HDL) cholesterol] and triglycerides were measured and correlated with age and anthropometric data. Results: The mean ± SD serum total-cholesterol levels were 4.39 ± 1.0mmol/l in men and 4.37 ± 1.0mmol/l in women, the mean LDL-cholesterol levels 2.51 ± 1.0 mmol/l in men and 2.62 ± 0.9 mmol/l in women, the mean HDL-cholesterol levels 1.15 ± 0.4mmol/l in both men and women and the mean fasting serum triglyceride levels 1.63 ± 0.6 mmol/l in men and 1.48 ± 0.7 mmol/l in women. Age correlated positively with total-cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels in both men and women. Levels of the cholesterol subtypes did not differ between the sexes (P > 0.01), although triglyceride levels were significantly higher in men (P <0.01). Lipoprotein lipids did not correlate significantly with height, weight, body-mass index or waist:hip ratio. When classified according to the recommendations of the US National Cholesterol Education Program for the determination of the prevalence of hyperlipidaemia, 43 individuals (14.3%; men 14.4% and women 14.3%) had borderline high cholesterol levels (5.20–6.18 mmol/l) and 24 (8%; men 7.9% and women 8.2%) had high cholesterol levels (≥ 6.21 mmol/l). Forty-five participants (15%) had borderline high LDL-cholesterol levels (3.36–4.11 mmol/l) and 20 (6.7%) had high LDL-cholesterol levels (≥ 4.14 mmol/l); low HDL-cholesterol levels (< 0.9 mmol/l) were found in 89 (29.7%). Eighteen participants (6%) had mild hypertriglyceridaemia (2.82–5.64 mmol/l) and two (0.7%) had severe hypertriglyceridaemia (>5.64 mmol/l). Conclusion: Total-cholesterol and LDL-cholesterol levels are low in a rural Indian population, although an atherogenic lipid profile is present in a significant proportion.

Twenty-year trends in cardiovascular risk factors in India and influence of educational status

Background: Urban middle-socioeconomic status (SES) subjects have high burden of cardiovascular risk factors in low-income countries. To determine secular trends in risk factors among this population and to correlate risks with educational status we performed epidemiological studies in India. Methods: Five cross-sectional studies were performed in middle-SES urban locations in Jaipur, India from years 1992 to 2010. Cluster sampling was performed. Subjects (men, women) aged 20–59 years evaluated were 712 (459, 253) in 1992–94, 558 (286, 272) in 1999–2001, 374 (179, 195) in 2002–03, 887 (414, 473) in 2004–05, and 530 (324, 206) in 2009–10. Data were obtained by history, anthropometry, and fasting blood glucose and lipids estimation. Response rates varied from 55 to 75%. Mean values and risk factor prevalence were determined. Secular trends were identified using quadratic and log-linear regression and chi-squared for trend. Results: Across the studies, there was high prevalence of overweight, hypertension, and lipid abnormalities. Age- and sex-adjusted trends showed significant increases in mean body mass index (BMI), fasting glucose, total cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides (quadratic and log-linear regression, p < 0.001). Systolic blood pressure (BP) decreased while insignificant changes were observed for waist–hip ratio and low-density lipoprotein (LDL) cholesterol. Categorical trends showed increase in overweight and decrease in smoking (p < 0.05); insignificant changes were observed in truncal obesity, hypertension, hypercholesterolaemia, and diabetes. Adjustment for educational status attenuated linear trends in BMI and total and LDL cholesterol and accentuated trends in systolic BP, glucose, and HDL cholesterol. There was significant association of an increase in education with decline in smoking and an increase in overweight (two-line regression p < 0.05). Conclusion: In Indian urban middle-SES subjects there is high prevalence of cardiovascular risk factors. Over a 20-year period BMI and overweight increased, smoking and systolic BP decreased, and truncal obesity, hypercholesterolaemia, and diabetes remained stable. Increasing educational status attenuated trends for systolic BP, glucose and HDL cholesterol, and BMI.

Cardiovascular risk according to educational status in India.

