Overweight/obesity, pre-diabetes, diabetes and its association with hypertension and other factors among rural adults (≥18 years) in India.

BACKGROUND: Non-communicable diseases are important causes of morbidity and mortality throughout the world. METHODS: A community-based cross-sectional study conducted in 10 Indian states using multi-stage random sampling procedures. Information was collected on socio-economic and demographic particulars, anthropometric measurements such as height, weight and waist circumference, fasting blood glucose and blood pressure was measured. One day 24-h dietary recall was done for foods and nutrient intakes. Bivariate and multivariate step-wise logistic regression analyses was done. RESULTS: The prevalence of overweight/obesity among rural adults was 23.4 % (95 % CI: 22.9-23.9), while age adjusted prevalence of pre-diabetes was 8.4 % (95 % CI: 8.1-8.7) and diabetes was 6.8, (95 % CI 6.7-7.1), respectively. The prevalence of diabetes was lowest in Uttar Pradesh, West Bengal and Odisha (3-4%) and higher in Kerala and Tamil Nadu (12-15 %). The odds of diabetes was 5.5 times more among elderly, 1.3 times higher among Christians and among high income groups, and 2 times among overweight (CI: 1.50-2.50), obese (CI: 1.61-2.76) and abdominal obesity (OR; 1.57; CI: 1.29-1.91) and 1.6 times more among hypertensives. The odds of diabetes were high among those consuming the lower tertiles of carbohydrates, pulses, milk and milk products and folic acid. CONCLUSION: the age-adjusted prevalence of diabetes and pre-diabetes was 6.8 % and 8.4 % respectively and the odds of diabetes was high among elderly, among high socio-economic groups, overweight/obese subjects and among hypertensives. Also, knowledge about symptoms of diabetes was low. There is a need to improve awareness for early diagnosis and treatment for control of diabetes and hypertension.

Differential Expression of SRY-Related HMG-Box Transcription Factor 2, Oligodendrocyte Lineage Transcription Factor 2, and Zinc Finger E-Box Binding Homeobox 1 in Serum-Derived Extracellular Vesicles: Implications for Mithramycin Sensitivity and Targeted Therapy in High-Grade Glioma.

Glioblastoma multiforme (GBM) is the most aggressive type of glioma and is often resistant to traditional therapies. Evidence suggests that glioma stem cells (GSCs) contribute to this resistance. Mithramycin (Mit-A) targets GSCs and exhibits antitumor activity in GBM by affecting transcriptional targets such as SRY-related HMG-box transcription factor 2 (SOX2), oligodendrocyte lineage transcription factor 2 (OLIG2), and zinc finger E-box binding homeobox 1 (ZEB1). However, its clinical use has been limited by toxicity. This study explored the diagnostic potential of serum extracellular vesicles (EVs) to identify Mit-A responders. Serum EVs were isolated from 70 glioma patients, and targeted gene expression was analyzed using qRT-PCR. Using chemosensitivity assay, we identified 8 Mit-A responders and 17 nonresponders among 25 glioma patients. The M-score showed a significant correlation (p = 0.045) with isocitrate dehydrogenase 1 mutation but not other clinical variables. The genes SOX2 (p = 0.005), OLIG2 (p = 0.003), and ZEB1 (p = 0.0281) were found to be upregulated in the responder EVs. SOX2 had the highest diagnostic potential (AUC = 0.875), followed by OLIG2 (AUC = 0.772) and ZEB1 (AUC = 0.632).The combined gene panel showed significant diagnostic efficacy (AUC = 0.956) through logistic regression analysis. The gene panel was further validated in the serum EVs of 45 glioma patients. These findings highlight the potential of Mit-A as a targeted therapy for high-grade glioma based on differential gene expression in serum EVs. The gene panel could serve as a diagnostic tool to predict Mit-A sensitivity, offering a promising approach for personalized treatment strategies and emphasizing the role of GSCs in therapeutic resistance.

Del Nido cardioplegia versus blood cardioplegia in coronary artery bypass grafting.

