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Biomedical subjects

V Vijay

Publications and source records attributed to V Vijay.

At least 55 records · Page 3Linked to original sources
PubMed1999

Impacts of urbanisation on the lifestyle and on the prevalence of diabetes in native Asian Indian population.

Recent studies from the Asian subcontinent show an increasing prevalence of diabetes. This increase has been attributed to factors related to lifestyle changes related to modernisation. A periurban rural population resembling the rural in their occupation, but with access to certain urban facilities was chosen for this study. The aim of the study was to assess the impact of modernisation on the rising prevalence of diabetes in the native Indians. A total of 1637 adults aged 20 years and above (749 men and 888 women) were tested for diabetes and impaired glucose tolerance (IGT) by 2 h post-glucose challenge. Demographic, anthropometric, dietary and occupational details, were recorded. Dietary habits were similar in all categories of socio-economic strata. In the present study group, the age standardised prevalence of Type 2 diabetes was 5.9%, which was intermediate to that in the urban (11.6%) and rural (2.4%) populations. The prevalence data of the latter two population were available from previous surveys. Prevalence of impaired glucose tolerance (IGT) was high (6.9%) and similar in all three population samples. In the periurban population, a large percentage of subjects were doing only routine household work and had a sedentary life-style. After correcting for the age and BMI, sedentary work and occupation had a significant association with diabetes, suggesting that sedentary lifestyle may be an important determinant for the higher prevalence of diabetes in an urbanising population.

Adult↗
PubMed1999

Insulin secretion and action in different stages of glucose tolerance in Asian Indians.

AIMS: To evaluate the sequence of changes in insulin secretion and action in different stages of glucose tolerance and the effect of obesity on insulin profile in South Indian adults. Blood samples from 260 consecutive cases with no known history of diabetes were collected. Plasma insulin levels were measured during a 75-g oral glucose tolerance test. Insulin resistance (IR) was calculated, using the homeostasis model assessment (HOMA). An index of insulin secretion was derived as the ratio of incremental insulin at 30 min divided by 30 minute plasma glucose (delta I/G). RESULTS: Normoglycaemia was present in 164, impaired glucose tolerance (IGT) in 60 and diabetes in 36 subjects. Fasting and 2 h insulin secretion showed bell shaped curves with increasing plasma glucose. The peak values corresponded to the cut-off values used for the diagnosis of clinical diabetes. IR was higher in obese than in nonobese, nondiabetic subjects but the effect of obesity on IR was not found in subjects with diabetes. IGT was associated with higher IR, but not with evidence of a beta-cell defect. CONCLUSIONS: Evaluation of insulin resistance and beta-cell function in different stages of glucose tolerance indicate that insulin resistance is manifested in the early stage of glucose intolerance in South Indians, i.e. IGT. A beta-cell defect was mostly found in people with diabetes. The beta-cell defect is more common in diabetes among the nonobese.

Adult↗
PubMed1999

Setting up a breast cancer family history clinic.

Breast cancer causes around 21,000 deaths per year in the UK, the vast majority of these occurring in women aged over 50 years with no genetic predisposition to the disease. Screening and symptomatic services for these women, although by no means perfect or homogeneous, have gradually improved over the last 10 years and, perhaps as a result of this, together with increased use of adjuvant systemic therapy, mortality in this group has fallen. Despite this reassuring state of affairs, media interest in the disease and patients' perception of their risk of developing breast cancer have risen. Part of this is undoubtedly due to the new scientific developments in cancer genetics and, in particular, identification of the BRCA1 gene in 1994 and BRCA2 gene shortly afterwards. These genes are dominantly inherited with up to 80% penetrance; thus, women (and occasionally men) inherit these genes and have a high lifetime risk of developing breast cancer, usually at a younger age than average and possibly of a more aggressive phenotype. Unaffected family members can now be screened and, if they prove carriers, screening for early detection and prevention strategies such as bilateral prophylactic mastectomy can be offered. Because of the high risk of ovarian cancer in BRCA1 carriers, screening or prophylactic ovariectomy may also be considered.

Adult↗
PubMed1999

Influence of life style factors in development of diabetes in Indians--scope for primary prevention.

