Thakor G. Patel

Prevalence of diabetes, metabolic syndrome, and cardiovascular risk factors in US Asian Indians: results from a national study

BACKGROUND Although studies of immigrant Asian Indians in other countries show high rates of diabetes (DM), metabolic syndrome (MetS), and cardiovascular disease (CVD), no randomized, population-based studies of this rapidly growing ethnic group exist in the US. METHODS The sample comprised 1038 randomly selected Asian Indian immigrants, aged 18 years and older at seven US sites. Prevalence of diabetes and MetS (age-adjusted and sex-adjusted means) was estimated and ANOVA was used to calculate gender and group differences (normoglycemia/impaired fasting glucose/diabetes) for CVD risk factors. RESULTS The mean age was 48.2 years. The majority of respondents were male, married, educated, and with some form of health insurance. Prevalence of diabetes was 17.4%, and 33% of the respondents had prediabetes. Cardiovascular risk factors, especially high levels of triglycerides, total cholesterol, LDL cholesterol, homocysteine, and C-reactive protein, and low levels of HDL cholesterol, were also prevalent; elevated lipoprotein(a) was not observed. The age-adjusted prevalence of MetS was 26.9% by the original NCEP/ATP III criteria, 32.7% by the modified NCEP/ATP III criteria, and 38.2% by the IDF criteria. The MetS rates for women, but not for men, increased with age using all three criteria. There was a progressive worsening of all metabolic parameters as individuals progressed from normal to IFG to diabetes. CONCLUSION The prevalence rates of diabetes and MetS among US Asian Indians are higher than reported in earlier, nonrandomized, smaller surveys. These data provide a firm basis for future mechanistic and interventional studies.

A Community-Based Participatory Diabetes Prevention and Management Intervention in Rural India Using Community Health Workers

Purpose The purpose of this study was to test the effectiveness of a 6-month community-based diabetes prevention and management program in rural Gujarat, India. Methods A community-based participatory research method was used to plan and tailor the intervention by engaging trained community health workers as change agents to provide lifestyle education, serve as community advocates, and collect data from 1638 rural Indians (81.9% response rate). Ten culturally and linguistically appropriate health education messages were provided in face-to-face individual and group sessions (demonstrations of model meals and cooking techniques). Results Mean age was 41.9 ± 15.9 years. Overall point prevalence of diabetes, prediabetes, obesity, and hypertension were 7.2%, 19.3%, 16.7%, and 28%, respectively, with significant differences between the low socioeconomic status (SES) participants (agricultural workers) and the high SES participants (business community) due to differing diet and activity levels. The intervention significantly reduced blood glucose levels by 5.7 and 14.9 mg/dL for individuals with prediabetes and diabetes, respectively, and systolic and diastolic blood pressure by 8 mm Hg and 4 mm Hg, respectively, in the overall population. Knowledge of diabetes and cardiovascular disease improved by 50% in the high SES group and doubled in the low SES group; general and abdominal obesity also decreased by ≤ 1%. High rates of undiagnosed hypertension (26.1%) were surprising. Among individuals with diabetes, metabolic complications such as diabetic nephropathy and chronic kidney disease were noted. Conclusions Through collective engagement of the community, participatory programs can serve as a prototype for future prevention and management efforts, which are rare and underutilized in India.

Health Promotion Behaviors of Gujurati Asian Indian Immigrants in the United States

The purpose of this paper was to examine the health promotion behaviors of Asian Indians, one of the fastest-growing immigrant groups in the United States. The sample consisted of 261 respondents randomly selected from the Charotar Patidar Samaj, a national Gujarati Association membership directory. Health promotion behaviors were obtained using the Health Promotion Lifestyle Profile II. Respondents demonstrated lower scores in physical activity and nutrition and higher scores in the areas of interpersonal skills and spiritual growth domain of the health promotion behaviors. Physical inactivity was the highest among adults of 25–50 years of age. A significant difference existed between males and females in the domain of health responsibility. Females were more responsible for their health and reported medical problems to a physician more often than their male counterparts. They also educated themselves about health promotion behaviors through reading and watching TV programs. Study results support previous research findings and make an important contribution to understanding the Asian Indians health-promoting lifestyle behaviors.

