Dietary profile of urban adult population in South India in the context of chronic disease epidemiology (CURES-68).

OBJECTIVE: Few dietary surveys have been done with reference to chronic diseases, such as diabetes, in India, which is considered to be the diabetes capital of the world. We report on the dietary intake of urban adults living in Chennai, South India. DESIGN: A population-based cross-sectional study. SETTING: A representative population of urban Chennai in southern India. SUBJECTS: The study population comprised 2042 individuals aged≥20 years selected from the Chennai Urban Rural Epidemiological Study (CURES). Dietary intake was measured using a validated and previously published interviewer-administered semi-quantitative meal-based FFQ. RESULTS: The mean daily energy intake was 10,393 (sd 2347) kJ (male: 10953 (sd 2364) kJ v. female: 9832 (sd 233) kJ). Carbohydrates were the major source of energy (64%), followed by fat (24%) and protein (12%). Refined cereals contributed to the bulk of the energy (45.8%), followed by visible fats and oils (12.4%) and pulses and legumes (7.8%). However, energy supply from sugar and sweetened beverages was within the recommended levels. Intake of micronutrient-rich foods, such as fruit and vegetable consumption (265 g/d), and fish and seafoods (20 g/d), was far below the FAO/WHO recommendation. Dairy and meat products intake was within the national recommended intake. CONCLUSIONS: The diet of this urban South Indian population consists mainly of refined cereals with low intake of fish, fruit and vegetables, and all of these could possibly contribute to the risk of non-communicable diseases such as diabetes in this population.

Association of depression with complications of type 2 diabetes--the Chennai Urban Rural Epidemiology Study (CURES- 102).

OBJECTIVE: The aim of the study was to assess the relationship between depression and diabetic complications among urban south Indian type 2 diabetic subjects [T2DM]. METHODS: T2DM subjects [n = 847] were recruited from the Chennai Urban Rural Epidemiology Study [CURES], a population based study in Chennai (formerly Madras) in South India. A previously validated depression questionnaire [PHQ-12 item] was administered. Four field stereo retinal colour photography was done and diabetic retinopathy [DR] was classified according to the Early Treatment Diabetic Retinopathy Study grading system. Neuropathy was diagnosed if the vibratory perception threshold of the right great toe, measured by biothesiometry, was > or = 20. Nephropathy was diagnosed if urinary albumin excretion was > or = 300 microg/mg creatinine. Peripheral vascular disease [PVD] was diagnosed if an ankle-brachial index was < 0.9. Coronary artery disease [CAD] was diagnosed based on a past history of documented myocardial infarction and/or electrocardiographic evidence of Q wave and/or ST segment changes. RESULTS: Of the 847 T2DM studied, 198 (23.4%) were found have depression. The prevalence of depression was significantly higher among diabetic subjects with DR (35.0% vs 21.1%, p < 0.001), neuropathy (28.4% vs 15.9%, p = 0.023), nephropathy (35.6% vs 24.5%, p = 0.04) and PVD (48.0% vs 27.4%, p < 0.001) as compared to subjects without these complications. DR, neuropathy, nephropathy, and PVD were associated with depression even after adjusting for age, gender, duration of diabetes and glycated haemoglobin. DR (Odds ratio [OR] = 2.19, Confidence interval [CI]:1.45-3.51, p < 0.001) was associated with depression even after adjusting for neuropathy and nephropathy. There was also a significant association between depression and neuropathy, after adjusting for retinopathy and nephropathy (OR = 2.07, CI: 1.41-3.04, p < 0.001). There was a significant association of depression with nephropathy but this was lost (OR = 1.71, CI: 0.87-3.35, p = 0.119) after adjustment for retinopathy. PVD (OR = 3.52, CI: 1.94-6.40, p < 0.001) remained significantly associated with depression even after adjusting for CAD. However, there was no significant association of depression with CAD (OR = 0.73, CI: 0.42 -1.27, p = 0.264). CONCLUSION: Among Asian Indians, the prevalence of depression is higher in T2DM subjects with retinopathy, neuropathy, nephropathy and PVD compared to those without the respective complications.