Purpose: The del Nido cardioplegia (DC) has been extensively used in congenital heart surgery for over two decades and is becoming popular in adult cardiac surgery. We evaluated the efficacy and safety of DC, compared to conventional blood cardioplegia (BC), in adult patients undergoing isolated coronary artery bypass grafting (CABG). Methods: This metachronous study included a total of 2330 consecutive patients who underwent isolated CABG. The study population was divided into two groups: BC group, consisting of 1165 patients (May 2012 through December 2015); and DC (del Nido) cardioplegia group consisting of 1165 patients (January 2016 through June 2018). Propensity matching yielded 735 well-matched pairs. The propensity-matched cohorts of BC and DC were compared in terms of myocardial function outcomes and other clinical outcomes to determine the efficacy and safety of both the cardioplegic solutions. Results: There was no difference in 30-day mortality [odds ratio (OR), 0.74; 95% confidence interval (CI), 0.16-3.35, p = 0.70]. There was a significant decrease in the DC group in the postoperative events, including re-exploration rates [OR, 0.25; 95% CI, 0.118-0.568, p < 0.001], myocardial infarction [OR, 0.282; 95% CI, 0.133-0.596, p < 0.001], left ventricular dysfunction [OR, 0.60; 95% CI, 0.396-0.916, p = 0.018], and acute kidney injury (AKI) [OR, 0.255; 95% CI, 0.156-0.418, p < 0.001]. The rate of spontaneous return to sinus rhythm was significantly higher in the DC group [OR, 5.162; 95% CI, 3.701-7.198, p < 0.001]. Cardiopulmonary bypass time (95.2 ± 29.1 min vs. 82.1 ± 28.8 min, p < 0.001) and aortic cross-clamp (ACC) time (57.3 ± 19 min vs. 48.7 ± 19.0 min, p < 0.001) were higher in the DC group, but the absolute difference in ACC time was only 8 min. There was no difference in AKI requiring renal replacement therapy [OR, 0.62; 95% CI, 0.203-1.912, p = 0.40], postoperative cerebrovascular accidents [OR, 0.398; 95% CI, 0.077-2.059, p = 0.073], and postoperative ventricular arrhythmias [OR, 0.80; 95% CI, 0.456-1.916, p = 0.47]. Conclusion: This study revealed comparable clinical outcomes and effective myocardial protection with DC, compared to BC in patients undergoing isolated CABG. In addition, DC demonstrated the ease of administration with the feasibility of single-dose administration.

Exploring urinary extracellular vesicles for organ transplant monitoring: A comprehensive study for detection of allograft dysfunction using immune-specific markers.

BACKGROUND: Allograft dysfunction (AGD) is a common complication following solid organ transplantation (SOT). This study leverages the potential of urinary extracellular vesicles (UEVs) for the non-invasive detection of AGD. AIM: We aimed to assess the diagnostic value of T-cell and B-cell markers characteristic of T-cell-mediated and antibody-mediated rejection in UEV-mRNA using renal transplantation as a model. MATERIALS AND METHODS: UEVs were isolated from 123 participants, spanning healthy controls, functional transplant recipients, and biopsy-proven AGD patients. T-cell and B-cell marker mRNA expressions were evaluated using RT-qPCR. RESULTS: We observed significant differences in marker expression between healthy controls and AGD patients. ROC analysis revealed an AUC of 0.80 for T-cell markers, 0.98 for B-cell markers, and 0.94 for combined markers. T-cell markers achieved 81.3 % sensitivity, 80 % specificity, and 80.4 % efficiency. A triad of T-cell markers (PRF1, OX40, and CD3e) increased sensitivity to 87.5 % and efficiency to 82.1 %. B-cell markers (CD20, CXCL3, CD46, and CF3) delivered 100 % sensitivity and 97.5 % specificity. The combined gene signature of T-cell and B-cell markers offered 93.8 % sensitivity and 95 % specificity. CONCLUSION: Our findings underscore the diagnostic potential of UEV-derived mRNA markers for T-cells and B-cells in AGD, suggesting a promising non-invasive strategy for monitoring graft health.

Assessment of virgin coconut oil in a balanced diet on indicators of cardiovascular health in non-obese volunteers: A human metabolic study.

BACKGROUND AND AIMS: Consumption of coconut oil is implicated in cardiovascular disease risk. On the contrary, virgin coconut oil (VCO) is believed to offer better health benefits, however, the evidence to support such claims is lacking, particularly in humans. Therefore, this study aimed at assessing the impact of VCO in a balanced diet on HDL-C and some of the anthropometric and biochemical parameters associated with human cardiovascular health before and after the feeding experiment. METHODS: In a crossover observational study, apparently healthy non-obese male volunteers (n = 22) aged between 28 and 50years with a mean body weight of 67.5 kg were inducted into a two-arm controlled feeding experiment one after another for eight weeks with a six-week washout period. In the first arm, the diets were prepared with VCO, whereas peanut oil was used in the second arm (∼35g/day) as the control. RESULTS: Compared to baseline, the consumption of VCO did not affect HDL-C and anthropometric measures at the end of the 8th week, whereas plasma total cholesterol (TC) and LDL-C levels (Means±standard error; 172 ± 5.6 mg/dL versus 186 ± 5.9 mg/dL and 113 ± 4.29 mg/dL versus 126 ± 4.17 mg/dL respectively) increased significantly. However, plasma triglycerides and some of the cardiovascular risk markers (namely, vascular cell-adhesion molecules, serum amyloid proteins and C-reactive protein) remained unaltered. Further, most of the changes in the VCO arm were comparable to the peanut oil regimen. CONCLUSION: The consumption of VCO in a balanced diet displayed neutral effects on most parameters related to cardiovascular risk. However, the rise in TC and LDL-C must be tested in a larger sample size over longer periods.

