Prasanta Kumar Borah

Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR–INDIAB population-based cross-sectional study

BACKGROUND Previous studies have not adequately captured the heterogeneous nature of the diabetes epidemic in India. The aim of the ongoing national Indian Council of Medical Research-INdia DIABetes study is to estimate the national prevalence of diabetes and prediabetes in India by estimating the prevalence by state. METHODS We used a stratified multistage design to obtain a community-based sample of 57 117 individuals aged 20 years or older. The sample population represented 14 of Indias 28 states (eight from the mainland and six from the northeast of the country) and one union territory. States were sampled in a phased manner: phase I included Tamil Nadu, Chandigarh, Jharkhand, and Maharashtra, sampled between Nov 17, 2008, and April 16, 2010; phase II included Andhra Pradesh, Bihar, Gujarat, Karnataka, and Punjab, sampled between Sept 24, 2012, and July 26, 2013; and the northeastern phase included Assam, Mizoram, Arunachal Pradesh, Tripura, Manipur, and Meghalaya, with sampling done between Jan 5, 2012, and July 3, 2015. Capillary oral glucose tolerance tests were used to diagnose diabetes and prediabetes in accordance with WHO criteria. Our methods did not allow us to differentiate between type 1 and type 2 diabetes. The prevalence of diabetes in different states was assessed in relation to socioeconomic status (SES) of individuals and the per-capita gross domestic product (GDP) of each state. We used multiple logistic regression analysis to examine the association of various factors with the prevalence of diabetes and prediabetes. FINDINGS The overall prevalence of diabetes in all 15 states of India was 7·3% (95% CI 7·0-7·5). The prevalence of diabetes varied from 4·3% in Bihar (95% CI 3·7-5·0) to 10·0% (8·7-11·2) in Punjab and was higher in urban areas (11·2%, 10·6-11·8) than in rural areas (5·2%, 4·9-5·4; p<0·0001) and higher in mainland states (8·3%, 7·9-8·7) than in the northeast (5·9%, 5·5-6·2; p<0·0001). Overall, 1862 (47·3%) of 3938 individuals identified as having diabetes had not been diagnosed previously. States with higher per-capita GDP seemed to have a higher prevalence of diabetes (eg, Chandigarh, which had the highest GDP of US

Role of household exposure, dietary habits and glutathione S-Transferases M1, T1 polymorphisms in susceptibility to lung cancer among women in Mizoram India.

3433, had the highest prevalence of 13·6%, 12.8-15·2). In rural areas of all states, diabetes was more prevalent in individuals of higher SES. However, in urban areas of some of the more affluent states (Chandigarh, Maharashtra, and Tamil Nadu), diabetes prevalence was higher in people with lower SES. The overall prevalence of prediabetes in all 15 states was 10·3% (10·0-10·6). The prevalence of prediabetes varied from 6·0% (5·1-6·8) in Mizoram to 14·7% (13·6-15·9) in Tripura, and the prevalence of impaired fasting glucose was generally higher than the prevalence of impaired glucose tolerance. Age, male sex, obesity, hypertension, and family history of diabetes were independent risk factors for diabetes in both urban and rural areas. INTERPRETATION There are large differences in diabetes prevalence between states in India. Our results show evidence of an epidemiological transition, with a higher prevalence of diabetes in low SES groups in the urban areas of the more economically developed states. The spread of diabetes to economically disadvantaged sections of society is a matter of great concern, warranting urgent preventive measures. FUNDING Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Glutathione S-Transferase M1 and T1 Gene Polymorphisms and Risk of Hypertension in Tea Garden Workers of North–East India