Decreased serum interleukin-17 and increased transforming growth factor-ß levels in subjects with metabolic syndrome (Chennai Urban Rural Epidemiology Study-95).

The term metabolic syndrome (MS) refers to a conglomeration of many metabolic disorders. Recent studies suggest that inflammation plays a vital role in MS. There are however no data available on the recently characterized novel T-cell-derived cytokine interleukin (IL)-17 in MS; studies on the anti-inflammatory cytokine transforming growth factor (TGF)-ß are also limited. The aim of the study was to look at IL-17 and TGF-ß levels in subjects with and without MS. The study subjects were recruited from the Chennai Urban Rural Epidemiology Study (CURES), a population-based study in Chennai (formerly Madras) in southern India. Group 1 consisted of subjects without MS (non-MS) (n = 98) and group 2 consisted of subjects with MS (n = 156). MS was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria modified for waist, according to the World Health Organization Asia Pacific guidelines. Serum IL-17 and TGF-ß levels were estimated by enzyme-linked immunosorbent assay. Interleukin-17 levels were decreased (P < .001) and TGF-ß levels (P < .001) were increased in subjects with MS compared to those without. With an increase in the number of metabolic risk factors, the IL-17 levels showed a decline, whereas the TGF-ß levels showed an increase (P < .001). With respect to individual components of MS, TGF-ß and IL-17 showed a significant association with blood pressure and blood glucose even after adjusting for age and sex. We report that IL-17 levels are decreased, whereas TGF-ß levels are increased, among Asian Indians with MS.

Association of Indian Diabetes Risk Score with arterial stiffness in Asian Indian nondiabetic subjects: the Chennai Urban Rural Epidemiology Study (CURES-84).

OBJECTIVE: In this study, we aim to determine the association of Indian Diabetes Risk Score (IDRS) with augmentation index (AI), a preclinical marker of early atherosclerotic changes. METHODS: Subjects without known diabetes (n = 1985) were randomly selected from the Chennai Urban Rural Epidemiology Study, an ongoing population-based study on a representative population (aged >or=20 years) of Chennai, the largest city in Southern India. Augmentation index was measured using the Sphygmocor apparatus (Sphygmocor BPAS-1; PWV Medical, Sydney, Australia). Serum lipids were measured in an overnight fasting sample along with other biochemical parameters. Indian Diabetes Risk Score includes four parameters: age, abdominal obesity, family history of type 2 diabetes, and physical activity. RESULTS: Arterial stiffness values increased with an increase in IDRS. Subjects with IDRS >or=60 had significantly higher AI (24.6 +/- 7.2; p < .001) compared to subjects with an IDRS of 30-60 (16.4 +/- 5.5; p < .001) and with IDRS <30 (13.3 +/- 4.5), and the p for trend was statistically significant (<.001). Pearson correlation analysis in the total population revealed that AI was significantly correlated with age (p < .001), systolic and diastolic blood pressure (p < .001), IDRS (p < .001), glycated hemoglobin A1c (A1C) (p < .001), serum cholesterol (p < .001), serum triglycerides (p < .001), high-density lipoprotein (HDL) cholesterol (p < .001), low-density lipoprotein cholesterol (p < .001), and non-HDL cholesterol (p < .001). In linear regression analysis, IDRS showed a significant association with AI even after adjusting for blood pressure, smoking, insulin resistance, A1C, cholesterol, and triglycerides (beta = 6.388; p < .001). CONCLUSION: This study shows that, in addition to identifying unknown diabetes, IDRS also helps to identify those with arterial stiffness.

Glycaemic index of Indian flatbreads (rotis) prepared using whole wheat flour and 'atta mix'-added whole wheat flour.