Assessment of Knowledge and Awareness Among the Stakeholders of Clinical Research at the Site: A Collaborative, Electronic-Survey Approach to Identify the Indicators of Quality.

BACKGROUND: There has been a concern about the quality of clinical trials conducted in terms of data integrity, accuracy or ethical conduct. This study aimed to assess the tangible gap existing in knowledge and application of rules and guidelines among the Researcher, Research staff (RS) and Ethics Committee (EC) members - the three research stakeholders at the study sites. METHODS: A validated e-questionnaire with details for demography, role, years of experience, affiliation and questions on knowledge and understanding about their clinical research functions based on the New Drugs and Clinical Trials (NDCT) Rules 2019, including: 'Role and responsibility, Regulations, Reporting timelines, Documentation, Conflict of interest and Miscellaneous' was circulated among the seven research sites of one organization with their fourteen Institutional ECs, as part of planned annual survey. Responses with >60% correct answers were arbitrarily considered to represent adequate knowledge. RESULTS: Of 201 participants, there were 27.4% Researchers, 50.2% were from the EC and 22.4% RS. A greater proportion of the Researchers (43.6%) had >5 years of experience. The mean ± SD of correct answers obtained was 66.9 ± 14.77 and was statistically significant (p<0.05) among the groups, highest for the EC members (71.4 ± 11.51), those with 2-5 years of experience (68.4 ± 14.40), and least for the RS (56.8 ± 11.93). Researchers (> 90%) were aware of their role in the clinical trial agreement and the importance of the trial registration in the Clinical Trials Registry India. There were gaps in the knowledge on Informed Consent (IC) process and post-trial access. Awareness regarding the IC process was adequate among the RS (84%). Awareness that the responsibility of all delegation at the site finally lies with the Researchers was adequate (60%), but 20% incorrectly believed that the sponsor can have access to subject identification details. Deficiencies were noted regarding documentation, NDCT rules -2019 and serious adverse event (SAE) reporting process. Five percent answered that Data Clarification Forms were generated after reviewing the case report forms. The awareness that NDCT rules-2019 was not for medical devices, student projects or Investigator Initiated Studies was inadequate (56%). The EC members' awareness of roles and responsibilities was adequate (≥ 90%). Knowledge gaps were noted in EC monitoring of the ongoing trials (32%) and SAE reporting on the SUGAM portal (8.8%), where stakeholders can access the regulator's web services using a single window interface for clinical trial related activities. CONCLUSION: There are gaps in the knowledge of the 3 stakeholders at the site. Identifying and rectifying the gray areas will improve the site's performance. There is a need for regular training and assessments.

Topography and Choroidal Thickness Measurement in Healthy Asian Indian Subjects using RTVue XR 100 Optical Coherence Tomography.

PURPOSE: The purpose was to study the choroidal thickness and its profile, derived from different point locations in healthy Asian Indian subjects using RTVue XR 100 optical coherence tomography (OCT) and to determine its correlation with age, refractive error, and axial length. METHODS: In this cross-sectional study, 300 eyes of 150 healthy subjects, with no ocular pathology, were scanned in a single session, using a line scan protocol of RTVue XR 100 OCT. Choroidal thickness was measured at the subfoveal region, and six measurements were obtained on either side of the fovea (temporal and nasal) at 500 µm interval apart, up to 3000 µm. The correlation between subfoveal choroidal thickness and age, refractive error, and axial length was assessed. RESULTS: Three hundred eyes of 150 healthy subjects were included in the analysis. Median age of the study participants was 55 years (interquartile range [IQR]: 44-61). The median subfoveal choroidal thickness was 235 µm (IQR: 210-263). The choroidal thickness was minimum at nasal 3000 µm from the fovea, while it was maximum in the subfoveal region. The point zones which were near the fovea showed thicker choroidal thickness than the outer zones, both nasally and temporally (P < 0.00001 at all locations), and at all point locations the choroid were thicker temporally than nasally (All P < 0.00001). Subfoveal choroidal thickness showed negative correlation with age (coefficient = -0.62, P = 0.03) and axial length (correlation = -8.52, P = 0.02). A decrease in subfoveal choroidal thickness of 0.62 µm/year was found by regression analysis. CONCLUSION: Our study provides normative database and topographic profile of choroidal thickness in the normal Asian Indian eyes using RTVue XR 100 OCT.

