Prediabetes in rural adolescent girls from DERVAN cohort: data from the KONKAN region of the state of Maharashtra, India (DERVAN-4).

Background: India is witnessing an epidemic of type 2 diabetes. Overweight/obesity, overnutrition, physical inactivity, and family history are well-known risk factors for diabetes. We investigated the role of undernutrition in the development of diabetes among rural adolescent girls. Methods: DERVAN cohort study was set up in the KONKAN region of the western Indian state of Maharashtra. It enrolled 1,520 adolescent girls (16-18 years old at the time of enrollment). We measured glycemic parameters (glucose, insulin, and HbA1C) and body size using anthropometry and body composition using bioimpedance. Prediabetes was diagnosed using the American Diabetic Association (ADA) criteria. We also calculated various HOMA indices for insulin resistance (HOMA-IR), ß-cell function (HOMA-ß), insulin sensitivity (HOMA-S), and compensatory ß-cell response using a homeostasis model. BMI, body fat%, and waist circumferences were treated as exposures and all the glycemic parameters and indices as outcomes. Results: The median age of the subjects was 16.6 years. The median weight, height, and BMI were 40.7 kg, 151.7 cm, and 17.5 kg/m2, respectively. Prevalence of underweight was 28.8%, and stunting was observed in 30.4%. Thinness and obesity using BMI were observed in 58.4% and 4.2%, respectively. The median body fat% was 22.5, and excess body fat (>35%) was observed in 5.7%. The prevalence of prediabetes was 39.4%. Fasting insulin concentrations, HOMA-IR, and HOMA-ß showed a positive trend across body composition quartiles (p < 0.001). HOMA-S and compensatory ß-cell response showed an inverse trend (p < 0.001). Compared with prediabetic girls in the overweight/obese group, girls most undernourished group had lower median insulin concentrations (8.1 µIU/ml vs. 17.1 µIU/ml), lower HOMA-IR (1.1 vs. 2.3), and lower HOMA-ß (75.6 vs. 129.2) but higher sensitivity (87.4 vs. 43.7) (p < 0.001) for all. Conclusion: We have reported a high prevalence of prediabetes among rural adolescent girls with a very low prevalence of obesity. Prediabetes in obesity is driven by hyperinsulinemia and overworking of the pancreas while poor ß-cell function and poor insulin secretion are major drivers in the undernourished group. The high-risk diabetes screening programs are much needed for the undernourished populations. Caution should be exercised for planning the interventions as overfeeding (or overnutrition) is likely to put the populations at risk of development of obesity and insulin resistance.

Diurnal variation in salivary progesterone in fertile Indian women.

Research question: Is there a diurnal variation in salivary progesterone levels during menstrual cycle among Indian women? Design: A longitudinal study was carried out to measure progesterone in saliva among small cross-sectional sample (n = 31) of fertile Indian women of reproductive age comprising young adults (18-25 years, n = 11), adults (26-38 years, n = 9) and middle aged (39-45 years, n = 11). Saliva samples were collected twice daily (morning and evening) across the entire menstrual cycle of 31 women. Results: Mean ages at enrolment and menarche were 30.6 years and 13.6 years respectively. Fifty-five percent of the women were married. The menstrual cycle range was 20-40 days. After controlling for age and menstrual cycle length, statistically significant diurnal variation in progesterone levels was observed across menstrual cycles with high levels in the morning. Conclusions: This is the first report on salivary progesterone in subjects with Indian ethnicity and could have clinical implications for designing point of care kits for menstrual cycle management, fertility and reproduction.

Determination of Manganese in Serum Using GFAAS: Serum Reference Values for Manganese in the Adolescent Girls of the DERVAN Cohort.

Current proposed method allows for the determination of manganese in serum sample using aqueous standard calibration technique on Graphite Furnace atomic absorption spectrophotometer (GFAAS) using deuterium background correction. This method involves determination of manganese from digested serum samples without the use of matrix modifier. Pyrolysis and atomization temperatures are 1200 °C and 2200 °C respectively. The limit of detection (LoD) and limit of quantitation (LoQ) of the method are 0.0097 ng/ml (0.18 nmol/l) and 0.032 ng/ml (0.58 nmol/l) respectively. Validation of the method was carried out using seronorm trace element level-1 serum standard with excellent agreement between measured value and certified value. Accuracy was demonstrated by the spike and recovery study with analytical recovery between 98.8 and 100.6% in serum. The serum reference value for manganese in adolescent girls of rural Konkan region of India range from 4.7 to 215 nmol/l.