To compare the glycaemic index (GI) of newly developed 'atta mix' roti with whole wheat flour roti. Eighteen healthy non-diabetic subjects consumed 50 g available carbohydrate portions of a reference food (glucose) and two test foods (whole wheat flour roti and atta mix roti) in random order after an overnight fast. The reference food was tested on three separate occasions, while the test foods were each tested once. Capillary blood samples were measured from finger-prick samples in fasted subjects ( - 5 and 0 min) and at 15, 30, 45, 60, 90 and 120 min from the start of each food. No significant difference was observed between roti prepared from whole wheat flour and atta mix in terms of appearance, texture, flavour, taste or acceptability. For each test food, the incremental area under the curve and GI values were determined. The GI of atta mix roti (27.3 (sem 2.2)) was considerably lower than the whole wheat flour roti (45.1 (sem 3.5), P < 0.001). Development of foods with lower dietary glycaemic load such as the atta mix roti could help in the prevention and control of diabetes in South Asian populations, which habitually consume very high glycaemic load diets.

A1C cut points to define various glucose intolerance groups in Asian Indians.

OBJECTIVE To determine A1C cut points for glucose intolerance in Asian Indians. RESEARCH DESIGN AND METHODS A total of 2,188 participants without known diabetes were randomly selected from the Chennai Urban Rural Epidemiology Study. All had fasting plasma glucose (FPG) and 2-h postload plasma glucose measurements after a 75-g load and were classified as having impaired fasting glucose (IFG) (American Diabetes Association [ADA] criteria, FPG > or =5.5 and <7 mmol/l, and World Health Organization [WHO] criteria, FPG > or =6.1 and <7 mmol/l), impaired glucose tolerance (IGT) (2-h postload plasma glucose > or =7.8 and <11.1 mmol/l), or diabetes (FPG > or =7 mmol/l and/or 2-h postload plasma glucose > or =11.1 mmol/l). A1C was measured using the Bio-Rad Variant machine. Based on receiver operating characteristic curves, optimum sensitivity and specificity were derived for defining A1C cut points for diabetes, IGT, and IFG. RESULTS Mean +/- SD values of A1C among subjects with normal glucose tolerance, IGT, and diabetes were 5.5 +/- 0.4, 5.9 +/- 0.6, and 8.3 +/- 2.0%, respectively (P(trend) < 0.001) with considerable overlap. To identify diabetes based on 2-h postload plasma glucose, the A1C cut point of 6.1% had an area under the curve (AUC) of 0.941 with 88.0% sensitivity and 87.9% specificity. When diabetes was defined as FPG > or =7.0 mmol/l, the A1C cut point was 6.4% (AUC = 0.966, sensitivity 93.3%, and specificity 92.3%). For IGT, AUC = 0.708; for IFG, AUC = 0.632 (WHO criteria) and 0.708 (ADA criteria), and the A1C cut point was 5.6%. CONCLUSIONS In Asian Indians, A1C cut points of 6.1 and 6.4% defined diabetes by 2-h postload plasma glucose or FPG criteria, respectively. A value of 5.6% optimally identified IGT or IFG but was <70% accurate.

Prevalence and clinical profile of autosomal dominant type 2 diabetes from a diabetes centre in India.

AIMS: To study the prevalence, and clinical profile of autosomal dominant (AD) inherited forms of type 2 diabetes mellitus (T2DM). METHODS: Detailed pedigree charts were drawn on 510 consecutive T2DM subjects attending a tertiary care diabetes centre in South India. Clinical and biochemical features of T2DM subjects with and without AD inheritance were compared. RESULTS: Overall, 36.1% of T2DM had one parent with diabetes, in 10.6%, both parents had diabetes and 10.2% had features of AD. Age at diagnosis of diabetes was the lowest among AD group compared to other groups (p for trend <0.001). Only 22.6% of T2DM with AD inheritance had age at diagnosis of diabetes below 25 years and in 26.4%, it was diagnosed above 45 years. There were no significant differences in the clinical features, including prevalence of diabetic complications, between T2DM with and without AD inheritance. CONCLUSIONS: In this clinic-based study, 10.2% of T2DM subjects had evidence of AD inheritance. While the AD cases occurred at younger age, older age at diagnosis was not uncommon. Clinical features, including complications, did not differ between the T2DM patients with or without AD.

Dietary carbohydrates, glycaemic load, food groups and newly detected type 2 diabetes among urban Asian Indian population in Chennai, India (Chennai Urban Rural Epidemiology Study 59).