OBJECTIVE Influence of socioeconomic status on cardiovascular risk has not been well studied in low income countries. To determine risks in various educational status (ES) subjects we performed a study in India. METHODS Epidemiological study was performed in years 1999-2003 in Jaipur (India) for coronary risk factors among 1280 adults 20-59 years (men 619, women 661). ES was categorized into low (education ≤5 years); middle (6-12 years) and high (>12 years). Prevalence of risk factors and Framingham risk scores were determined. RESULTS Low ES was in 306, middle in 436 and high in 538. In low, middle and high ES respectively age-adjusted prevalence (%) of smoking was 19.0, 19.3, and 11.7; obesity 9.5, 16.7, and 22.1, hypertension 15.3, 30.5, and 44.0; hypercholesterolemia ≥200mg/dl 46.0, 48.4, and 54.6; low HDL cholesterol <40mg/dl 46.4, 56.4, and 38.3; metabolic syndrome 20.9, 25.7, and 28.6; and diabetes 6.9, 5.5, and 26.4. Framingham risk score was 5.7±4.8, 6.3±5.7 and 4.7±5.1 and calculated cardiovascular risk probability 5.2±5.7, 6.8±7.8 and 5.2±6.0 (P(trend)<0.05). Framingham risk score was significantly greater in low and middle ES (6.1±5.3) compared to high (4.7±5.1) (p<0.001). Adjustment for smoking attenuated the risk. CONCLUSION Low and middle educational status urban subjects in India have greater cardiovascular risk.

Secular trends in cholesterol lipoproteins and triglycerides and prevalence of dyslipidemias in an urban Indian population.

BackgroundCoronary heart disease is increasing in urban Indian subjects and lipid abnormalities are important risk factors. To determine secular trends in prevalence of various lipid abnormalities we performed studies in an urban Indian population.MethodsSuccessive epidemiological Jaipur Heart Watch (JHW) studies were performed in Western India in urban locations. The studies evaluated adults ≥ 20 years for multiple coronary risk factors using standardized methodology (JHW-1, 1993–94, n = 2212; JHW-2, 1999–2001, n = 1123; JHW-3, 2002–03, n = 458, and JHW-4 2004–2005, n = 1127). For the present analyses data of subjects 20–59 years (n = 4136, men 2341, women 1795) have been included. In successive studies, fasting measurements for cholesterol lipoproteins (total cholesterol, LDL cholesterol, HDL cholesterol) and triglycerides were performed in 193, 454, 179 and 252 men (n = 1078) and 83, 472, 195, 248 women (n = 998) respectively (total 2076). Age-group specific levels of various cholesterol lipoproteins, triglycerides and their ratios were determined. Prevalence of various dyslipidemias (total cholesterol ≥ 200 mg/dl, LDL cholesterol ≥ 130 mg/dl, non-HDL cholesterol ≥ 160 mg/dl, triglycerides ≥ 150 mg/dl, low HDL cholesterol <40 mg/dl, high cholesterol remnants ≥ 25 mg/dl, and high total:HDL cholesterol ratio ≥ 5.0, and ≥ 4.0 were also determined. Significance of secular trends in prevalence of dyslipidemias was determined using linear-curve estimation regression. Association of changing trends in prevalence of dyslipidemias with trends in educational status, obesity and truncal obesity (high waist:hip ratio) were determined using two-line regression analysis.ResultsMean levels of various lipoproteins increased sharply from JHW-1 to JHW-2 and then gradually in JHW-3 and JHW-4. Age-adjusted mean values (mg/dl) in JHW-1, JHW-2, JHW-3 and JHW-4 studies respectively showed a significant increase in total cholesterol (174.9 ± 45, 196.0 ± 42, 187.5 ± 38, 193.5 ± 39, 2-stage least-squares regression R = 0.11, p < 0.001), LDL cholesterol (106.2 ± 40, 127.6 ± 39, 122.6 ± 44, 119.2 ± 31, R = 0.11, p < 0.001), non-HDL cholesterol (131.3 ± 43, 156.4 ± 43, 150.1 ± 41, 150.9 ± 32, R = 0.12, p < 0.001), remnant cholesterol (25.1 ± 11, 28.9 ± 14, 26.0 ± 11, 31.7 ± 14, R = 0.06, p = 0.001), total:HDL cholesterol ratio (4.26 ± 1.3, 5.18 ± 1.7, 5.21 ± 1.7, 4.69 ± 1.2, R = 0.10, p < 0.001) and triglycerides (125.6 ± 53, 144.5 ± 71, 130.1 ± 57, 158.7 ± 72, R = 0.06, p = 0.001) and decrease in HDL cholesterol (43.6 ± 14, 39.7 ± 8, 37.3 ± 6, 42.5 ± 6, R = 0.04, p = 0.027). Trends in age-adjusted prevalence (%) of dyslipidemias in JHW-1, JHW-2, JHW-3 and JHW-4 studies respectively showed insignificant changes in high total cholesterol (26.3, 35.1, 25.6, 26.0, linear curve-estimation coefficient multiple R = 0.034), high LDL cholesterol ≥ 130 mg/dl (24.2, 36.2, 31.0, 22.2, R = 0.062), and high low HDL cholesterol < 40 mg/dl (46.2, 53.3, 55.4, 33.7, R = 0.136). Increase was observed in prevalence of high non-HDL cholesterol (23.0, 33.5, 27.4, 26.6, R = 0.026), high remnant cholesterol (40.1, 40.3, 30.1, 60.6, R = 0.143), high total:HDL cholesterol ratio ≥ 5.0 (22.2, 47.6, 53.2, 26.3, R = 0.031) and ≥ 4.0 (58.6, 72.5, 70.1, 62.0, R = 0.006), and high triglycerides (25.7, 28.2, 17.5, 34.2, R = 0.047). Greater correlation of increasing non-HDL cholesterol, remnant cholesterol, triglycerides and total:HDL cholesterol ratio was observed with increasing truncal obesity than generalized obesity (two-line regression analysis p < 0.05). Greater educational level, as marker of socioeconomic status, correlated significantly with increasing obesity (r2 men 0.98, women 0.99), and truncal obesity (r2 men 0.71, women 0.90).ConclusionIn an urban Indian population, trends reveal increase in mean total-, non-HDL-, remnant-, and total:HDL cholesterol, and triglycerides and decline in HDL cholesterol levels. Prevalence of subjects with high total cholesterol did not change significantly while those with high non-HDL cholesterol, cholesterol remnants, triglycerides and total-HDL cholesterol ratio increased. Increasing dyslipidemias correlate significantly with increasing truncal obesity and obesity.