OBJECTIVE: The objective of the study was to evaluate the influence of physical activity and stress factors on the development of diabetes mellitus (DM). METHODS: One hundred and eighty-seven adult subjects (M:F 112:75), registered in the primary prevention of diabetes programme for 2 or more years were studied prospectively. The study was done only in those who had either normal glucose tolerance (NGT) or diabetes at the time of review (tR). At entry (tE), 121 (64.7%) had normal glucose tolerance (NGT) and 66 (34.3%) had impaired glucose tolerance (IGT) by the WHO criteria. Dietary modifications and regular exercise programme were advised. Dietary modifications and regular exercise programme were advised. Study subjects were reviewed during August 1997 to October 1998. At review (TR) none had known history of diabetes. At TR, the status of glucose tolerance was assessed by oral GTT and influence of intervention measures and evaluation of the role of physical and psychological stress on glucose tolerance were assessed by a questionnaire method. RESULTS: At tR, 100 (53.5%) had NGT, and 87 (46.5%) had developed diabetes (DM). Adherence to exercise and other preventive measures was poor in the DM compared to nondiabetic group (NGT) (P < 0.0012). They showed lower dietary adherence (P = 0.042) and scores on mental stress was higher than in NGT group (P < 0.001). After controlling for age, gender and the initial 2 h plasma glucose, non-adherence to exercise and high scores of psychological stress showed strong association with diabetes. CONCLUSION: In this study, significant and independent roles of physical inactivity and psychological stress factors are demonstrated in the development of diabetes.

Adult↗
PubMed1999

Prevalence of vascular complications and their risk factors in type 2 diabetes.

OBJECTIVE: a) To determine the prevalence of microvascular and macrovascular complications in Type 2 diabetes in India and b) to identify the major factors for the complications. METHODS: A study was done in 3010 subjects (M:F 1892:1118, Mean age 52 +/- 9.7 years) attending a diabetic clinic. The study sample resembled the population sample in anthropometry, age and socioeconomic factors. All patients had undergone the tests for retinopathy, nephropathy, neuropathy, peripheral vascular disease (PVD) and cardiovascular disease by ECG. RESULTS: Retinopathy was diagnosed in 23.7% (background retinopathy in 20.0% and proliferative in 3.7%), proteinuria was present in 19.7% and persistant proteinuria of > or = 500 mg/dl was seen in 5.5% of them, CHD was present in 11.4% and PVD was present in 4.0%. Of the total 119 cases with PVD, 18 had gangrene and 21 had undergone amputations. Peripheral neuropathy was present in 27.5%. Cerebrovascular accidents were reported in 26 cases (0.9%). Hypertension was present in 38% of the cases. Multiple logistic regression analyses showed that age had a significant association with retinopathy, neuropathy, CHD and PVD. Duration of diabetes had significant association with the complications other than CHD. Higher HbA1 increased the risk of retinopathy, neuropathy and nephropathy. Hypertension was associated with the complications except PVD and neuropathy. The strongest association was between hypertension and nephropathy. CONCLUSION: The study highlights the high prevalence of vascular complications in Type 2 diabetes in India. Retinopathy and neuropathy were the commonest complications of diabetes.

Diabetes Mellitus, Type 2↗
PubMed1999

Difference in body fat percentage does not explain the gender dimorphism in leptin in Asian Indians.