Public-Private Partnership Model to Provide Humanitarian Services in Developing Countries

Received October 26, 2016; Revised December 20, 2016; Acce December 21, 2016. From the USU-Walter Reed Department of Surgery (Jindal), and Departments of Medicine (Patel) and Preventive Medicine and Biostati (Waller), Uniformed Service University, Bethesda, MD. Correspondence address: Rahul M Jindal, MD, PhD, FACS, M USU-Walter Reed Department of Surgery, Uniformed Services Univer 8901 Wisconsin Ave, Bethesda, MD 20889. email: jindalr@msn.com

SEVAK Project in India and Guyana Modeled After the Independent Duty Corpsman of the U.S. Navy

INTRODUCTION SEVAK Project (www.sevakproject.org) was initiated in July 2010 in India and empowers and pays a local person to look after the health of the people in their own village. The acronym SEVAK stands for “Sanitation and Health, Education in Village communities through improved Awareness and Knowledge of Prevention/Management of Diseases and Health Promotion.” The inspiration for this project came from the long-standing and successful—Independent Duty Corpsman (IDC) program in the U.S. Navy. One of the authors, Dr Thakor G. Patel, retired U.S. Navy Captain worked extensively with the U.S. Navy IDC program during his distinguished career and used this experience to design the SEVAK program. IDC are high-school graduates interested in health care who were given 12 months of intensive training and then assigned to Marine Corps units or Navy Ships, where they are fondly referred to as the “doc.” IDCs provide primary and preventive care, evaluate trauma, and initiate disaster management protocols. In addition, they monitor occupational health through environmental checks such as humidity, temperature and sanitation. In global health terms, they are community health workers trained in a consistent fashion to provide health services and monitoring for a specific population. The SEVAK Project aimed to produce similar capability for underserved civilian villages with an intense two and a half month curriculum. SEVAK training emphasizes lifestyle intervention and health screening for diabetes, hypertension, obesity, immunization, and chronic diseases. SEVAKs also received basic training in sanitation, environment, water purification, infectious diseases, and how to build toilets and smokeless cooking stoves. The project started in July 2010 in the Indian state of Gujarat and was approved by the Prime Minister N. Modi, when he was the Governor of Gujarat (http://sevakproject.org/index.html). It is the basis of Modi’s current national program to improve sanitation in the entire country of India (http://www.narendramodi.in/pm-modissanitation-campaign-gets-lauded-by-united-nations/) and the SEVAK Project compliments and supports the existing public health system and plans. The SEVAK Project was extended to Guyana, South America, in 2013. So in addition to the one village per district (n = 27) in Gujarat, India, the project added 14 villages in Guyana, South America, with an intent to screen the residents for diabetes, hypertension, obesity and monitor those with chronic diseases. The major difference between the Indian model and the Guyanese model is that the SEVAKS in Guyana are still in high school and they work in their villages only during the weekends, whereas SEVAKs in India are full-time workers and are paid a salary. The Guyana Project involves coordinating with the villages and identifying bright, interested individuals with, medical and or nonmedical, backgrounds (one per a village of 1,000–1,500 population) to be SEVAKs. Training includes techniques for good sanitation practices, safe drinking water, smoking cessation and malaria prevention. SEVAKs are also trained for monitoring/recording of blood pressure, blood sugar, observing for peripheral edema, lifestyle modification education and noting dietary practices, so that they could keep better surveillance on the health of their respective villages. Biology teachers from the local school accomplish day-to-day supervision of the Guyana SEVAKs. The SEVAK Project in Guyana recently received approval from the Government of Guyana. Preand postevaluation of the training is done by the authors via Internet and visits to India and Guyana. During these visits, we accompany the SEVAKS in the field and monitor their progress. Particular attention is paid to visit the patients who have been diagnosed with hypertension and diabetes to confirm the findings of the SEVAKS. Our preliminary *Division of Global Health, Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. †Department of Medicine, University of Pittsburgh Medical Center, 3550 Terrace Street, Pittsburgh, PA 15261. ‡Government Medical College, Khatodra Wadi, Surat, Gujarat 395001, India. §Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. The views expressed are those of the authors and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the U.S. Navy, the Department of Defense, or the U.S. Government. doi: 10.7205/MILMED-D-15-00340

Risk factors for low high-density lipoprotein among Asian Indians in the United States