BACKGROUND A case-control study was conducted to evaluate the effect of household exposure, dietary habits, smoking and Glutathione S-Transferases M1, T1 polymorphisms on lung cancer among women in Mizoram, India. MATERIALS AND METHODS We selected 230 newly diagnosed primary lung cases and 460 controls from women in Mizoram. Multivariate logistic regression analysis was performed to estimate adjusted odds ratio (OR). RESULTS Exposure of cooking oil fumes (p<0.003), wood as heating source for cooking (p=0.004), kitchen inside living room (p=0.001), improper ventilated house (p=0.003), roasting of soda in kitchen (p=0.001), current smokers of tobacco (p=0.043), intake of smoked fish (p=0.006), smoked meat (p=0.001), Soda (p<0.001) and GSTM1 null genotype (p=0.003) were significantly associated with increased risk of lung cancer among women in Mizoram. Significantly protective effect was observed for intake of bamboo shoots (p=<0.001) and egg (p<0.001). A clear increase in dose response gradient was observed for total cooking dish years. Risk for lung cancer tends to increase with collegial effect of indoor environmental sources (p=0.022). Significant correlation was also observed for interaction of GST polymorphisms with some of dietary habits. CONCLUSIONS We confirmed the important role of exposure of cooking oil emission and wood smoke, intake of smoked meat, smoked fish and soda (an alkali preparation used as food additives in Mizoram) and tobacco consumption for increase risk of lung cancer among Women in Mizoram.

Interaction of Tobacco Smoking and Chewing with Angiotensin Converting Enzyme (Insertion/Deletion) Gene Polymorphisms and Risk of Lung Cancer in a High Risk Area from Northeast India

AIMS Polymorphisms of genes encoding phase II metabolic enzymes, for example, glutathione S-transferase, have been linked with hypertension. The present study aimed at finding out the association between GSTM1 and GSTT1 polymorphism and hypertension in a population from North-East India. MATERIALS AND METHODS We carried out a case-control study in tea garden workers of Assam. A total of 223 hypertensive cases and 236 normotensive control subjects were recruited with a record of socio-demographic information, blood pressure, and anthropometric data. Fasting venous blood samples from all subjects were obtained and subjected to DNA extraction and polymerase chain reaction to detect polymorphism of the GSTM1 and GSTT1 genes. RESULTS The null genotype was prevalent in 38.1% and 28.1% of the study participants (cases and controls) for GSTM1 and GSTT1 genes, respectively. Hypertensive subjects had a significantly higher prevalence of the GSTM1 null genotype (43% vs. 33.5%, than normotensive control subjects, p=0.035). Association between the GSTM1 null genotype and hypertension was significant in younger subjects. Tobacco users with the GSTT1 null genotype were at an increased risk for hypertension. CONCLUSION The knowledge of GSTM1 and GSTT1 variant status will be useful to predict the risk of hypertension in a population.

Endothelial Nitric Oxide Synthase Gene Polymorphisms and the Risk of Hypertension in an Indian Population

BACKGROUND Association of angiotensin converting enzyme (ACE) gene polymorphisms with lung cancer susceptibility remains uncertain and varies with ethnicity. Northeast India represents a geographically, culturally, and ethnically isolated population. The area reports an especially high rate of tobacco usage in a variety of ways of consumption, compared with the rest of the Indian population. MATERIALS AND METHODS We conducted a population based case control study in two major high risk region for lung cancer from Northeast India. A total of 151 consecutive lung cancer cases diagnosed histopathologically and equal numbers of controls were recruited with record of relevant sociodemographic information. Blood samples were collected and processed to identify ACE gene polymorphism. RESULTS Significantly higher (40.4 % vs 29.1%, OR=1.97, CI=1.04-3.72; p=0.037) prevalence of the ACE II genotype was observed among lung cancer cases. Smoking was significantly associated with increased risk of lung cancer (OR=1.70, CI=1.02-2.81; p=0.041). An enhanced risk was also observed for interaction of ACE II genotype with tobacco smoking (OR=4.09, CI=1.51-11.05; p=0.005) and chewing (OR=3.68, CI=1.22-11.13; p=0.021). CONCLUSIONS The present study indicates significant association s of the ACE II genotype with lung cancer in high risk Northeast India.