OBJECTIVE: Leptin is a hormone probably having regulatory function on energy intake and metabolic activities in humans. The study was done: (a) To determine the relation of leptin with the body fat% in Indians, (b) To see whether the differences in body fat accounted for the gender differences in the concentration of leptin and (c) to look for the effect of diabetes on the levels of leptin. METHODS: Glucose tolerance was determined by oral glucose tolerance test (GTT) in 87 subjects with no known history of diabetes. Leptin was estimated by radio immuno assay. Age, height, weight, waist and hip circumferences were noted. Body mass index (BMI, weight kg/height m2) and waist:hip ratio (WHR) were calculated. The body fat % was estimated by bioelectrical impedance analysis. RESULTS: Leptin correlated with log fat % and BMI, body weight and waist circumference in different categories of glucose tolerance (Pearson's correlation test). Leptin values were higher in women than in men even after correcting for the body fat % indicating that the gender dimorphism was not explained by the higher fat % in women. The geometric mean of leptin concentration in men was 3.6 ng/ml and in women 10.9 ng/ml (P < 0.0001). Leptin level were not influenced by the status of glucose tolerance. Gender showed a significant effect on leptin concentration (F = 11.0, df = 1.39, P = 0.002) after adjusting for the effect of covariates i.e. percentage of fat (log), BMI, age, WHR and 2 h plasma glucose by ANCOVA. None of the covariates except BMI (P < 0.0001) showed significant correlation with leptin. The total variance explained was 68.4%. CONCLUSION: We conclude that (1) Plasma leptin is strongly correlated to the body fat content (2) the gender dimorphism of leptin is not explained by the differences in fat percentage and (3) hyperglycemia does not influence plasma leptin levels.

Adipose Tissue↗
PubMed1999

Patients' adherence to diabetes treatment.

OBJECTIVES: a) To evaluate the patients' adherence to the treatment prescriptions and b) to analyse the reasons for non adherence. METHODS: A random sample of 386--type 2 diabetic subjects (M:F 223:163) were studied. Each subject was personally interviewed using a computerised proforma. The mean age of the study group was 52 +/- 10 years and 53% were treated with oral hypolycenic agent (OHA) and the rest with a combination of insulin and OHA. The mean duration of diabetes was 11.0 +/- 6.9 yrs. The overall adherence to the treatment regimen, diet and drug prescriptions and also regularity of home glucose monitoring by blood or urine tests were assessed. RESULTS: It was noted that only 25% of the study group were adhering to the treatment regularly. Dietary prescriptions were followed regularly only by thirty seven percent. Home glucose monitoring was being done only by twenty three percent. Non adherence was not related either to the age or duration of diabetes. Non adherence was more in the lower socio-economic group and was inversely related to the educational status. It was noted that approximately 20% of the subjects had an indifferent attitude to the advice given. CONCLUSIONS: The results showed that the rate of non adherence of treatment prescriptions was high. It stresses the need for constant motivation and one to one level education at frequent intervals to ensure better compliance to the treatment.

Adult↗
PubMed1998

Plasma leptin is not associated with insulin resistance and proinsulin in non-diabetic South Asian Indians.

In an earlier study, we observed only a weak association between plasma insulin (non-specific assay) and leptin in South Asian Indians. This was in contrast to the observations in many other ethnic groups. With the availability of measurements of specific insulin (SI) and proinsulin (PI) in the same study group, we have reanalysed the data to look for possible correlation of leptin with proinsulin and with insulin resistance calculated from the fasting values of specific insulin and glucose using the HOMA model. Subjects with normoglycaemia (n = 117) and impaired glucose tolerance (n = 27, WHO criteria) were included in the analysis. Leptin values were higher in women. Multiple linear regression analysis showed that the variations in leptin concentrations in men were associated with BMI, WHR, and 2 h SI values (R2 = 56.2%) while fasting SI and proinsulin concentrations had no significant association. In women BMI and age showed a significant association with serum leptin values (R2 = 40.1%). Univariate and multivariate analyses using insulin resistance as the dependent variable showed that it had no association with leptin in both genders. Leptin had no correlation with proinsulin also. This study confirmed that in Asian Indians the association between plasma leptin and insulin concentrations is weak and that leptin has no influence on insulin resistance. Proinsulin and leptin are also not correlated in this population. Insulin resistance shows correlation with the beta-cell function both in men and women.

Adult↗
PubMed1998

Specific insulin and proinsulin concentrations in nondiabetic South Indians.