The aim of the study was to examine the association of dietary carbohydrates and glycaemic load with the risk of type 2 diabetes among an urban adult Asian Indian population. Adult subjects aged >20 years (n 1843) were randomly selected from the Chennai Urban Rural Epidemiology Study, in Chennai city in southern India. Dietary carbohydrates, glycaemic load and food groups were assessed using FFQ. Oral glucose tolerance tests were performed using 75 g glucose in all subjects. Diagnosis of diabetes was based on WHO Consulting Group criteria. OR for newly detected diabetes were calculated for carbohydrates, glycaemic load and specific food groups comparing subjects in the highest with those in the lowest quartiles, after adjustment for potential confounders such as age, sex, BMI, family history of diabetes, physical activity, current smoking, alcohol consumption and relevant dietary factors. We identified 156 (8.5 %) newly diagnosed cases of type 2 diabetes. Refined grain intake was positively associated with the risk of type 2 diabetes (OR 5.31 (95 % CI 2.98, 9.45); P < 0.001). In the multivariate model, after adjustment for potential confounders, total carbohydrate (OR 4.98 (95 % CI 2.69, 9.19), P < 0.001), glycaemic load (OR 4.25 (95 % CI 2.33, 7.77); P < 0.001) and glycaemic index (OR 2.51 (95 % CI 1.42, 4.43); P = 0.006) were associated with type 2 diabetes. Dietary fibre intake was inversely associated with diabetes (OR 0.31 (95 % CI 0.15, 0.62); P < 0.001). In urban south Indians, total dietary carbohydrate and glycaemic load are associated with increased, and dietary fibre with decreased, risk of type 2 diabetes.

Refined grain consumption and the metabolic syndrome in urban Asian Indians (Chennai Urban Rural Epidemiology Study 57).

The objective of the study was to evaluate the association of refined grains consumption with insulin resistance and the metabolic syndrome in an urban south Indian population. The study population comprised 2042 individuals aged > or = 20 years randomly selected from the Chennai Urban Rural Epidemiology Study (CURES), a cross-sectional study on a representative population of Chennai, southern India. The metabolic syndrome was defined according to modified Adult Treatment Panel III guidelines; and insulin resistance, by the homeostasis assessment model. The mean refined grain intake was 333 g/d (46.9% of total calories) in this population. After adjustment for age, sex, body mass index, metabolic equivalent, total energy intake, and other dietary factors, higher refined grain intake was significantly associated with higher waist circumference (8% higher for the highest vs the lowest quartile, P for trend < .0001), systolic blood pressure (2.9%, P for trend < .0001), diastolic blood pressure (1.7%, P for trend = .03), fasting blood glucose (7.9%, P for trend = .007), serum triglyceride (36.5%, P for trend < .0001), low high-density lipoprotein cholesterol (-10.1%, P for trend < .0001), and insulin resistance (13.6%, P < .001). Compared with participants in the bottom quartile, participants who were in the highest quartile of refined grain intake were significantly more likely to have the metabolic syndrome (odds ratio, 7.83; 95% confidence interval, 4.72-12.99). Higher intake of refined grains was associated with insulin resistance and the metabolic syndrome in this population of Asian Indians who habitually consume high-carbohydrate diets.

Random capillary blood glucose cut points for diabetes and pre-diabetes derived from community-based opportunistic screening in India.

OBJECTIVE: To determine random capillary blood glucose (RCBG) cut points that discriminate diabetic and pre-diabetic subjects from normal individuals. RESEARCH DESIGN AND METHODS: RCBG was performed in 1,333 individuals randomly chosen from 63,305 individuals who had participated in an opportunistic screening program. An oral glucose tolerance test was also performed by venous plasma glucose on an autoanalyzer. RCBG cut points that discriminate diabetes, impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) were determined using receiver operating characteristic curves. RESULTS: Using 2-h plasma glucose >or=200 mg/dl (11.1 mmol/l) criterion, the RCBG cut point of 140 mg/dl (7.7 mmol/l) gave the highest sensitivity and specificity. For 2-h plasma glucose >or=200 mg/dl (11.1 mmol/l) and fasting plasma glucose (FPG) >or=126 mg/dl (7.0 mmol/l) criteria, either 2-h plasma glucose >or=200 mg/dl (11.1 mmol/l) or FPG >or=126 mg/dl (7.0 mmol/l) criterion, and the FPG >or=126 mg/dl (7.0 mmol/l) criterion, RCBG cut point was 143 mg/dl (7.9 mmol/l). RCBG cut points for IGT, IFG according to World Health Organization criterion, and IFG according to American Diabetes Association criterion were 119 mg/dl (6.6 mmol/l), 118 mg/dl (6.6 mmol/l), and 113 mg/dl (6.3 mmol/l), respectively. CONCLUSIONS: Asian Indians with RCBG >110 mg/dl at screening can be recommended to undergo definitive testing.

