Efficacy and safety of various oral regimens (three oral doses) and schedules (daily v. monthly) of cholecalciferol in North Indian adults with low vitamin D status: evidence from a randomised controlled trial.

Vitamin D (VD) deficiency (serum 25 hydroxy vitamin D (25(OH)D) concentration of < 20 ng/ml), in endemic proportions, demands a supplementation strategy with optimal dosing regimens. A randomised parallel-group, active-controlled trial was conducted among apparently healthy, VD-deficient subjects, aged 18-60 years who received 600 µg/d (Group A), 1000 µg/d (Group B), 2000 µg/d (Group C) and 60 000 µg/month (Group D) of oral cholecalciferol. The intervention was carried in two phases (I and II) of 12 weeks each, with same dose, separated by a washout phase of 12 weeks. Serum 25(OH)D, intact parathyroid hormones (iPTH), Ca, phosphorous (PO4), alkaline phosphatase (ALP) and spot urine Ca/Cr were measured at baseline, 12, 24 and 36 weeks following the intervention, and adverse events were recorded at each occurrence and at 12, 24 and 36 weeks. A statistically significant time-group interaction was found in serum 25(OH)D concentration (P < 0·05). Serum 25(OH)D concentration increased significantly from baseline to 12 weeks (P < 0·05) in all the groups with no change at 24 weeks but further increase at 36 weeks (P < 0·05). At the end of the study, Group C had maximum increment in serum 25(OH)D concentration, while as Groups C and D (95 %, and 90 %) had higher proportion of subjects VD sufficient than Groups A and B (65 % and 78 %) (P < 0·05). No significant time-dose interactions were observed in serum iPTH, Ca, PO4 and ALP or urine Ca/Cr ratio. Three subjects (two in Group C and one in Group D) developed transient hypercalciuria. Supplementation with daily 2000 µg or monthly 60 000 µg of oral cholecalciferol among adults seems optimal and safe.

Prevalence and Determinants of Sarcopenic Obesity in Older Adults: Secondary Data Analysis of the Longitudinal Ageing Study in India (LASI) Wave 1 Survey (2017-18).

INTRODUCTION: Sarcopenic obesity (SO) represents the confluence of two epidemics-an aging population and an increasing rate of obesity. The two diseases may act synergistically, and SO may significantly affect morbidity and mortality. However, the burden is not defined to drive the policy changes. Hence the present study was done to estimate the prevalence and predictors of SO in India. METHODS: We did a secondary data analysis of the 72,250 older adults who participated in the first wave of the Longitudinal Aging Study in India (2017-18). Possible sarcopenia was defined as per the guidelines by the Asian Working Group for Sarcopenia (AWGS) criteria. The modified criterion of overweight and obesity for Asian adults was used to categorize obesity. Presence of both sarcopenia and obesity depicted SO. Weighted analysis was done to estimate the prevalence of SO, and multinomial bivariate logistics regression was used to identify the predictors of SO. RESULTS: The overall prevalence of obesity, sarcopenia, and SO was 27.1%, 41.9%, and 8.7%, respectively. The mean age, weight, body mass index (BMI), and blood pressure of adults with SO were significantly higher compared to others. Higher age, urban residence, west and south regions of India, consumption of tobacco or alcohol, no physical activity, and presence of diabetes contribute to SO. CONCLUSION: The burden of SO seems to be less but amounts to a massive number in an aging country. We stress increased screening of the geriatric age group and advocate increased physical activity and dietary modifications to realize the concept of healthy aging.

Thyroid Function, Urinary Iodine, and Thyroid Antibody Status Among the Tribal Population of Kashmir Valley: Data From Endemic Zone of a Sub-Himalayan Region.

Background: There are scarce data on the prevalence of thyroid disorders and urinary iodine status among tribal populations of India, with no reported data from Kashmir valley. Objectives: To estimate the prevalence of thyroid disorders and evaluate urinary iodine concentration (UIC) and thyroid autoantibody status among Gujjar and Bakerwal tribes of Kashmir valley. Methods: This cross-sectional study recruited tribal subjects using multistage cluster sampling from 5 out of 22 districts of Jammu and Kashmir (J&K). Using a predesigned questionnaire, the details of past or current medical history and drug intake, including thyroid hormone medication etc. were recorded after obtaining an informed consent. Examination included anthropometry (height, weight, waist circumference), blood pressure measurement, and relevant general physical examination focusing on goiter palpation, while as laboratory assessment included estimation of serum thyroid hormone levels, antithyroid peroxidase antibody (anti-TPO Ab), and urinary iodine concentration. Results: A total of 763 subjects (56.4% women and 43.6% men) with a mean(±SD) age of 39.46 (±17.51) ranging from 10 to 85 years and mean(±SD) body mass index (BMI) of 21.28 (±4.16) kg/m2 were studied. Goiter was detected in 6.8%, while 33.2% subjects had some form of thyroid dysfunction (including 24.1% subclinical and 6.8% overt hypothyroidism). Subclinical and overt hyperthyroidism were observed in 1.3 and 0.9% of cases, respectively. Anti-TPO Ab was elevated in 13.6%, while the median [interquartile range (IQR)] for UIC was 154.50 (135) µg/L [156.13 (134) µg/L in men and 147.26 (136) µg/L in women]. A negative correlation was observed between UIC and anti-TPO Ab (r = -0.087, P = <0.05). Conclusion: These novel data on iodine and thyroid status among a tribal population of India generally inhabiting in remote sub-Himalayan belts demonstrate high prevalence of subclinical hypothyroidism (SCH) with persistent iodine deficiency. These preliminary data may warrant large well-designed studies to carry out comprehensive assessment of the problem in this high-risk and marginalized population.