Fatty acid oxidation and other biochemical changes induced by cooking in commonly used Indian fats and oils

Purpose – Cooking can adversely affect chemical characteristics of edible oils. The purpose of this paper is to determine biochemical changes due to cooking in commonly used Indian fats and oils through an experimental study.Design/methodology/approach – Changes in chemical properties of various edible oils [Indian ghee (clarified butter), hydrogenated oil, coconut oil, mustard‐rapeseed oil, groundnut oil, soyabean oil, cottonseed oil and sunflower oil] were studied. Oils were subjected to various cooking methods (shallow frying, sauteing, single deep frying and multiple deep fryings) using an inert substance. Peroxide content was estimated as index of fatty‐acid oxidation, free fatty acids, iodine value for determination of fatty‐acid unsaturation and trans‐fatty acids at baseline and after cooking using colorimetric and gas‐liquid chromatography methods. Three samples were analyzed for each process (n = 144). Significance of change was determined using t‐test.Findings – There was a significant increase ...

Changing trends in otorhinolaryngological diseases at a non-government clinic in Jaipur

BackgroundOtorhinolaryngological (ENT) diseases are major health problem in India but the trends in occurrence of various disorders in clinical practice have not been well studied. To assess the types of such diseases and to determine changing trends in their incidence we performed this study.MethodsThe study was done at a non-government ENT center at Jaipur. From 1975 to 2005, >125000 patients of different diseases were evaluated here. The study includes randomly selected patients (n = 11454) from years 1980 to 2000 at an interval of 5 years to evaluate disease trends. Significance of trends was evaluated using least squares regression.ResultsIn the years 1980, 1985, 1990, 1995 and 2000 mean age of patients was 26.60 ± 17.81 (range 0.16 to 85), 27.07 ± 16.91 (0.08 to 90), 28.30 ± 17.73 (0.25 to 90), 28.79 ± 17.8 (0.25 to 90) and 28.74 ± 17.81 (0.25 to 85) years respectively. 51 types of ENT diseases were observed of which 19 contributed to 76.8% (8807) patients and analysis was restricted to them. Chronic suppurative otitis media (2203, 19.2%), otitis externa (859, 7.5%), deviated nasal septum with nasal obstruction (717, 6.3%) and chronic tonsillitis (695, 6.1%) were the most common, followed by ear wax (569, 4.9%), sensorineural hearing loss (545, 4.7%), chronic rhinosinusitis (428, 3.7%) and epistaxis (320, 2.8%). There was increasing trend for stomatitis (b = 0.0014), deviated nasal septum (b = 0.0290), allergic rhinitis (b = 0.0023), epistaxis (b = 0.0002), acute tonsillitis (b = 0.0003), hoarseness (b = 0.0017), deaf mutism (b = 0.0005), sensorineural hearing loss (b = 0.0038), tinnitus (b = 0.0006) and ear wax (b = 0.0050). Declining trend was observed for chronic rhinosinusitis (b = −0.0155), otitis externa (b = −0.0063), chronic suppurative otitis media (b = −0.0001), acute otitis media ( = −0.0007), secretory otitis media (b = −0.0013), otosclerosis (b = −0.0007), vertigo (b = −0.0007), neck swelling (b = −0.0005) and chronic tonsillitis (b = −0.0194).ConclusionThis study from an Indian urban ENT center shows a significantly increasing trend in chronic and degenerative ear diseases and decline in infection related diseases.