Effect of COVID-19 lockdown on lifestyle habits and self-care practices of diabetic and hypertensive patients in rural Shimla and Udaipur - Findings from the HealthRise India program.

Background: COVID-19 pandemic has increased the risk of mortality among patients with noncommunicable diseases. Maintaining a good metabolic control, lifestyle modification along with improved self-care practices are not only associated with less severe COVID-19 infections but also with a high recovery rate. Objectives: This research article explores the changes in lifestyle habits, self-care practices, and metabolic control among patients enrolled in the HealthRise program. The study compares behavioral changes, before COVID-19 pandemic and during COVID-19 pandemic, between intervention and control arms in Shimla and Udaipur. Methods: A quasi-experimental study design was employed for program implementation in select villages of Shimla district, and Udaipur district. A total of 459 patients from Shimla and 309 patients from Udaipur with diabetes mellitus or hypertension or with both were enrolled and followed for 1 year. Results: Metabolic control in Shimla intervention arm was 2.6 times higher than in control arm (P = 0.001) before COVID-19 pandemic. During COVID-19 pandemic, Odds of metabolic control in Shimla intervention was 1.5 times higher when compared with control arm (P = 0.03). In Udaipur, metabolic control before COVID-19 pandemic was comparable between control and intervention arms. During the pandemic, metabolic control in intervention arm of Udaipur was 5 times higher when compared to the control arm ((P = 0.001). Conclusion: Participants exposed to support, appreciate, learn, and transfer-community life competence process (SALT-CLCP) intervention maintained metabolic control during the COVID-19 pandemic with improved behavioral and self-care practices. Community-based interventions such as SALT-CLCP method bring ownership and empower community in achieving the better health outcomes.

Body fat, metabolic syndrome and hyperglycemia in South Asians.

The prevalence of overweight and obesity is escalating in South Asian countries. South Asians display higher total and abdominal obesity at a lower BMI when compared to Whites. Consequently, metabolic dysfunction leading to metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) will account for a majority of the health burden of these countries. In this review, we discuss those factors that contribute to MetS and T2DM in South Asians when compared to whites, focusing on adiposity. Abdominal obesity is the single-most important risk factor for MetS and its predisposition to T2DM. Excessive ectopic fat deposition in the liver (non-alcoholic fatty liver disease) has been linked to insulin resistance in Asian Indians, while the effects of ectopic fat accumulation in pancreas and skeletal muscle need more investigation. South Asians also have lower skeletal muscle mass than Whites, and this may contribute to their higher risk T2DM. Lifestyle factors contributing to MetS and T2DM in South Asians include inadequate physical activity and high intakes of refined carbohydrates and saturated fats. These are reflective of the recent but rapid economic transition and urbanization of the South Asian region. There is need to further the research into genetic determinants of dysmetabolism as well as gene x environment interactions. Collectively, MetS and T2DM have multi-factorial antecedents in South Asians and efforts to combat it through low-cost and socio-culturally appropriate lifestyle interventions need to be supported.

Slowing the diabetes epidemic in the World Health Organization South-East Asia Region: the role of diet and physical activity

The nutrition transition occurring in the World Health Organization South-EastAsia Region, as a result of rapid urbanization and economic development, hasperhaps made this region one of the epicentres of the diabetes epidemic. Thisreview attempts to evaluate the role of diet and physical inactivity in the South-EastAsia Region in promoting this epidemic and points to strategies to slow it downby lifestyle modification. The emerging new food-production technologies andsupermarkets have made energy-dense foods more easily available. This includesrefined carbohydrate foods like those with added sugars, and refined grainsand unhealthy fats. In addition, increased availability of modern technology andmotorized transport has led to decreased physical activity. South Asian diets tendto be based on high-carbohydrate foods, with a predominance of refined grains.All of these accentuate the risk of diabetes in people of this region, who alreadyhave a unique “south Asian phenotype”. However, there is increasing evidencethat altering diet by replacing refined cereals like white rice with whole grains (e.g.brown rice) and increasing physical activity can help to prevent diabetes in highrisk individuals. An urgent, concerted effort is now needed to improve diet qualityand encourage physical activity, by introducing changes in policies related to foodand built environments, and improving health systems to tackle noncommunicablediseases like diabetes.

Dietary fat intake and its association with risk of selected components of the metabolic syndrome among rural South Indians.