Expression of inflammasome complex mRNA and its targeted microRNA in type 2 diabetes mellitus: A possible predictor of the severity of diabetic nephropathy

Genetic variants of eNOS gene play a significant role in the pathogenesis of hypertension. Many environmental factors have, also, been implicated in the aetiology of hypertension. We carried out an age-matched case-control study among adults. Hypertension was defined according to JNC-VII criteria and eNOS gene polymorphisms were determined by PCR and PCR followed by PCR-RFLP. eNOS intron 4 aa genotype (adjusted OR 6.81; 95% CI 2.29–20.25) and eNOS 894TT genotype (adjusted OR 7.84; 95% CI 2.57–23.96) were associated with the risk of hypertension. Tobacco users (either smoking/chewing or both) with eNOS intron 4 aa genotype (OR 14.00: 95% CI 1.20–163.37), eNOS 894GG genotype (OR 5.56: 95% CI 3.72–8.31), and eNOS T-786C CC genotype (OR 9.00: 95% CI 1.14–71.04) were at an increased risk of hypertension. Similarly a significant gene-environment interaction was observed between individuals consuming alcohol with eNOS intron 4 aa genotype (OR 12.00: 95% CI 1.20–143.73) and eNOS 894GG genotype (OR 1.95: 95% CI 1.35–2.81). The present study identified few susceptible genotypes of the eNOS gene with the risk of hypertension. Moreover, the interactive effects between the environmental factors and the risk of hypertension were dependent on the eNOS genotypes.

An information, education and communication module to reduce dietary salt intake and blood pressure among tea garden workers of Assam

Diabetic nephropathy (DN) is a major cause of morbidity and mortality in diabetes mellitus (DM) that develops due to persistent hyperglycemia and poor glycemic control. Recent studies into the etiology of DN suggest the involvement of multiple growth factors and biochemical mediators, although the exact pathomechanism remains unknown. Structural and functional aberration in diabetic kidney (DK) promotes a decrease in the glomerular filtration rate (GFR), which ultimately leads to renal failure. Recently, it was revealed that prolonged inflammation in DK may be crucial for the pathogenesis of DN, but this remains to be comprehensively explored in humans. It has been documented that treatment of naïve DM subjects is associated with elevated levels of the nod like receptor (NLR)dependent inflammasome complex (IC). In a rat model, IC downregulation after administration of antidiabetic medication has been documented in vitro. The role of the NLR-dependent-IC (NLR family pyrin domain containing 3 (NLRP3), Caspase 1 (CASP1) and PYD and CARD domain containing (PYCARD)) in the pathogenesis of DN has been recently documented in animals, and in humans but studies are limited. Epigenomic changes, including in microRNAs (miRNAs), are crucial regulators of gene expression and are recognized as potential players in metabolic diseases. Thus, in the present study we investigated the effects of the expression profile of IC molecules (NLRP3, CASP1, and PYCARD) and their miRNAs (hsa-miR-22-3p, hsa-miR-4291, and hsa-miR-185-3p, respectively) on GFR in subjects with type 2 DM (T2DM) to understand the severity of DN.

Pro- and antiangiogenic VEGF and its receptor status for the severity of diabetic retinopathy

Objective High salt diet increases blood pressure. Tea garden workers (TGW) of Assam, India have high (60.8%) prevalence of hypertension (HTN), which may be due to consumption of extra salt (salt as side dish) and salted tea at work place and home. The present study evaluated an information, education and communication (IEC) module to reduce salt intake and blood pressure among TGW. Methods Two tea gardens (usual care and intervention) were selected at random covering a total population of 13,458. The IEC module consisting of poster display, leaflets, health rally, documentary show, individual and group discussion was introduced in the intervention garden targeting study participants, health care providers, key stake holders, school children and teachers. IEC intervention was continued for one year. Participants from usual care and intervention were followed at three monthly intervals and BP and other information were compared after one year. Results A total of 393 study participants (Non intervention: 194; intervention: 199) were included. After one year of follow up, consumption of extra salt was reduced significantly in the intervention participants (66.3 vs. 45.5%, p = 0.000). Intention to treat analysis revealed significant reduction in systolic [−6.4 (−8.6 to −4.2)] and diastolic [−6.9 (−8.1 to −5.7)] blood pressure after one year. Prevalence of HTN was reduced significantly (52.5 vs. 40.0%, p = 0.02) among them. Conclusions Our IEC module created awareness about risk of hypertension associated with high salt intake and could reduce dietary salt intake and BP.