Socio-demographic factors, overweight/obesity and nutrients associated with hypertension among rural adults (≥18 years): Findings from National Nutrition Monitoring Bureau survey.

BACKGROUND: Hypertension is the leading cause of death throughout the world. The study was conducted to assess the prevalence, determinants and knowledge & practices about hypertension among rural adults in India. METHODS: A community-based cross-sectional study was carried out in 10 major states of India. Information on socio-economic & demographic particulars was collected and anthropometric measurements like height, weight, waist & hip circumference and blood pressure were measured. Foods and nutrient intakes were assessed by 24-h recall method. Analysis was done using SPSS window 22. RESULTS: The prevalence of pre-hypertension was 45.3% (95% CI: 44.6-46.0) and hypertension was 22% (95% CI: 21.5-22.3) (age standardized prevalence; 20.2%) while, overweight/obesity was 22.6% (95% CI: 22.2-23.0) as per Asian cut offs (BMI≥23). The prevalence of hypertension was higher in West Bengal (29.5%) and Kerala (28.9%) and low in Madhya Pradesh and Uttar Pradesh (16-19%). The odds of hypertension was 1.2 times higher among forward communities, businessmen, tobacco users and those consuming alcohol, 2-3 times higher among overweight (CI: 1.87-2.25) and obese (2.65-3.27). The odds of hypertension was 1.2 times higher among those consuming lower tertile of carbohydrates (CI = 1.02-1.41) and zinc (CI = 1.11-1.42). About 76% were aware of hypertension, 21% were old hypertensive & 19% were on treatment. CONCLUSIONS: Age standardized prevalence of hypertension was 20% among adults and was associated with age, occupation, overweight/obesity, tobacco and alcohol use, low intake of carbohydrates and zinc. Therefore, increasing awareness and consumption of healthy diet through behavior change communication will help to control hypertension among adults.

Energy expenditure in COVID-19 mechanically ventilated patients: A comparison of three methods of energy estimation.

BACKGROUND: Indirect calorimetry (IC) is the gold standard for measuring resting energy expenditure. Energy expenditure (EE) estimated by ventilator-derived carbon dioxide consumption (EEVCO2 ) has also been proposed. In the absence of IC, predictive weight-based equations have been recommended to estimate daily energy requirements. This study aims to compare simple predictive weight-based equations with those estimated by EEVCO2 and IC in mechanically ventilated patients of COVID-19. METHODS: Retrospective study of a cohort of critically ill adult patients with COVID-19 requiring mechanical ventilation and artificial nutrition to compare energy estimations by three methods through the calculation of bias and precision agreement, reliability, and accuracy rates. RESULTS: In 58 mechanically ventilated patients, a total of 117 paired measurements were obtained. The mean estimated energy derived from weight-based calculations was 2576 ± 469 kcal/24 h, as compared with 1507 ± 499 kcal/24 h when EE was estimated by IC, resulting in a significant bias of 1069 kcal/day (95% CI [-2158 to 18.7 kcal]; P < 0.001). Similarly, estimated mean EEVCO2 was 1388 ± 467 kcal/24 h when compared with estimation of EE from IC. A significant bias of only 118 kcal/day (95% CI [-187 to 422 kcal]; P < 0.001), compared by the Bland-Altman plot, was noted. CONCLUSION: The energy estimated with EEVCO2 correlated better with IC values than energy derived from weight-based calculations. Our data suggest that the use of simple predictive equations may potentially lead to overfeeding in mechanically ventilated patients with COVID-19.

Prevalence and Impact of Preexisting Comorbidities on Overall Clinical Outcomes of Hospitalized COVID-19 Patients.

