A comprehensive yoga programme for weight reduction in children & adolescents with obesity: A randomized controlled trial

Background & objectives: Obesity is a rising pandemic in childhood. There is scarcity of evidence on the efficacy of yoga in achieving weight loss in overweight/obese children. The objective of this study was to assess the efficacy of family-based comprehensive yoga intervention in the reduction of body mass index (BMI) in overweight/obese children, in comparison to standard dietary and lifestyle counselling and control group. Methods: This was an open-label randomized controlled study. Children aged 8-15 yr who were overweight or had obesity were randomized to one of the three arms for 18 wk; standard weight management (group 1), yoga with dietary modification (group 2) and control (no intervention; group 3). Reduction in BMI and improvement in physiological, biochemical and psychological parameters from baseline to 18 wk was compared between the three arms. Late follow up was also done at 6-12 months. Results: A total of 165 children with mean±standard deviation (SD) age of 11.6±1.8 yr and mean BMI 26.3±4.2 kg/m2 were enrolled. Outcome analysis at 18 wk was performed for 109 children. Improved diet quality and reduced intake were observed in both intervention arms. The median (IQR) reduction in BMI in standard and yoga arms was similar [?1.4 (?3.1, ?0.5) kg/m2 and ?1.2 (?2.3, ?0.6) kg/m2, respectively], while it increased by +0.3 (?0.3, 0.1) in the control arm. In the yoga arm, mean systolic BP reduced from 118 (10) to 114 (8) mmHg, (P=0.019). In the standard arm, significant improvement in psychological scores was noted. In group 3, the mean fasting glucose increased from 93±10 to 102±12 mg/dl (P<0.001). Interpretation & conclusions: The findings of the present study suggest that yoga in conjunction with dietary modification is equally effective as the standard weight management for BMI reduction in the paediatric age group.

Interleukin-6, vitamin D & diabetes risk-factors modified by a short-term yoga-based lifestyle intervention in overweight/obese individuals.

Background & objectives: Several diabetes prevention programmes have demonstrated a reduction in incidence of diabetes in individuals with prediabetes through weight loss. Short-term yoga-based lifestyle intervention programmes have also been shown to be efficacious in weight loss. This study was undertaken to investigate if interleukin (IL)-6, vitamin D, neopterin, vaspin, and diabetes risk factors can be modified by a short-term yoga-based lifestyle intervention in overweight/obese subjects. Methods: In this pilot study, 34 overweight/obese [body mass index (BMI) ≥23 to <35 kg/m2 per Asian cut-off values] individuals were enrolled, and received directly supervised intervention for 10 days. Thereafter, they were advised to follow this yoga-based lifestyle at home for one month, and were reassessed for study variables at day 30. Results: There was a reduction from baseline to day 10 in weight (p<0.001), BMI (p<0.001), waist/hip-ratio (p<0.05), blood glucose (p<0.01), and a significant improvement in lipid profile. There was a decrease in median fasting insulin (p<0.05), homeostatic model assessment-insulin resistance (p<0.01), and IL-6 (p<0.05). A non-significant increase in 25-OH-vitamin D, and a decrease in neopterin and vaspin were observed. Twenty subjects returned for follow up assessments. At day 30, weight loss was sustained while systolic blood pressure also showed reduction (p<0.05). Changes in vitamin D levels were significantly and negatively correlated with changes in weight, BMI and fasting blood glucose, and positively with change in high density lipoprotein. Changes in body weight and BMI significantly and positively correlated with insulin. Changes in IL-6 levels positively and significantly correlated with change in neopterin levels. Interpretation & conclusions: the findings showed that IL-6, vitamin D, and diabetes risk factors were favourably modified by a short-term yoga-based lifestyle intervention in obesity. This study also highlighted the challenges in compliance associated with the follow up of subjects following an aggressive supervised intervention of 10 days.

Age and gender might influence big five factors of personality : a preliminary report in Indian population.

