Prevalence and Factors Influencing Diabesity among Persons with Type 2 Diabetes Mellitus in Urban Puducherry: A Cross-Sectional Analytical Study.

BACKGROUND: The risk for cardiovascular diseases (CVDs) increase exponentially when type 2 diabetes mellitus (T2DM) and obesity coexist. OBJECTIVE: To estimate the proportion of people with diabesity and assess the sociodemographic, dietary, and morbidity related factors associated with diabesity. METHODS: A hospital-based cross-sectional analytical study was conducted in 2018 among persons with T2DM attending an urban Primary Health Centre in Puducherry using a structured questionnaire. RESULTS: The mean (standard deviation) age of 151 study participants was 58.2 (11.8) years with 66% (n = 100), 77% (n = 116) and 40% (n = 60) being females, sedentary workers and belonging to lower socioeconomic status, respectively. Of total, 71% (n = 107) had hypertension, 66% (n = 99) had uncontrolled fasting blood sugar (FBS) level and 74% (n = 111) did not consume fruits daily. The proportion of diabesity was found to be 66.9% (95% CI 58.8-74.3). After adjusting for other factors, obesity was significantly high among T2DM patients aged 50 years and less (adjusted prevalence ratio- (aPR) 1.4; (95% confidence interval [CI]: 1.07-1.83) compared to >60 years. Having uncontrolled FBS values (aPR 1.28; [95% CI: 1.01-1.64]), deficient in calorie intake (aPR 1.66; [95% CI: 1.25-2.22]), deficient in fruits intake (aPR 1.45; [95% CI: 1.07-1.97]), and high fat consumption (aPR 1.26; [95% CI: 1.02-1.57]) had significant association with diabesity. CONCLUSION: Considering the rising burden of diabetes associated with obesity, vigilant strategy to reduce modifiable risk factors for CVD needs further emphasis at primary care settings.

Adherence to iron and folic acid supplementation among antenatal mothers attending a tertiary care center, Puducherry: A mixed-methods study.

BACKGROUND: Iron-deficiency anemia in pregnancy is a major public health problem despite the efforts taken by the Ministry of Health and Family Welfare for the past five decades. Adherence to iron and folic acid supplementation (IFAS) is the key factor for the prevention and management of nutrition anemia. AIM: The aim of this study was to assess the adherence to its associated factors and to explore the reasons for the non-adherenc among pregnant women attending a tertiary care center. MATERIALS AND METHODS: It is an explanatory mixed-methods design (quantitative cross-sectional analytical design and qualitative descriptive design). STATISTICAL ANALYSIS USED: Results presented as proportion with 95% confidence interval (CI). Chi-square test was done to assess the association of the factors to adherence. Qualitative data were transcribed verbatim, translated to English, and analyzed by manual content analysis. RESULTS: A total of 340 pregnant women were included, and the adherence to IFAS among the antenatal mothers was 63.8 (95% CI [58.61-68.6]). The factors associated with adherence to IFAS (prevalence ratio with 95% CI) were primigravida status [1.22 [1.02-1.45]), nonanemic in the first trimester (1.27 [1.09-1.49]), and absence of side effects (3.16 [1.95-5.12]). Conceptual framework was constructed using the emerging themes: (i) knowledge-related factors, (ii) behavior-related factors, and (iii) facilitating factors. CONCLUSION: About three-fourth of the participants were adherent to IFAS. Compliance is directly influenced by the gravida status, anemic status, and absence of side effects. Based on qualitative results, measures to improve palatability and the quality of IFAS are recommended.

Screening for red flag symptoms of cancer: A community-based cross-sectional study from urban Puducherry, India.

BACKGROUND: Patients with cancer often delay seeking medical advice in developing countries. In India, only 20%-30% of cancers are being diagnosed in Stages I and II. Screening for red flag symptoms of cancer can be used to identify high-risk individuals in the community. METHODOLOGY: A community-based cross-sectional study was conducted in February 2017 among 302 participants in one of the service areas of Jawaharlal Institute of Postgraduate Medical Education and Research urban health center selected by universal sampling. Data on the presence of red flag symptoms of cancer (persistent cough, persistent change in bowel/bladder habits, nonhealing ulcer, persistent difficulty in swallowing, unexplained weight loss, unexplained lump, persistent unexplained pain, unexplained bleeding, and change in the appearance of mole) and presence of risk factors were collected through interviews. The collected data were entered using EpiData version 3.0. RESULTS: The mean (standard deviation) age of the study participants was 44 (11) years and 50.6% of them were male. At least one red flag symptom of cancer was present in 22 (7.3%) individuals; 9 (2.8%) had unexplained pain, 4 (1.3%) had change in bowel habits, 4 (1.3%) had change in bladder habits, 3 (1%) had cough, 3 (1%) had nonhealing ulcer, 2 (0.6%) had unexplained bleeding, 1 (0.3%) had difficulty in swallowing, 1 (0.3%) had weight loss, 1 (0.3%) had lump, and 1 (0.3%) had change in the appearance of mole. CONCLUSION: Screening for red flag symptoms of cancer is an easy tool that can be used in the community to identify high-risk individuals, which will facilitate early diagnosis of cancer.