COVID-19 risk increases with comorbidities, and the effect is magnified due to the contribution of individual and combined comorbidities to the overall clinical outcomes. We aimed to explore the influence of demographic factors, clinical manifestations, and underlying comorbidities on mortality, severity, and hospital stay in COVID-19 patients. Therefore, retrospective chart reviews were performed to identify all laboratory-confirmed cases of SARS-CoV-2 infection in Apollo Hospitals, Hyderabad, between March 2020 and August 2020.A total of 369 confirmed SARS-CoV-2 cases were identified: 272 (73.7%) patients were male, and 97 (26.2%) were female. Of the confirmed cases, 218 (59.1%) had comorbidities, and 151 (40.9%) were devoid of comorbidities. This study showed that old age and underlying comorbidities significantly increase mortality, hospital stay, and severity due to COVID-19 infection. The presence of all four comorbidities, diabetes mellitus (DM) + Hypertension (HTN) + coronary artery disease (CAD) + chronic kidney disease (CKD), conferred the most severity (81%). The highest mortality (OR: 44.03, 95% CI: 8.64-224.27) was observed during the hospital stay (12.73 ± 11.38; 95% CI: 5.08-20.38) in the above group. Multivariate analysis revealed that nonsurvivors are highest (81%) in (DM + HTN + CAD + CKD) category with an odds ratio (95% CI) of 44.03 (8.64-224.27). Age, gender, and comorbidities adjusted odds ratio decreased to 20.25 (3.77-108.77). Median survival of 7 days was observed in the (DM + HTN + CAD + CKD) category. In summary, the presence of underlying comorbidities has contributed to a higher mortality rate, greater risk of severe disease, and extended hospitalization periods, hence, resulting in overall poorer clinical outcomes in hospitalized COVID-19 patients.

Exosomal PTEN as a Predictive Marker of Aggressive Gliomas.

Background: Liquid biopsies have emerged as convenient alternative diagnostic methods to invasive biopsies, by evaluating disease-specific biomarkers and monitoring the disease risk noninvasively. Phosphatase and tensin homolog deleted in chromosome 10 (PTEN) is a potent tumor suppressor, and its deletion/mutations are common in gliomas. Objective: Evaluate the feasibility of non-invasive detection of PTEN and its downstream genes in serum exosomes of glioma patients. Materials and methods: PTEN, Yes-associated-protein 1 (YAP1), and lysyl oxidase (LOX) transcript expression were monitored through polymerase chain reaction (PCR) in serum exosomes and their paired tumor tissues. The impact of PTEN and its axis genes expression on the overall survival (OS) was monitored. Results: Out of the 106 glioma serum samples evaluated, PTEN was retained/lost in 65.4%/34.6% of the tumor samples while it was retained/lost in 67.1%/32.9% of their paired exosomal fractions. PTEN expression in both tissue and paired exosomal fractions was observed in 48.11% of the samples. Sanger sequencing detected three mutations (Chr10: 89720791(A>G), Chr10:89720749(C>T), and Chr10:89720850(A>G). Both PTEN-responsive downstream genes (YAP1) and LOX axis were upregulated in the PTEN-deficient samples. PTEN loss was associated with poor survival in the glioma patients (hazard ratio (HR) 0.68, confidence interval (CI): 0.35-1.31, P = 0.28). The OS of the exosomal PTEN cohort coincided with the tumor-tissue PTEN devoid group (HR 1.08, CI: 0.49-2.36, P = 0.85). While, old age yielded the worst prognosis; gender, location, and grade were not prognostic of OS in the multivariate analysis. Conclusions: PTEN and its responsive genes YAP1 and LOX can be detected in serum exosomes and can serve as essential tools for the non-invasive evaluation/identification of aggressive gliomas.

Repeatability of Choroidal Thickness Measurements in Healthy Subjects using RTVue XR Optical Coherence Tomography.

Purpose: To determine the intrasession, intraobserver, interobserver, and repeatability of choroidal thickness measurements in the healthy subjects imaged on enhanced depth imaging system of RTVue XR spectral domain optical coherence tomography (OCT). Methods: In this prospective, cross-sectional study, seventy eyes of 70 healthy volunteers with no known ocular disease were imaged using high-density scanning protocol of RTVue XR OCT. In a single imaging session, three sequential 12 mm macular-enhanced depth horizontal line scans were obtained through the fovea. Two experienced examiners measured the subfoveal choroidal thickness (SFCT), choroidal thickness at 500 µm nasally and temporally from the fovea in all the eyes, using the manual calipers provided in the software. The graders were masked to each other's measurement readings. The coefficient of repeatability (CR) and intraclass correlation coefficient (ICC) were used to measure the reliability within graders. Intergrader variability was assessed using Bland-Altman method and 95% limits of agreement (LoA). Results: Intragrader CR for grader one was 4.11 µm (95% confidence interval [CI], -2.84-11.06) for SFCT and 5.73 µm (95% CI, -3.71-15.16) for the grader two. Intragrader ICC of grader one ranged from 0.996 for SFCT to 0.994 for temporal choroidal thickness. Intragrader ICC of grader two ranged from 0.993 for temporal choroidal thickness to 0.991 for SFCT. Intergrader CR ranged from 5.24 µm (95% CI, -4.66-15.15) for SFCT to 5.89 µm (95% CI, -7.27-19.04) for temporal choroidal thickness. Intergrader 95% LoA for SFCT, nasal and temporal choroidal thickness were, -15.84-12.15 µm, -15.99-17.7 µm, and - 19.12-15.57 µm, respectively. Conclusion: Choroidal thickness measurements can be quantified with good repeatability using RTVue XR OCT, which would be useful in patients with chorioretinal diseases.