Age and gender are two important physiological variables which might influence the personality of an individual. The influence of age and gender on big five personality domains in Indian population was assessed in this cross-sectional study that included 155 subjects (female=76, male=79) aged from 16-75 years. Big five personality factors were evaluated using 60-item NEO-Five Factor Inventory (NEO-FFI) at a single point in time. Among the big five factors of personality, Conscientiousness was positively correlated (r=0.195; P<0.05) with age in total study population, and retained the significance (P<0.05)in men only when analyzed by gender subgroups. Further, age and gender sub-group analysis also showed that Neuroticism was inversely correlated with age in women aged 26-35 years (P<0.05). Neuroticism and Extraversion showed a positive correlation with age in men aged 36-45 years (P<0.001 and P<0.05, respectively). Neuroticism was inversely correlated with age in men aged 46-55 years (P<0.05). This preliminary report suggested that personality traits might change with age, and is gender-dependent.

Obesity-related inflammation & cardiovascular disease: Efficacy of a yoga-based lifestyle intervention.

Obesity is a global health burden and its prevalence is increasing substantially due to changing lifestyle. Chronic adiposity is associated with metabolic imbalance leading to dyslipidaemia, diabetes, hypertension and cardiovascular diseases (CVD). Adipose tissue acts as an endocrine organ releasing several adipocytokines, and is associated with increased levels of tissue and circulating inflammatory biomolecules causing vascular inflammation and atherogenesis. Further, inflammation is also associated independently with obesity as well as CVD. Keeping this in view, it is possible that a reduction in weight may lead to a decrease in inflammation, resulting in CVD risk reduction, and better management of patients with CVD. Lifestyle intervention has been endorsed by several health authorities in prevention and management of chronic diseases. A yoga-based lifestyle intervention appears to be a promising option in reducing the risk for CVD as well as management of patients with CVD as it is simple to follow and cost-effective with high compliance. The efficacy of such lifestyle intervention programmes is multifaceted, and is achieved via reduction in weight, obesity-related inflammation and stress, thereby culminating into risk reduction towards several chronic diseases including CVD. In this review, the association between obesity-related inflammation and CVD, and the role of yoga-based lifestyle intervention in prevention and management of CVD are discussed.

Evaluation of lactose and milk intolerance, and bone mineral density in Indian patients with inflammatory bowel disease.

Background. A misconception that milk and lactose intolerance increases disease activity in inflammatory bowel disease leads to the exclusion of dietary dairy products, and patients are at an increased risk of low bone mineral density. Methods. Patients with inflammatory bowel disease (n=45, 19 men and 26 women) and healthy controls were included in this prospective open-label study. As part of exploratory dietary intervention, patients were advised to exclude milk and milk products from diet for the first 7 days and reintroduce at least 250 ml of milk for the next 21 days. Milk and lactose intolerance was assessed in patients and healthy subjects using clinical symptoms and lactose hydrogen breath test, respectively; bone mineral density was assessed in patients using a Hologic QDR 4500A DXA machine. Results. Milk and lactose intolerance was statistically comparable in patients with inflammatory bowel disease (31% and 44%, respectively) and healthy subjects (22% and 27%, respectively). Most of the patients (40%) had excluded dairy products from their diet, and 53% had dietary intake of calcium <200 mg/day. More than 60% of the patients had either osteopenia or osteoporosis. Conclusion. Milk and lactose intolerance in patients with inflammatory bowel disease was not different from that in healthy subjects. The proportion of patients with osteoporosis and osteopenia was high in this population. Hence, patients with inflammatory bowel disease in remission phase may be encouraged to add dairy products in their diet, unless otherwise indicated.

A pilot study on short term heart rate variability & its correlation with disease activity in Indian patients with rheumatoid arthritis.

Background & objectives: Cardiovascular complications may lead to mortality in patients with rheumatoid arthritis (RA). We assessed heart rate variability (HRV), an important autonomic function, to quantify the risk for cardiovascular complications in Indian patients with RA. Methods: The study was carried out in RA patients (n=45) diagnosed as per American College of Rheumatology criteria and healthy controls. HRV recording and analysis was done using Nevrokard software using time and frequency domain analyses. The overall autonomic tone, parasympathetic drive, sympathetic drive and sympatho-vagal ratio were quantified by using various parameters. It included standard deviation of all R-R intervals (SDNN), standard deviation of successive differences between adjoining normal cycles (SDSD), root-mean square of successive differences (RMSSD), and number of R-R intervals differing by >50 ms from adjacent intervals (NN50) in the time domain analysis. In frequency domain analysis, low frequency (LF) and high frequency (HF), LF/HF and total power were assessed. Results: Demographic profile was comparable between groups; however, systolic BP was higher in patients with RA. SDNN, SDSD, RMSSD, NN50, LF and HF power and total power (ms × ms) were significantly lower in patients with RA versus healthy controls (P<0.001). Disease activity score at 28 joints indicating severity of the disease was significantly and positively correlated with SDSD (r=0.375, R2=14.06; P=0.045) while LF and HF power (ms × ms) were significantly and inversely correlated with rheumatoid factor (r=-0.438 and -0.445; R2=19.1 and 19.8; P=0.017 and 0.016, respectively). Interpretation & conclusions: HRV was significantly altered in patients with RA and independently associated with disease activity. Hence autonomic function testing, using HRV, may be useful as part of cardiovascular risk assessment in these patients.