Can mid-upper arm circumference and calf circumference be the proxy measures to detect undernutrition among elderly? Findings of a community-based survey in rural Puducherry, India.

INTRODUCTION: Major proportion of the elderly with under nutrition is undetected in the community. One of the feasible ways to detect under nutrition among elderly would be screening in the field settings. in this study, we aimed to identify the utility of alternate anthropometric measures such as mid-upper arm circumference (MUAC), calf circumference, and skin fold thickness in identifying under nutrition among elderly. MATERIALS AND METHODS: A community-based cross-sectional survey was done among elderly in one of the randomly selected subcenters. Anthropometric measures such as weight, arm span, MUAC, and triceps skinfold thickness were measured as per the standard measurement guidelines by a trained medical graduate. The elderly were identified as undernourished if body mass index (BMI) is <18.5 kg/m2. Utility of alternate anthropometric markers against BMI is represented by area under the curve (AUC) value from receiver operating characteristic curve and correlation coefficient (r). RESULTS: Mean MUAC, calf circumference, and triceps skinfold thickness measured among 271 elderly were 25.6 cm ± 3.7 cm, 27.6 cm ± 3.7 cm, and 3.0 mm ± 1.3 mm, respectively. Among all three proxy anthropometric measures, MUAC had the highest AUC value (AUC = 0.88) Triceps skinfold thickness had the least AUC (AUC = 0.61). The correlation of anthropometric measurements such as MUAC, calf circumference, and triceps skinfold thickness with BMI was 0.74, -0.04, and 0.64, respectively. CONCLUSION: As MUAC and calf circumference are easy to measure and they are highly correlating with BMI, they can be used routinely by peripheral field workers to assess undernutrition in elderly during their regular house visits.

Prevalence of under-nutrition, associated factors and perceived nutritional status among elderly in a rural area of Puducherry, South India.

BACKGROUND: Under-nutrition among elderly goes undetected, despite their nature of vulnerability to it. Majority of the available literature assessed under nutrition in the facility based settings. We aimed to determine the prevalence of under-nutrition and its associated factors among elderly, in a rural setting. METHODS: A community based cross sectional survey was conducted among elderly in one of the randomly selected sub centre catchment area in rural Puducherry, south India. Information on socio demographic characteristics, morbidities and perception on their nutritional status were obtained. Anthropometric measures such as weight and arm span were measured by trained medical graduate as per the standard guidelines. Bodymass index (BMI) less than 18.5kg/m(2) was considered as under-nutrition. RESULTS: Of total 296 elderly in the study setting, 271 (92%) participated in the study. The prevalence of under nutrition among the elderly was 24.8% (95% CI: 19.7-30.3). More than half of the elderly (58.7%) perceived their nutritional status as poor; of them 28.9% were actually under-nourished. Mean (SD) BMI scores were higher for elderly women compared to that of men [elderly women vs men: 22 (4.6)kg/m(2) vs 21 (3.8)kg/m(2), p=0.03]. In multivariate analysis, being an elderly male, age more than 70 years and per capita income less than 1000 INR were found to be significantly associated with under-nutrition. CONCLUSION: In this rural area, one fourth of elderly were under nourished. Urgent inter-sectoral measures including food security programs are required to address this huge nutritional problem in this vulnerable group.

Non-pharmacological Interventions in Hypertension: A Community-based Cross-over Randomized Controlled Trial.

BACKGROUND: Hypertension is the most prevalent non-communicable disease causing significant morbidity/mortality through cardiovascular, cerebrovascular, and renal complications. OBJECTIVES: This community-based study tested the efficacy of non-pharmacological interventions in preventing/controlling hypertension. MATERIALS AND METHODS: This is a cross-over randomized controlled trial (RCT) of the earlier RCT (2007) of non-pharmacological interventions in hypertension, conducted in the urban service area of our Institute. The subjects, prehypertensive and hypertensive young adults (98 subjects: 25, 23, 25, 25 in four groups) were randomly allotted into a group that he/she had not belonged to in the earlier RCT: Control (New Group I), Physical Exercise (NG II)-brisk walking for 50 to 60 minutes, three to four days/week, Salt Intake Reduction (NG III) to at least half of their previous intake, Yoga (NG IV) for 30 to 45 minutes/day, five days/week. Blood pressure was measured before and after eight weeks of intervention. Analysis was by ANOVA with a Games-Howell post hoc test. RESULTS: Ninety-four participants (25, 23, 21, 25) completed the study. All three intervention groups showed significant reduction in BP (SBP/DBP mmHg: 5.3/6.0 in NG II, 2.5/2.0 in NG III, and 2.3/2.4 in NG IV, respectively), while the Control Group showed no significant difference. Persistence of significant reduction in BP in the three intervention groups after cross-over confirmed the biological plausibility of these non-pharmacological interventions. This study reconfirmed that physical exercise was more effective than Salt Reduction or Yoga. Salt Reduction, and Yoga were equally effective. CONCLUSION: Physical exercise, salt intake reduction, and yoga are effective non-pharmacological methods for reducing blood pressure in young pre-hypertensive and hypertensive adults.