Tailoring nutrition therapy amid the COVID-19 pandemic: Does it work?

BACKGROUND: The COVID-19 pandemic has been a challenge for nutrition monitoring and delivery. This study evaluates clinical and nutritional characteristics of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and investigates the relationship between nutrition delivery and clinical outcomes. METHODS: Prospective observational study of adults admitted for >24 hrs to a tertiary-care hospital during a period of 2months. Data was collected on disease severity, energy, protein delivery and adequacy, use of mechanical ventilation (MV), hospital length of stay (LOS). Multivariate logistic regression models were used to determine the associations with mortality as the primary outcome. RESULTS: 1083 patients: 69% male (n = 747), 31% females (n = 336), mean age 58.2 ± 12.8 with 26.6 ± 4.32 BMI were analysed. 1021 patients survived and 62 deaths occurred, with 183 and 900 patients in the ICU and ward, respectively. Inadequate calorie and protein delivery had significantly higher mortality than those with adequate provision (p < 0.001) among the ICU patients. In bivariate logistic regression analysis, inadequacy of energy and protein, disease severity, comorbidities ≥3, NRS score ≥3 and prone ventilation correlates with mortality (p < 0.001). In multivariate logistic regression analysis of the ICU patients, energy inadequacy (OR:3.6, 95%CI:1.25-10.2) and prone ventilation (OR:11.0, 95%CI:3.8-31.9) were significantly (p < 0.05) associated with mortality after adjusting for disease severity, comorbidities and MV days. CONCLUSION: Most patients infected with SARS-CoV-2 are at nutrition risk that can impact outcome. Our data suggest that addressing nutritional adequacy can be one of the measures to reduce hospital LOS, and mortality among nutritionally risk patients.

Association Between Nutrition Delivery, Modified Nutrition Risk In Critically III Score, and 28-Day Mortality.

BACKGROUND: Nutrition delivery, is a key component in the management of critical illness. Traditional scoring systems are inadequate in the intensive care unit (ICU), as patients are sedated. Our study examines the associations between calorie and protein adequacy, 28-day mortality, and modified Nutrition Risk in Critically Ill (mNUTRIC) score and identify at-risk ICU patients who may benefit more from nutrition intervention. METHODS: Prospective observational study of adults admitted for >24h to the ICU of a tertiary care hospital during a period of 7 months. Data were collected on nutrition delivery, mNUTRIC score, use of mechanical ventilation, and ICU/hospital length of stay (LOS). Multivariate logistic regression analysis was done with 28-day mortality as the primary outcome. RESULTS: Two hundred forty-eight patients were recruited for the study with 60% male, 40% female, mean age 60.8 ± 14.7, and body mass index of 24.2 ± 4.8. Patients with inadequate calorie and protein delivery had significantly higher 28-day mortality than those with adequate provision (P=.032 and P =. 017). In bivariate logistic regression analysis, mNUTRIC score (odds ratio [OR], 1.802; 95% CI, 1.042-3.117; P = .035) and adequacy of energy (OR, 1.92) and protein (OR, 2.49) correlate with 28-day mortality. The Kaplan-Meier survival curve showed a survival benefit in the ≥80% energy and protein group among the total patients and was also significantly associated with lower hospital and ICU LOS, even after matching (log-rank test, P < 0.001). CONCLUSION: Adequacy of energy and protein to ≥80% may shorten ICU/hospital LOS and reduce 28-day mortality among both high and low nutrition risk patients.

Guava with an institutional supplementary meal improves iron status of preschoolers: a cluster-randomized controlled trial.

