Associations of trunk fat depots with insulin resistance, ß cell function and glycaemia--a multiple technique study.

OBJECTIVE: Central (truncal) adiposity is associated strongly with insulin resistance and diabetes. There are very few reports comparing methods of trunk fat measurement in their ability to predict glycaemia and insulin resistance. We report a comparative analysis of different trunk fat measurements in predicting glycaemia and insulin resistance in middle aged Indian men. MATERIALS AND METHODS: Trunk fat measurements were performed using anthropometry, magnetic resonance imaging (MRI), dual-energy X-ray absorptiometry (DXA) and computed tomography (CT) on 128 men. Additional measurements were taken to characterise insulin resistance (Matsuda index) and beta cell function (Insulinogenic Index), glycaemia (fasting and 120 min glucose concentrations). Using residual approach we compared the ability of different trunk fat measurement techniques to predict insulin resistance, beta cell function and glycaemia. RESULTS: There was a strong association between trunk fat measures from each technique with glycaemia and insulin resistance indices but not with the Insulinogenic Index. Insulin resistance and glycaemia, were best predicted using anthropometric measurements, notably by waist circumference and subscapular skinfold thickness. Neither MRI measures of trunk or visceral fat nor DXA trunk fat added significantly. CT liver density contributed to some extent to predict insulin resistance and 120 min glucose after anthropometric measurements. CONCLUSIONS: Our results suggest that, in Indian men, anthropometric measurements are good predictors of glycaemia and insulin resistance. Other complex measurements such as MRI, DXA and CT make only a small addition to the prediction. This finding supports the application of anthropometry for determining trunk fat in clinical and epidemiological settings.

Conventional and novel cardiovascular risk factors and markers of vascular damage in rural and urban Indian men.

BACKGROUND: India is undergoing rapid epidemiological and nutritional transition largely as a consequence of rapid urbanisation. We investigated conventional and novel cardiovascular risk factors in rural and urban Indian men and studied their association with markers of vascular damage. METHODS: We randomly selected and studied 149 rural, 142 urban slum residents and 150 urban middle class middle aged Indian men. We measured conventional (obesity, blood pressure, lipids, smoking habits) and novel (proinflammatory and prothrombotic factors) cardiovascular risk factors and markers of vascular damage (carotid intima media thickness (IMT), von Willebrand Factor (vWF), e-selectin). RESULTS: There was a progressive increase in most of the conventional cardiovascular (CV) risk factors from rural to slum to urban middle class men. Plasminogen activator inhibitor-1 (PAI-1), platelet count, total homocysteine and C-reactive protein showed similar patterns. Carotid IMT was similar in the three groups; vWF was highest in rural and e-selectin in slum men. Adjusting for location, age explained 17%, obesity 3% and conventional risk factors 1% of the variance in carotid IMT, whilst novel cardiovascular risk factors were without any significant impact. CONCLUSIONS: Urbanisation increases obesity related as well as prothrombotic and proinflammatory CV risk factors in Indian men, but appears not to impact on IMT.

Maternal and paternal height and BMI and patterns of fetal growth: the Pune Maternal Nutrition Study.

We examined the differential associations of each parent's height and BMI with fetal growth, and examined the pattern of the associations through gestation. Data are from 557 term pregnancies in the Pune Maternal Nutrition Study. Size and conditional growth outcomes from 17 to 29 weeks to birth were derived from ultrasound and birth measures of head circumference, abdominal circumference, femur length and placental volume (at 17 weeks only). Parental height was positively associated with fetal head circumference and femur length. The associations with paternal height were detectible earlier in gestation (17-29 weeks) compared to the associations with maternal height. Fetuses of mothers with a higher BMI had a smaller mean head circumference at 17 weeks, but caught up to have larger head circumference at birth. Maternal but not paternal BMI, and paternal but not maternal height, were positively associated with placental volume. The opposing associations of placenta and fetal head growth with maternal BMI at 17 weeks could indicate prioritisation of early placental development, possibly as a strategy to facilitate growth in late gestation. This study has highlighted how the pattern of parental-fetal associations varies over gestation. Further follow-up will determine whether and how these variations in fetal/placental development relate to health in later life.

Patterns of fetal growth in a rural Indian cohort and comparison with a Western European population: data from the Pune maternal nutrition study.

OBJECTIVE: The purpose of this study was to describe fetal size on sonography in a rural Indian population and compare it with those in European and urban Indian populations. Methods. Participants were from the Pune Maternal Nutrition Study of India. Fetal growth curves were constructed from serial ultrasound scans at approximately 18, 30, and 36 weeks' gestation in 653 singleton pregnancies. Measurements included femur length (FL), abdominal circumference (AC), biparietal diameter (BPD), and occipitofrontal diameter, from which head circumference (HC) was estimated. Measurements were compared with data from a large population-based study in France and a study of urban mothers in Vellore, south India. RESULTS: Fetal AC and BPD were smaller than the French reference at 18 weeks' gestation (-1.38 and -1.30 SD, respectively), whereas FL and HC were more comparable (-0.77 and -0.59 SD). The deficit remained similar at 36 weeks for AC (-0.97 SD), FL (-0.43 SD), and HC (-0.52 SD) and increased for BPD (-2.3 SD). Sonography at 18 weeks underestimated gestational age compared with the last menstrual period date by a median of -1.4 (interquartile range, -4.6, 1.8) days. The Pune fetuses were smaller, even at the first scan, than the urban Vellore sample. CONCLUSIONS: Fetal size was smaller in a rural Indian population than in European and urban Indian populations, even in mid pregnancy. The deficit varied for different fetal measurements; it was greatest for AC and BPD and least for FL and HC.

Safety profile of ciprofloxacin used for neonatal septicemia.

We conducted a case matched control study to observe the adverse effects of ciprofloxacin used in neonatal septicemia We enrolled 30 neonates with multidrug-resistant septicemia who were treated with intravenous ciprofloxacin for 14 days. Thirty matched neonates with septicemia treated with other antibiotics were enrolled as controls There was no difference in the mean serum electrolytes, hepatic, renal and hematologic parameters of the two groups. Serial ultrasonographic measurements of the cartilage of the knee after 1 and 6 months showed no difference in the two groups. The femoral cartilage showed an increase of 78.8% in the mean longitudinal area after 6 months in the study group. In the control group, the femoral cartilage showed a 78.4% increase after 6 months. Similarly, the tibial cartilage showed no difference in the percentage increase in size of the study and control group at the end of 6 months. When controlled for birth weight and gestation, cartilage size was not affected by ciprofloxacin.