Association of fruit and vegetable intake with cardiovascular risk factors in urban south Indians.

The study examines the relationship between fruit and vegetable intake (g/d) and CVD risk factors in urban south Indians. The study population comprised of 983 individuals aged > or = 20 years selected from the Chennai Urban Rural Epidemiological Study (CURES), a population-based cross-sectional study on a representative population of Chennai in southern India. Fruit and vegetable intake (g/d) was measured using a validated semi-quantitative FFQ. Linear regression analysis revealed that after adjusting for potential confounders such as age, sex, smoking, alcohol, BMI and total energy intake, the highest quartile of fruit and vegetable intake (g/d) showed a significant inverse association with systolic blood pressure (beta = - 2.6 (95 % CI - 5.92, - 1.02) mmHg; P = 0.027), BMI (beta = - 2.3 (95 % CI - 2.96, - 1.57) kg/m2; P < 0.0001), waist circumference (beta = - 2.6 (95 % CI - 3.69, - 1.46) cm; P < 0.0001), total cholesterol (beta = - 50 (95 % CI - 113.9, - 13.6) mg/l; P = 0.017) and LDL-cholesterol concentration (beta = - 55 (95 % CI - 110.8, - 11.1) mg/l; P = 0.039) when compared with the lowest quartile. A higher intake of fruit and vegetables explained 48 % of the protective effect against CVD risk factors. Increased intake of fruits and vegetables could play a protective role against CVD in Asian Indians who have high rates of premature coronary artery disease.

Association of A1C with cardiovascular disease and metabolic syndrome in Asian Indians with normal glucose tolerance.

OBJECTIVE: This study examines the association of A1C with cardiovascular disease (CVD) risk factors, coronary artery disease (CAD), and metabolic syndrome in Asian Indians with normal glucose tolerance (NGT). RESEARCH DESIGN AND METHODS: This cross-sectional study recruited subjects from phase III of the Chennai Urban Rural Epidemiology Study (CURES), an epidemiological study in a representative population of Chennai (formerly Madras) in South India, conducted between January 2003 and June 2004. Included were 1,644 subjects with NGT, i.e., fasting plasma glucose <100 mg/dl (5.6 mmol/l) and 2-h postload plasma glucose <140 mg/dl (7.8 mmol/l). A1C was measured using the Biorad Variant machine. Metabolic syndrome was defined based on modified Adult Treatment Panel III guidelines. RESULTS: The mean +/- SD A1C value in the study cohort was 5.5 +/- 0.4%. A1C showed a significant association with BMI (beta = 0.017, P < 0.001), systolic (beta = 0.002, P = 0.028) and diastolic (beta = 0.202, P = 0.017) blood pressure, waist circumference (beta = 0.007, P < 0.001), serum cholesterol (beta = 0.002, P < 0.001), triglycerides (beta = 0.001, P < 0.001), LDL cholesterol (beta = 0.002, P < 0.001), fasting insulin (beta = 0.009, P < 0.001), and homeostasis model assessment of insulin resistance (beta = 0.047, P < 0.001) after adjusting for age and sex. Regression analysis showed that A1C had a strong association with metabolic syndrome that persisted after adjusting for age and sex (odds ratio [OR] 2.9 [95% CI 2.08-4.00]; P < 0.001). A1C also had a strong association with CAD (2.6 [1.23-5.63]; P = 0.01), but the significance was lost when adjusted for age and sex. CONCLUSIONS: There is a strong association of A1C with prevalent CVD risk factors in Asian-Indian subjects with NGT.