RESUMO
Background: Recent studies have shown the association of disproportionate body size measurements with noncommunicable diseases like diabetes. This concept is described in Ayurveda (1500 BC), which uses Anguli Parimana (the breadth of one’s own finger as 1 unit) to measure the body proportions. Excessive tallness or shortness (deviation from the reference value of Anguli Parimana) indicated deranged meda dhaatu (mainly adipose tissue). Deranged meda dhatu was associated with Prameha (diabetes). Objectives: To find association of Anguli Parimana with modern parameters of adiposity and diabetes. Materials and Methods: We studied 192 village residents representing the whole population (94 men and 98 women) to measure height, arm span, facial structures and limbs and expressed them in Anguli pariman (ratio of each measure as: Length or height of the body part [cm]/anguli, i.e. average finger breadth [cm]). The Anguli measurements were associated with body mass index, body fat percentage by DEXA, glucose and fasting insulin levels. Results: The volunteers were adults between 20 and 40 years age. Their mean fasting and 2 h plasma glucose concentrations were 91.6 mg% and 102.8 mg%, respectively. Of all, only 6 subjects had impaired glucose tolerance, while 3 were diabetic (WHO 1999). When compared with reference Anguli measurements mentioned by Charaka Samhita and Sushruta Samhita, the participants had smaller height, facial structures, and lower limbs. Those, who had proportionately smaller facial, neck and limb structures, had higher obesity, adiposity, plasma glucose, insulin and insulin resistance (homeostatic model assessment [HOMA]‑R) indicating higher metabolic risk. In contrast, those who had proportionately larger forehead and face had higher beta cell function measured as HOMA‑B indicating lower risk for diabetes (r = 0.20 both P < 0.05 all, adjusted for age and gender). Conclusion: Compared with ancient Indian Anguli reference, our subjects were proportionately smaller in most of the measurements except fingers and upper arm. Relative smallness of body parts was predictive of increased risk of type 2 diabetes.
RESUMO
Justification: Neural tube defects (NTDs) are one of the commonest birth defects with a high incidence in India. However, few studies have systematically looked into the etio-pathogeneis of NTDs, which mainly includes nutritional deficiencies and genetic predisposition. Efforts are afoot for universal food fortification with folic acid in the hope of preventing NTDs, without factual evidence of folate deficiency in the target population. Evidence acquisition: We conducted a review of Indian literature on NTDs focusing on the role of folate and vitamin B12 nutrition and common genetic polymorphisms in 1-carbon metabolism. We performed a literature search of Medline and Indian Medlars (www. indmed.nic.in) for articles using following search terms: Neural tube defect and India, published up to November 2008, on human subjects. We did not include individual case reports and case series describing surgical and medical management, genetic syndromes where NTD was only one of the features or unusual associations of NTDs with other clinical findings. Results: Absence of a nationally representative large study, lack of interventional studies and methodological differences were conspicuous during this review. Larger studies are, therefore, urgently needed to delineate gene-nutrient interactions in association with NTDs in India. We urge that caution should be exercised before widespread folic acid fortification of food, without addressing the issue of concurrent B12 deficiency.