Kashish Goel

Effect of Supervised Progressive Resistance-Exercise Training Protocol on Insulin Sensitivity, Glycemia, Lipids, and Body Composition in Asian Indians With Type 2 Diabetes

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

Improvement in nutrition-related knowledge and behaviour of urban Asian Indian school children: findings from the 'Medical education for children/Adolescents for Realistic prevention of obesity and diabetes and for healthy aGeing' (MARG) intervention study.

Increasing prevalence of childhood obesity calls for comprehensive and cost-effective educative measures in developing countries such as India. School-based educative programmes greatly influence childrens behaviour towards healthy living. We aimed to evaluate the impact of a school-based health and nutritional education programme on knowledge and behaviour of urban Asian Indian school children. Benchmark assessment of parents and teachers was also done. We educated 40 196 children (aged 8-18 years), 25 000 parents and 1500 teachers about health, nutrition, physical activity, non-communicable diseases and healthy cooking practices in three cities of North India. A pre-tested questionnaire was used to assess randomly selected 3128 children, 2241 parents and 841 teachers before intervention and 2329 children after intervention. Low baseline knowledge and behaviour scores were reported in 75-94 % government and 48-78 % private school children, across all age groups. A small proportion of government school children gave correct answers about protein (14-17 %), carbohydrates (25-27 %) and saturated fats (18-32 %). Private school children, parents and teachers performed significantly better than government school subjects (P < 0.05). Following the intervention, scores improved in all children irrespective of the type of school (P < 0.001). A significantly higher improvement was observed in younger children (aged 8-11 years) as compared with those aged 12-18 years, in females compared with males and in government schools compared with private schools (P < 0.05 for all). Major gaps exist in health and nutrition-related knowledge and behaviour of urban Asian Indian children, parents and teachers. This successful and comprehensive educative intervention could be incorporated in future school-based health and nutritional education programmes.

The High Burden of Obesity and Abdominal Obesity in Urban Indian Schoolchildren: A Multicentric Study of 38,296 Children

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

Predictive Equations for Body Fat and Abdominal Fat With DXA and MRI as Reference in Asian Indians

Objective: To develop accurate and reliable equations from simple anthropometric parameters that would predict percentage of total body fat (%BF), total abdominal fat (TAF), subcutaneous abdominal adipose tissue (SCAT), and intra‐abdominal adipose tissue (IAAT) with a fair degree of accuracy.

Impact of obesity on the left ventricular functions and morphology of healthy Asian Indians.

BACKGROUND The aim of this study was to determine the impact of obesity on alteration of left ventricular (LV) functions and morphology in nondiabetic, nonhypertensive, and normo-lipidemic obese Asian Indians. A total of 239 consecutive Asian Indians (175 males and 64 females, ages 17-64 years) were divided into obese and nonobese groups based on body mass index (BMI), waist-to-hip circumference ratio (W-HR), and percentage of body fat (%BF). METHODS Anthropometry (BMI, W-HR), %BF, and two-dimensional echocardiography including tissue Doppler imaging (TDI) were performed for all the subjects. The unpaired t-test was applied after matching age and gender in all the comparison groups. Nonobese subjects acted as controls for the obese subjects (cases). RESULTS Obese subjects had a larger LV end-diastolic diameter (P < 0.001), LV end-systolic diameter (P < 0.001), and LV mass (P < 0.001) as compared to the nonobese subjects. Subclinical systolic dysfunction was apparent in obese subjects only on TDI in the form of reduced systolic mitral annular velocity (P = 0.009). Diastolic dysfunction, as suggested by a lower ratio of early to late transmitral ventricular filling velocity (E/A), lower early to late (Em/Am) diastolic mitral annular velocity, and a higher E/Em ratio (P < 0.001, p = 0.001 and P < 0.001, respectively), was noted in the obese cohort. In addition, the left atrial diameter (P < 0.001) was also increased in obese subjects. Alteration of LV morphology and function correlated with the anthropometric variables BMI, W-HR, and %BF. CONCLUSIONS Asian Indians with uncomplicated obesity (without associated co-morbidities) had significant morphological and functional cardiac dysfunction (systolic and diastolic), which correlated with anthropometric variables.