Descriptive epidemiology of body mass index of an urban adult population in western India.

STUDY OBJECTIVE: To describe height, weight, and body mass index (BMI) of the adult urban population in Mumbai, western India and to estimate the prevalence and severity of thinness and overweight in this population. To describe the association of BMI with education, age, and tobacco habits in an urban Indian population. DESIGN: Cross sectional representative survey of 99 598 adults (40 071 men and 59 527 women). SETTING: The survey was carried out in the city of Mumbai (formerly known as Bombay) in western India. PARTICIPANTS: Men and women aged > or =35 years who were residents of the main city of Mumbai. MAIN RESULTS: The mean height, weight, and BMI were 161.0 (SD 6.7) cm, 56.7 (SD 11.0) kg, and 21.8 (SD 3.8) kg/m(2) for men and 148.0 (SD 6.2) cm, 49.8 (SD 11.2) kg, and 22.7 (SD 4.7) kg/m(2) for women, respectively. Some 19% of men and women were thin (BMI<18.5 kg/m(2)), while 19% of men and 30% of women were overweight (BMI> or =25kg/m(2)). Multivariable logistic regression analyses showed that age, level of education, and tobacco use were independently associated with BMI. The odds ratio (OR) and 95% confidence intervals (CI) for thinness (BMI<18.5 kg/m(2)) were OR 6.52, 95%CI 5.38 to 7.89 for men and OR 4.83, 95%CI 3.71 to 6.28 for women, respectively, (p<0.001) for the lowest level of education (illiterate group). The OR and 95%CI for overweight were 2.25, 2.20 to 2.58 for college educated men and 1.90, 1.64 to 2.20 for college educated women, respectively, p<0.001. Both smoking (2.33, 2.09 to 2.59; 2.89, 1.77 to 4.72 for men and women, respectively, p<0.001) and smokeless tobacco use (1.65, 1.52 to 1.80; 2.26, 2.14 to 2.38 for men and women, respectively p<0.0001) were significantly associated with low BMI. CONCLUSIONS: Sequelae of thinness and overweight represent major public health problems. The results of this study, indicating an equal prevalence of thinness and overweight in an urban area and their association with age, level of education, and tobacco use raise concerns of an emerging public health crisis in urban India.

Cohort study of all-cause mortality among tobacco users in Mumbai, India.

INTRODUCTION: Overall mortality rates are higher among cigarette smokers than non-smokers. However, very little is known about the health effects of other forms of tobacco use widely prevalent in India, such as bidi smoking and various forms of smokeless tobacco (e.g. chewing betel-quid). We therefore carried out a cohort study in the city of Mumbai, India, to estimate the relative risks for all-cause mortality among various kinds of tobacco users. METHODS: A baseline survey of all individuals aged > or = 35 years using voters' lists as a selection frame was conducted using a house-to-house approach and face-to-face interviews. RESULTS: Active follow-up of 52,568 individuals in the cohort was undertaken 5-6 years after the baseline study, and 97.6% were traced. A total of 4358 deaths were recorded among these individuals. The annual age-adjusted mortality rates were 18.4 per 1000 for men and 12.4 per 1000 for women. For men the mortality rates for smokers were higher than those of non-users of tobacco across all age groups, with the difference being greater for lower age groups (35-54 years). The relative risk was 1.39 for cigarette smokers and 1.78 for bidi smokers, with an apparent dose-response relationship for frequency of smoking. Women were basically smokeless tobacco users, with the relative risk among such users being 1.35 and a suggestion of a dose-response relationship. DISCUSSION: These findings establish bidi smoking as no less hazardous than cigarette smoking and indicate that smokeless tobacco use may also cause higher mortality. Further studies should be carried out to obtain cause-specific mortality rates and relative risks.

Serum lactate dehydrogenase in diagnosis of megaloblastic anaemia.

The present study was carried out in 75 patients of macrocytic anaemia categorised on bone marrow examination (into megaloblastic and non-megaloblastic anaemia) to evaluate the efficacy of total serum LDH levels and LDH isoenzyme pattern in the diagnosis of megaloblastic anaemia. 25 healthy adults were taken as controls. From this study it can be concluded that total serum LDH levels more than 3000 IU/L are diagnostic of megaloblastic anaemia. Reversed LDH isoenzyme pattern (LDH1 > LDH2) by chloroform inhibition test is an adjuvant in the diagnosis where total serum LDH levels are between 451-3000 IU/L and it will also differentiate megaloblastic anaemia from haemolytic anaemia.

Hyperhomocysteinemia and cardiovascular disease: The nutritional perspectives.

Several members of the vitamin B-complex family are known to participate in the normal metabolism of homocysteine (Hcy). Leaving aside the genetic determinants of hyperhomocysteinemia (HHC), the deficiencies of these vitamins can also result in HHC. The situation of sustained and long standing HHC is likely to be prevalent in population groups with low/average socio-economic status, geriatric population and alcohol abusers. If not corrected by supplementation, these population groups certainly are more vulnerable to develop atherosclerosis (AS) and subsequently, cardiovascular disease (CVD). Hyperhomocysteinemia per se and/or HHC-induced oxidative stress result(s) in chronic chemical endothelial injury/dysfunction, smooth muscle proliferation, prothrombotic state and oxidation of low density lipoproteins (LDL) leading to diverse cardiovascular complications. In the first decade of the new millennium, major research efforts would be directed towards understanding the basic mechanism of HHC-induced oxidative stress and the pathophysiology of HHC-induced CVD, culminating in the evolution of hitherto unknown therapeutic strategies such as nutriceuticals and oxidant-antidotes.