CONTEXT: There is limited literature on the dietary fat intake of rural Indian populations, particularly in relation to the risk of metabolic syndrome (MS). AIM: This study aims to assess the dietary fat intake and analyze its association with the risk of selected components of the MS among rural population in the state of Tamil Nadu. SETTINGS AND DESIGN: Adults (n = 27012) ≥20 years of age were recruited from the rural component of the Chennai Urban Rural Epidemiological Study, a cross-sectional study conducted in 42 villages in Kanchipuram District of Tamil Nadu. SUBJECTS AND METHODS: Using a validated food frequency questionnaire, data were obtained on the fat intake among 6907 adults. Anthropometric and clinical measures were collected using standard methods. The components of the MS assessed were abdominal obesity, hypertension, and impaired fasting glucose. All analyses were performed using SPSS software (version 20). RESULTS: Prevalence of abdominal obesity, hypertension, and impaired fasting glucose were significantly higher in the highest quintile of fat intake (33%, P < 0.001; 39%, P = 0.04, and 23.3%, P = 0.003, respectively). Highest intake of fat was also significantly associated with risk of abdominal obesity (P < 0.001), hypertension (P = 0.04), and impaired fasting glucose (P = 0.01). Sunflower oil as the main cooking oil was significantly associated with a higher risk of these components of the MS (P for trend <0.001) compared to traditional oils and palmolein. CONCLUSIONS: Higher dietary fat was significantly associated with risk of components of the MS and use of sunflower oil as main cooking oil increased metabolic risk in rural South Indians.

Study design and methods for a randomized crossover trial substituting brown rice for white rice on diabetes risk factors in India.

India has the second largest number of people with diabetes in the world following China. Evidence indicates that consumption of whole grains can reduce the risk of type 2 diabetes. This article describes the study design and methods of a trial in progress evaluating the effects of substituting whole grain brown rice for polished (refined) white rice on biomarkers of diabetes risk (glucose metabolism, dyslipidemia, inflammation). This is a randomized controlled clinical trial with a crossover design conducted in Chennai, India among overweight but otherwise healthy volunteers aged 25-65 y with a body mass index ≥23 kg/m(2) and habitual rice consumption ≥200 g/day. The feasibility and cultural appropriateness of this type of intervention in the local environment will also be examined. If the intervention is efficacious, the findings can be incorporated into national-level policies which could include the provision of brown rice as an option or replacement for white rice in government institutions and food programs. This relatively simple dietary intervention has the potential to substantially diminish the burden of diabetes in Asia and elsewhere.

Association of dietary fiber intake with serum total cholesterol and low density lipoprotein cholesterol levels in Urban Asian-Indian adults with type 2 diabetes.

CONTEXT: There is little data correlating dietary fibre (DF) intake and cardiovascular risk in Asian Indians with diabetes. AIM: To assess the DF intake and its association with lipid profile (total serum cholesterol and low density lipoprotein [LDL] - cholesterol levels) in urban Asian Indians with diabetes. SUBJECTS AND METHODS: Dietary assessment using validated Food Frequency Questionnaire was conducted in 1191 free-living adults with known diabetes in the Chennai Urban Rural Epidemiology Study. Subjects taking medication for dyslipidemia, and those with cardiovascular disease and implausible energy intake (n = 262) were excluded, leaving 929 participants. Anthropometric and relevant biochemical parameters were measured using standardized techniques. RESULTS: Diabetic individuals who consumed DF < median intake (29 g/day) had a higher prevalence of hypercholesterolemia (49.5% vs. 40.1% [P = 0.01]) and higher LDL cholesterol (46.2% vs. 35.5% [P = 0.001]) than those in the > median intake of DF group. The risk of hypercholesterolemia (odds ratio [OR] =1.38 [95% confidence interval [CI]: 1.02-1.85], P = 0.04), and high LDL cholesterol (OR: 1.43 [95% CI: 1.06-1.94], P = 0.02) was higher among those whose DF intake was less than the median. Serum triglycerides and high density lipoprotein cholesterol were not associated with DF intake. The main sources of DF were vegetables and legumes. CONCLUSION: In urban Asian Indians with diabetes, lower DF intake is positively related to total cholesterol and LDL cholesterol levels.

Processing and storage of Indian cereal and cereal products alters its resistant starch content.

Resistant Starch (RS) is prebiotic in nature and is defined as the sum of starch and products of starch degradation not absorbed in small intestine of healthy individuals but later are fermented by natural microflora of the colon to produce short chain fatty acids. RS acts as a nutraceutical and its consumption leads to many health benefits. The aim of the study is to analyze the RS content in raw and processed cereals and cereal products and determine various processing and storage effects on the RS content. RS content in raw cereals ranged from 0.53 g% (pearl millet)-2.09 g% (rice). Of all the processing techniques applied in the study, roasting, baking and boiling increased the RS content followed by shallow frying. Steaming and frying showed a decrease in RS content. The puffed, flaked and extruded cereal products obtained from market when analyzed also showed very less retention of RS content. Storage of different cereal products at 4°C up to 12 and 24 h significantly increased RS content. Amylose showed a higher correlation with RS in maize produces than in other cereal products.