The Integrated Child Development Services of India provides Supplementary Nutrition Program (SNP) to preschoolers. Using this platform, the current study examined the impact of diversifying a cereal/pulse-based SNP-meal with guava on iron status and cognitive development among 24-48 months old children. A three-arm, nonblinded, cluster-randomized controlled trial (CTRI/2014/09/004983) included 399 beneficiaries from 28 preschools in 16 villages in Telangana state, India. The villages were randomly assigned to receive 25 g of guava (guava group (GG)), banana (banana group (BG)), or cucumber (cucumber group (CG)) along with a SNP meal for 140 days. Nutrient biomarkers (iron status, plasma vitamin C, vitamin B12 , and folate), cognitive development, anthropometric indicators (WAZ, HAZ, and WHZ), and morbidity were assessed at baseline and endline. A linear mixed model and a generalized estimating equation were applied to compare changes in outcomes across the groups. All outcome variables were comparable across groups at baseline. The iron to vitamin C molar ratio improved in the GG from 1:1.4 to 1:12 but remained unaltered in control groups. Higher hemoglobin (P = 0.002), serum ferritin (SF; P < 0.001), vitamin C (P = 0.047), and lower soluble transferrin receptor (sTfR; P < 0.001) causing decreased prevalence of iron deficiency (ID) (P = 0.003) were observed in the GG compared with BG and CG. Prevalence of acute respiratory infection (ARI) was lower in the GG (P = 0.035) versus controls. No impact was observed on cognitive development or growth. Thus, diversifying a cereal/pulse-based meal with guava increased meal vitamin C content, thereby reducing ID and ARI-related morbidity. This approach represents a valid and scalable strategy to address ID among young children.

Sex-specific role of CYP24A1 rs2762939 in the risk of essential hypertension based on the serum vitamin D and total renin concentrations.

CYP24A1, Vitamin D 24-hydroxylase catabolizes 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D to 24-hydroxylated vitamin D products. It is widely known that low Vitamin D can lead to increased renal renin and angiotensin II production, consequently elevating blood pressure or development of essential hypertension (EH). We have conducted an investigation on hypertensives and controls to evaluate the association of the gene variant, CYP24A1 rs2762939 and 25(OH)D in an Indian population with EH. On gender-based stratification, with multivariate logistic analysis after adjustment for covariates, the CYP24A1 rs2762939 CC variant showed a higher risk of EH in males (aOR = 3.141, CI 1.164-8.478, P = .024) while females illustrated an inverse association with EH (aOR = 0.398, CI 0.172-0.092, P = .031). The 25(OH)D levels among the three genotypes of hypertensives substantiate these results. Our results clearly suggest that gender, CYP24A1 rs2762939, and Vitamin D status may play a significant role in disease susceptibility towards EH in Indian population.

Prevalence of Nutritional Anemia and Hyperhomocysteinemia in Urban Elderly.

The data on the prevalence of nutritional anemia among the urban elderly population in India was limited. Hence, the present study was carried out with an aim to assess the prevalence of nutritional anemia and its association with vitamin B12, folate, ferritin and homocystine among the urban elderly population. A community- based cross-sectional study was carried out among 282 urban elderly (≥ 60 years) subjects (186 males and 96 females) in Hyderabad. Fasting blood samples were collected and hemoglobin (Hb) was estimated by cyanmethemoglobin method. Plasma Folic acid and vitamin B12 levels were estimated by RIA and homocysteine and ferritin levels were estimated by ELISA methods. The overall prevalence of anemia (Hb < 12 g/dL for females and < 13 g/dL for males) among the urban elderly was 20.6% and the prevalence was found to be increasing with the age. The prevalence of vitamin B12 (< 203 pg/mL), folic acid (< 4 ng/mL), ferritin (< 15 ng/mL) and hyperhomocysteinemia (≥ 12 µmol/L) in these subjects was 36.0%, 8.2%, 1.1% and 24.3% respectively. The prevalence of anemia due to deficiencies of iron (ferritin < 15 ng/mL), folate and vitamin B12 was 5.45%, 9.1% and 42.3% respectively. A significant association was observed between the prevalence of anemia with ferritin and hyperhomocysteinemia. In conclusion, the prevalence of anemia and nutritional anemia among the urban-based elderly was 20.6% and 56.85% respectively. The association of anemia with hyperhomocysteinemia needs further studies.

A sequential, exploratory, mixed-methods approach for development and validation of a context-specific knowledge, attitude and practice questionnaire on micronutrients for literate mothers of school-age children.