Oral submucous fibrosis in India: a new epidemic?

BACKGROUND: Oral submucous fibrosis (OSF) is a precancerous condition caused by use of the areca nut. The reported prevalence of OSF in Bhavnagar district during 1967 was 0.16%. We investigated whether the impression of an increase in the incidence of the disease was real. METHODS: A house-to-house survey was conducted in Bhavnagar district, Gujarat state. The use of areca nut-containing products and tobacco was assessed through an interviewer administered questionnaire. The oral examination was done by dentists. The diagnostic criteria for OSF was the presence of palpable fibrous bands. RESULTS: A total of 11,262 men and 10,590 women aged 15 years and older were interviewed for their tobacco habits. Among 5018 men who reported the use of tobacco or areca nut, 164 were diagnosed as suffering from OSF. All but four cases were diagnosed among 1786 current areca nut users (age-adjusted relative risk: 60.6). Areca nut was used mostly in mawa, a mixture of tobacco, lime and areca nut, and 10.9% of mawa users had OSF (age-adjusted relative risk: 75.6). The disease as well as areca nut use was concentrated (about 85%) in the lower (< 35 years) age group. CONCLUSIONS: An increase in the prevalence of OSF, especially in the lower age groups, directly attributable to the use of areca nut products was observed. This could lead to an increase in the incidence of oral cancer in the future.

Investigation into the possible mechanisms involved in altered digoxin levels in diabetic patients.

The present study was undertaken to investigate the possible factors which may contribute to the altered digoxin levels in diabetic patients. The digoxin levels were found to be significantly higher in diabetics (1.74 +/- 0.09 ng/ml) as compared to non-diabetics (0.76 +/- 0.07 ng /ml). There was a positive correlation between digoxin levels and glycosylated haemoglobin levels. All diabetic patients had serum creatinine, urea and potassium levels within normal limits. However, serum TSH levels were found to be significantly higher in diabetics as compared to controls. Serum tri-iodo-1-thyronine (T3) levels were found to be lower in diabetics as compared to non-diabetics. Our data suggests that diabetes-mellitus causes alteration of digoxin levels. One of the causes of this increase in digoxin levels may be a tendency towards mild hypothyroidism associated with diabetes mellitus.

Management of accidental kerosene ingestion.

Accidental kerosene ingestion is still a common problem in Libya. It causes considerable morbidity and occasionally mortality. The role and choice of antibacterial agents in its management remain unsettled. Pulmonary damage has been reported as resulting from aspiration. In aspiration pneumonia, anaerobic organisms may be important pathogens and metronidazole may have a place in therapy. The present randomized trial in 100 children with accidental kerosene ingestion assesses the role of ampicillin, carbenicillin and metronidazole in its management. The results are not conclusive but chemoprophylaxis appears to decrease morbidity. Of the various regimens used, the ampicillin/metronidazole combination was found to be slightly better than the others. Further study is recommended.

Hepatotoxicity of high dose salicylate therapy in acute rheumatic fever.

Liver function tests, including serum alanine aminotransferase (ALT) activity, serum bilirubin, alkaline phosphatase, serum proteins, blood ammonia levels and intravenous glucose utilization, were monitored in 50 children with acute rheumatic fever receiving anti-rheumatic doses of aspirin. There was a significant increase in blood ammonia levels and serum ALT after aspirin therapy. A significant fall in glucose utilization coefficient was also recorded. Serum alkaline phosphatase, bilirubin and total proteins did not change significantly. Twenty-two of the 50 children recorded a rise in serum ALT; in 12, the rise was five- to tenfold. These 12 children developed adverse symptoms to aspirin. Also, all had a marked rise in blood ammonia levels. The children improved clinically and biochemically on withdrawal of aspirin. There was no constant relationship between hepatocellular function and serum salicylate levels.

Biochemical aspects of malabsorption in marasmus: effect of dietary rehabilitation.

1. Sixty marasmic children were investigated for the absorption of xylose, proteins and fats. Their duodenal juice samples were also analysed for bile salts and microflora. 2. The marasmic children were then studied in three groups of twenty by allocating them to three different dietary schedules: a high-protein diet (30% of the total energy from protein), a high-fat diet (40% of the total energy from fat) and a high-carbohydrate diet (70% of the total energy from carbohydrate) for 2 weeks and the previous measurements repeated. 3. Whereas the high-fat diet resulted in improved fat absorption, along with an increase in total and conjugated bile acids, and the high-carbohydrate diet led to improved xylose absorption, the diet rich in protein resulted in an improvement in the absorption of all three dietary ingredients. It appears that a high-protein diet improves the overall absorption process by improving the intestinal environment as a whole, while high-carbohydrate and high-fat diets bring about adaptive changes related to the respective absorptive processes.

Enzyme immunoassay for pregnancy-associated plasma protein-A.

This enzyme immunoassay procedure for pregnancy-associated plasma protein type A involves a "sandwich"-type system in microtitration plates. One can detect 0.27 mg of the protein per liter of serum, with a between-batch CV of 10.2%, and the antiserum used does not cross react with any of the other placentally derived proteins. A reference interval for the last trimester of pregnancy is presented. The procedure described is suitable for studying the behavior of this protein during pregnancy.