AIM To examine the differences in metabolic risk factors (RFs) by gender in the Asian Indian (AI) population in the United States. METHODS Using cross-sectional data from 1038 randomly selected Asian Indians, we investigated the relationship between metabolic syndrome (MetS) RFs, cardiovascular disease, and diabetes. RESULTS A greater percent of women in this group had increased waist circumference and low high density lipoprotein (HDL) levels than men, but AI males had increased blood glucose, increased blood pressure, and increased triglycerides compared to females. Those individuals who met the MetS criteria had increased cardiovascular disease. One of the biggest single RFs for cardiovascular disease and diabetes reported in the literature for AIs is low HDL. CONCLUSION Our results show that lack of knowledge about diabetes, low physical activity, increased body mass index, and age were the factors most significantly correlated with low HDL in this population. Future studies and prospective trials are needed to further elucidate causes of the MetS and diabetes in AIs.

Diabetes, hypertension, sanitation, and health education by high school students in Guyana, South America

We initiated a program for early detection of diabetes and hypertension, the main causes of kidney failure in Guyana, South America. We trained local high school students with the goal that these students would stay in the villages for long-term, become health advocates and shift the reliance away from physicians. This project involved 7 high school students who were taught to monitor the health of one village of 1000–1500 population each. The program will be implemented for 3 years in which the entire population of seven villages (approximately 10,000 people) will be covered. This represents 1.3% population in Guyana. We present data from the pilot study from the sample of 619 people. The prevalence of diabetes mellitus was 13.9%. Among diabetics, 33.7% were using insulin and 86% oral hypoglycemic agents. Prevalence of hypertension was 29.4%, 63.2% were overweight and 17% were obese. About 9.9% patients were unaware about the existence of hypertension. We have shown in our study that high school students can be used to collect health data and monitor diabetes and hypertension. There was also a significant incidence of undetected diabetes and hypertension.

Vegetarian Diet and Cardiometabolic Risk among Asian Indians in the United States

Research studies have shown that plant-based diets confer cardiovascular and metabolic health benefits. Asian Indians (AIs) in the US (who have often followed plant-based diets) have elevated risk for chronic diseases such as diabetes, metabolic syndrome, and obesity suggesting ethnic vulnerability that imply genetic and/or lifestyle causative links. This study explored the association between this ethnic group and diabetes, obesity, and metabolic syndrome after controlling for demographics, acculturation, family history of diabetes, and lifestyle and clinical risk factors. The sample comprised of 1038 randomly selected adult AIs in seven US sites. Prevalence and metabolic syndrome was estimated, and obesity was calculated using the WHO Asian criteria. Multivariate analysis included multinomial logistic regression. The mean age and length of residency in the US were 47 and 18.5 years, respectively. The majority of respondents were vegetarians (62%) and educated. A vegetarian lifestyle was associated with females, food label users, respondents with poor/fair current health status, less acculturated, and those who reported their diet had not changed after coming to the US. Vegetarian status was a protective factor and lowered the risk for diabetes but not for metabolic syndrome and obesity in the regression model. Results provide a firm basis for educational programs.

Red Meat Consumption (Heme Iron Intake) and Risk for Diabetes and Comorbidities

Purpose of ReviewTo examine the role of red meat consumption, especially heme iron intake, and risk for diabetes and its comorbidities.Recent FindingsStudies consistently show that consumption of red meat has been contributory to a multitude of chronic conditions such as diabetes, CVD, and malignancies. There are various emerging reasons that strengthen this link—from the basic constituents of red meat like the heme iron component, the metabolic reactions that take place after consumption, and finally to the methods used to cook it. The causative links show that even occasional use raises the risk of T2DM.SummaryPrior studies show how nitrites and nitrates in red meat can lead to increased insulin resistance, dysregulated blood glucose levels, and elevated oxidative stress all leading to chronic diseases. With the rise in these preventable chronic diseases, we examine how disease-causing links can be eliminated with appropriate lifestyle choices.

Incidence of diabetes and hypertension in indigenous Amerindian village in Guyana, South America

389 Indian Journal of Nephrology Sep 2016 / Vol 26 / Issue 5 Mission) Guyana, South America. The village is home to approximately 200 people of mainly Arawak descent, where there is no health care.[1] The approximately 740,000 people living in the country is made up out of Amerindians (5.3%), Blacks (30.5%), East Indians (51.4%), Chinese (0.2%), White (2.1%), and Mixed (10%).[1] Population mix of the country lends itself to anthropological, social, lifestyle, and genetic studies which may yield important information.[2]