The study was performed to determine plasma levels of proinsulin (PI) and specific insulin (SI) in normoglycemic (NGT) Asian Indians and to assess the effect of obesity and impaired glucose tolerance (IGT) on these concentrations. Blood samples from 151 adult nondiabetic South Indian subjects were collected during an epidemiological survey of diabetes. Plasma SI and PI levels were measured in fasting and 30-minute and 120-minute samples of a glucose tolerance test (World Health Organization criteria) using monospecific antibodies. The total insulin (TI) level was also measured by the nonspecific assay. The molar ratio of PI to SI (PI/SI) was calculated. Correlations of the peptides with anthropometry, serum lipids, and blood pressure (BP) were studied by univariate and multivariate analyses. Comparisons were also made in NGT versus IGT groups. As expected, TI values were higher than SI values, but the patterns of response were similar for both. SI and PI responses in NGT were similar to the values found in Mexican-Americans who had a higher body mass index (BMI). Asian Indians were thus found to have a high SI response despite a low BMI. Obesity and IGT produced an increased response of both PI and SI, with normal PI/SI ratios thus showing an absence of hyperproinsulinemia in either condition. Fasting PI showed a strong association with serum triglycerides, and proinsulin at 120 minutes was associated with cholesterol. None of the peptides showed a correlation with BP. Using specific assays for insulin and PI, it is shown that Asian Indians with NGT have a hyperinsulinemic response despite a low BMI. Obesity and mild hyperglycemia in IGT produce a simultaneous increase in PI and SI with no alteration in the PI/SI ratio.

Adult↗
PubMed1998

Effects of genetic predisposition on proinsulin responses in Asian Indians.

This study was done in adult offspring of two diabetic (NIDDM) parents (ODP) to look for changes in specific insulin (insulin) and proinsulin responses due to strong familial background and also in different states of glucose intolerance. Equal numbers (20 in each group) of ODP with normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and diabetes (DM) were chosen. Twenty, age and BMI matched healthy controls, without family history of diabetes, were also studied for comparison. Plasma specific insulin and proinsulin were measured by radioimmunoassays in fasting and 120' plasma samples collected during the GTT. Proinsulin to insulin ratio were calculated. Insulin resistance (IR-HOMA) was calculated. In NGT, fasting proinsulin-insulin ratio was significantly higher than the control value (P = 0.023). Insulin values at 120' was higher than control values, though it did not reach statistical significance. Proinsulin at 120' was higher than controls (P = 0.016). In IGT, the fasting proinsulin to insulin ratio, the 120' proinsulin and insulin values were higher than controls (P = 0.048, 0.0013 and 0.0001, respectively). Fasting proinsulin-insulin ratio in IGT was similar to the value in NGT. In diabetic subjects proinsulin concentrations were significantly higher than controls at fasting (P = 0.0004), and 120' (P = 0.0007). The fasting values were higher compared to NGT also (P = 0.037). Proinsulin-insulin ratios were higher than the values in controls (P = 0.0008), IGT (P = 0.047) and NGT (P = 0.05). Diabetic subjects had higher fasting insulin values compared to the control values although between the groups no statistical significance was found (P = 0.22 by Kruscall Wallis test). At 120' both insulin and proinsulin values increased from NGT to IGT, but with development of diabetes a reduction was seen in the responses. Insulin resistance (IR-HOMA) increased steadily from NGT to diabetes. The difference between NGT and controls in IR was not statistically significant. This study of Asian Indian offspring of diabetic parents has shown that genetic predisposition to diabetes resulted in increased proinsulin to insulin ratio at the fasting state. Absolute hyperproinsulinaemia occurred only with development of diabetes.

Adult↗
PubMed1998

Foetal outcome in gestational diabetes in south Indians.

The study was performed to reassess the prevalence of gestational diabetes mellitus (GDM) in south Indians and to study the foetal outcome in women with GDM in comparison with normal pregnancies. In 1036 pregnant women, glucose tolerance was tested with 75-g oral glucose load, in the second or third trimester. Those with 2-h plasma glucose of > or = 200 mg/dl were considered as diabetic (WHO Criteria). Those with 2-h values of 140-199 underwent a 3-h glucose tolerance test (GTT) with 100-g glucose load (O'Sullivan and Mahan criteria). GDM was diagnosed in nine women (0.87%) by this criteria. Foetal outcome in 211 GDM referred to the diabetes centre was compared with the outcome in 853 normal pregnancies. There were no cases of aborted pregnancy among the GDM, while six cases were reported among the normal glucose tolerance (NGT). Still birth and the number of premature babies were higher in GDM. Babies with birth weight > or = 3.5 kg were more among the GDM (P < 0.001). There was no difference in the occurrence of congenital anomalies in the two groups. It was noted that congenital abnormalities in the foetus were more common among those born of mothers with higher plasma glucose (9 versus 1.1%). Multiple linear regression analyses in NGT and GDM showed that the birth weight of the baby was dependent on the plasma glucose and the body mass index of the mothers. The results of the present study show that the prevalence of GDM in urban south India was low, when the NDDG criteria was used. It also indicated that the WHO criteria may be more appropriate as the foetal outcome was determined by even a small rise in maternal plasma glucose. With good metabolic control in GDM, the foetal risks are very much reduced.