OBJECTIVE: To develop and validate a context-specific comprehensive knowledge, attitude and practice (KAP) questionnaire for literate mothers on factors affecting micronutrient status of 6-10-year-old children. DESIGN: Sequential exploratory mixed-methods study using focus group discussions (FGD) and psychometric validation. SETTING: Seven randomly selected villages with >500 households with three to five family members each, in Ghatkesar sub-district, Medchal district, Telangana state, India.ParticipantsLiterate mothers from middle-income households with at least one child (6-10 years) for FGD (n 44), for testing the internal consistency (n 80) and for test-retest reliability (n 30). RESULTS: The themes for FGD were diet diversity, micronutrients, cooking and eating practices, national programmes and sunlight exposure. Knowledge among caregivers about sources of micronutrients, deficiency symptoms, cooking/eating practices was low, while attitude towards diet diversity and sunlight was good. Non-availability of fruits and vegetables was a barrier to diet diversity. About 72 % of the questions from the item pool were based on FGD. After content validity, 125 items were selected for the questionnaire which, upon psychometric validation, was reduced to an eighty-eight-item questionnaire with difficulty index of 0·10-0·91, discrimination index of 0·09-0·68, Cronbach's α of 0·78 (reliability of knowledge and attitude) and 0·50 (practice). A Bland-Altman plot showed good agreement between test and retest scores. CONCLUSIONS: The questionnaire developed and validated using a sequential exploratory mixed-methods approach can be used for assessing KAP on micronutrients and factors affecting consumption of diverse diets in rural Indian households.

Energy Balance Coexists With Disproportionate Macronutrient Consumption Across Pretraining, During Training, and Posttraining Among Indian Junior Soccer Players.

PURPOSE: To evaluate energy expenditure, energy intake, and nutrient adequacy of Indian junior soccer players. METHOD: Forty junior national-level soccer players (Under-12 and Under-16 age groups) were assessed for 3-day weighed food records and 3-day energy expenditure. Energy and nutrient intake was analyzed from food records, and energy expenditure was measured using a portable metabolic analyzer and activity records. Nutrient adequacy was determined by comparing intake with prevailing recommendations. RESULTS: Players exhibited no significant difference between energy intake (boys = 3062 [340.9] and girls = 2243 [320.3] kcal·d-1) and expenditure (boys = 2875 [717.3] and girls = 2442 [350.3] kcal·d-1). Across age groups, the Under-12 boys showed positive energy balance as against energy deficits in Under-16. Girls showed energy deficits, although not significant. There were 58% of girls showing energy availability <30 kcal·kg-1 fat-free mass, of which 37% were Under-16 players. Carbohydrates contributed to >60% of energy expenditure among 95.2% boys and 73.7% girls. Among 52.4% boys and 47.4% girls, <25% of energy expenditure was contributed by fat. More than 95% players consumed <1 g·kg-1 carbohydrates pretraining and 100% of them consumed >1.2 g·kg-1 carbohydrates posttraining. CONCLUSION: Junior soccer players consumed more than recommended carbohydrates in the diet, although not aligning with the pretraining, during training, and posttraining meal requirements. Considering the energy deficits observed among Under-16 players, a suitable dietary modification is warranted.

mRNA expression profile in peripheral blood mononuclear cells based on ADRB1 Ser49Gly and Arg389Gly polymorphisms in essential hypertension - a case-control pilot investigation in South Indian population.

BACKGROUND: ß1-Adrenoreceptor (ADRB1) genetic polymorphisms are widely studied for susceptibility to many cardiovascular diseases such as essential hypertension. However, the mRNA expression of ADRB1 is rarely studied. METHODS: A case-control pilot study with 292 hypertensives and 324 controls was designed to evaluate the role of the Ser49Gly and Arg389Gly, which are commonly studied single nucleotide polymorphisms (SNP), in the mRNA levels of ADRB1, in conjunction with its genetic predisposition to essential hypertension. RESULTS: Differential expression of ADRB1 mRNA was seen between hypertensives and controls (p<0.01) based on genetic variants of Ser49Gly. Among hypertensive subjects, Ser49Ser and Gly49Gly were highly expressed in comparison to Ser49Gly (p<0.05 and p<0.01, respectively), whereas genetic variants of Arg389Gly did not demonstrate any such variations. We found no association between the ADRB1 SNPs viz., Ser49Gly and Arg389Gly and essential hypertension. CONCLUSIONS: The increased mRNA levels of Gly49Gly may indicate a plausible role in the interindividual variations in drug response. Further, ADRB1 polymorphisms did not contribute to the genetic risk of essential hypertension. Studies with larger sample size are warranted to confirm these observations in the South Indian population.