Autonomic status in systemic sclerosis in India.

Systemic sclerosis (SSc) is a systemic connective tissue disease characterized by vasomotor disturbances. Autonomic dysfunction has been implicated in the pathogenesis of various symptoms in patients with SSc. In this retrospective study, thirty patients with SSc as cases and thirty age matched healthy subjects were enrolled as controls. The patients as well as controls were subjected to a standard battery of autonomic tests including reactivity and activity (tone) tests. Resting autonomic variables like blood pressure (BP), heart rate (HR) and respiratory rate (RR) were also recorded. In our study, we found significantly higher HR and RR in the patient group (P = 0.0001 and 0.012 respectively). We also observed significantly lower parasympathetic tone and parasympathetic reactivity in SSc patients than the controls. This study shows the status of autonomic functions in SSc patients in India, with lower central parasympathetic drive to the heart. The present study may give some insight for better understanding of this multisystem disorder of unknown etiology.

Effect of a comprehensive yoga-based lifestyle modification program on lipid peroxidation.

Oxidative stress contributes to the process of aging as well as a variety of chronic degenerative diseases. There are indications that psychological stress increases oxidative stress whereas relaxation decreases it. We have measured the concentration of thiobarbituric acid reactive substances (TBARS) in blood as an indicator of oxidative stress at the beginning and at the end of a comprehensive yoga-based lifestyle modification program (YLMP). The data was collected from 104 subjects (59 male, 45 female), 19-71 years of age (mean +/- SD, 41.2 +/- 14.6 years). The YLMP consisted of a nine-day educational out-patient course on the theory and practice of yoga and included, besides a daily one-hour practice of physical postures (asanas) and breathing exercises (pranayama), lecture and films on yoga, stress management and nutrition, practice of meditation and shavasana (a relaxation technique), and individual counseling. Venous blood samples were collected on the first and last day of the course. The serum concentration of TBARS decreased significantly from 1.72 +/- 0.72 nmoles/ml on day 1 to 1.57 +/- 0.72 nmoles/ml on day 10 (P<0.05). The study suggests that a brief low cost lifestyle intervention based on yoga reduces oxidative stress.

Effects of garlic (Allium sativum) extract on the heart rate, rhythm and force of contraction in frog: a dose-dependent study.

Garlic juice (dose equivalent to 3.3 g to 33 g garlic) mainly caused bradycardia in frog Rana tigerina. The disturbance in ventricular rhythm was observed prior to than that of atria. Rhythm was specially disturbed at higher doses causing bizarre pattern. Force of contraction of the heart also decreased with higher dose of the garlic extract. The results suggest that garlic extract has some beneficial effect on heart rate modulating the rate, rhythm and force of contraction positively but very high doses may exert non-desirable effects as well.

Effect of protein malnutrition on the intestinal absorption of monosaccharides in rats in vivo.

The present study was planned to elucidate the role of protein malnutrition on the intestinal absorption of monosaccharides particularly--glucose and xylose, in inbred female albino rats. The experimental rats were fed with protein deficient diet containing 3% protein, whereas the control rats were given a diet containing 18% protein. The study on intestinal absorption of monosaccharides was conducted on both the groups of rats after the 7th and 15th day of receiving respective diets. The results indicated no significant impairment of glucose absorption of experimental rats fed 3% diet for 7 days as compared to the controls. However a 42% decrease in glucose absorption was observed when the animals were fed with the same diet for 15 days. The impairment was significant in all segments of intestine suggesting diminution in the absorption capacity of small intestine in malnutrition perhaps as a result of some permanent injury to mucosal cells of small intestine. Regarding xylose absorption, in experimental rats an increase of intestinal uptake was noticed in most of the segments of small intestine as compared to control rats.