Adolescent↗
PubMed1998

Dietary profile of urban south Indians and its relations with glycaemic status.

This study was done to analyse the dietary profile of urban south Indian adults. It was also aimed to study, if the dietary profile influenced the glycaemic and anthropometric data. Dietary details were collected in a representative urban sample of 900 study subjects in the epidemiological survey for diabetes conducted in 1995 in the city of Madras. The details were collected by a 24-h recall method. All the dietary factors were similar in the non-diabetic (NGT) and newly diagnosed diabetic cases, but the values were lower in known diabetic cases due to dietary modifications (P < 0.001 for all compared to NGT and new diabetic cases). For further analysis, known diabetic cases were deleted and the rest were combined as one group. Men consumed higher calories (2066+/-437, range 1028-3662 kcal) than women (1745+/-343, range 870-3260 kcal) (P < 0.01). Older persons consumed lower calories and percentages of the proximate principles in diet were proportionately lower. Higher calorie consumption was due to consumption of higher quantities of food and not any specific dietary factor. BMI, WHR, plasma glucose, serum cholesterol and triglycerides were not significantly influenced by the total calorie consumption. Calorie consumption was higher in persons engaged in strenuous physical activity. Total calories and proportionately the proximate principles of diet were less in the high income group. The similarity in diet in the non-diabetic and the newly diagnosed diabetic persons showed that the development of diabetes was probably not related to changes in dietary habits. Lower consumption of calories and carbohydrates by the known cases of diabetes was due to the dietary modifications introduced in the management of the disease. Lower calorie consumption in women and older people could be related to lower physical activity. This study shows a uniform dietary pattern among the different strata of society with minor variations based on age, gender and physical activity. No difference has been noted in dietary habits of the newly diagnosed diabetic subjects and the non-diabetic adults.

Adult↗
PubMed1998

Clustering of cardiovascular risk factors in urban Asian Indians.

OBJECTIVE: To study the prevalence of cardiovascular risk factors in native urban Asian Indians and to look for the occurrence of clustering of these factors. RESEARCH DESIGN AND METHODS: The study included 953 subjects (532 men and 421 women), aged > or = 40 years, selected from a population survey for diabetes, which was conducted in 1994 in Madras, Tamil Nadu, India. Measurements of anthropometry, blood pressure, plasma lipid profile, glucose tolerance, plasma insulin response, and electrocardiogram were made. Based on the normal ranges derived from the population study, abnormalities in anthropometric values, plasma lipids, and insulin values were determined. Age-adjusted prevalences of the abnormalities were calculated using data from a 1991 urban census in Madras. The expected prevalences of the abnormalities in isolation and in combinations were calculated and compared with the corresponding observed figures. RESULTS: The prevalences of risk factors were in the order of central adiposity > dyslipidemia > hyperinsulinemia (2-h) > glucose intolerance > obesity > hypertension. The age-adjusted prevalence of coronary heart disease (CHD) was 3.9% (3.5% in men and 4.5% in women, NS), and T wave inversion was seen in an additional 10.3%. Isolated prevalences of all factors, except hypertension, were in lower frequency than expected. Combinations of each risk factor with one or two more risk factors occurred more frequently (1.3-4 times) than expected by chance. Impaired glucose tolerance and dyslipidemia showed association with hyperinsulinemia, whereas hypertension did not show such an association. CONCLUSIONS: Clustering of the cardiovascular risk factors or the components of insulin resistance syndrome occurs in the native Asian Indian population. This finding under-scores the need for preventive aspects of metabolic disorders and CHD.

Adult↗