A Body shape index significantly predicts MRI-defined abdominal adipose tissue depots in non-obese Asian Indians with type 2 diabetes mellitus

Introduction: We aimed to determine the correlations of volumes of subcutaneous abdominal adipose tissue (SCAT) (anterior, posterior, superficial and deep), total SCAT, intraperitoneal adipose tissue, retroperitoneal abdominal adipose tissue (RPAT), total intra-abdominal adipose tissue (IAAT), pancreatic volume, liver span, total body fat (TBF) and truncal fat mass (TFM) with anthropometric indices, viz., A Body Shape Index (ABSI), Hip Index, their Z scores and Anthropometric Risk Index in non-obese (body mass index (BMI) /m2) Asian Indians with type 2 diabetes mellitus (T2DM). Research design and methods: Non-obese patients with T2DM (cases; n, 85) and BMI-matched, healthy subjects (controls; n, 38) underwent anthropometry, dual energy X ray absorptiometry (DXA) for estimation of TBF, TFM and 1.5 T MRI for estimation of volumes of abdominal adipose tissue depots, pancreas and liver span. Spearman\u27s correlation analysis and Receiver Operator Characteristic curve analysis were applied. Results: The Z score of ABSI (Z_ABSI) showed significantly positive correlation with volumes of all depots of abdominal SCAT, total IAAT and RPAT in cases. Area under the curve for Z_ABSI (0.87) showed higher sensitivity: 82.0 %, specificity: 81.5 %, at a predictive cut-off value of 0.49 for abdominal adiposity. Conclusion: In non-obese Asian Indians with T2DM, the Z_ABSI showed significant correlation with IAAT and SCAT and higher predictive accuracy for abdominal adiposity. Highlights of the study: This is the first MRI-based study in the context of ABSI in non-obese (BMI /m2) Asian Indians with T2DM. Findings indicate that Z_ABSI has high predictive accuracy for abdominal adiposity in non-obese Asian Indians. The Z_ABSI index showed significantly positive correlation with volumes of adipose tissue depots, viz., abdominal SCAT, total IAAT and RPAT in cases

Predictors for Gingival Index in Middle-Aged Asian Indians with Type 2 Diabetes from South India: A Cross-Sectional Observational Study

Asian Indians develop type 2 diabetes mellitus (T2DM) much earlier as compared to White Caucasians, due to unique phenotypic and genetic architecture. Periodontitis in T2DM patients is often a neglected clinical feature. This study was conducted to derive predictor variables for gingival index in middle-aged Asian Indians with T2DM in a semiurban population of Dravidian ethnicity from Tamil Nadu, India. T2DM patients (n=232, mean age: 50.6±10.4 years) with periodontitis (n=123, mean age: 54.3±2.4 years) and without periodontitis (n=109, mean age: 55.2±3.1 years) were recruited between 2014 and 2016 by purposive sampling method. Dental examinations for pocket depth (PD) and clinical attachment level (CAL) were performed and gingival index was calculated. Fasting venous blood samples were analysed for measures of glycaemia and cholesterol. Significant positive correlation (p<0.01) was observed for gingival index with glycosylated haemoglobin (HbA1c), pocket depth, presence of T2DM, and clinical attachment level. Stepwise multiple linear regression analysis derived increased pocket depth (p<0.01), elevated HbA1c (p<0.01), clinical attachment level (p<0.01), and presence of diabetes (p<0.01) as significant predictors (r2 value = 0.67) for increased gingival index in middle aged patients with T2DM. These variables significantly (p<0.01) predispose middle-aged T2DM patients to increased gingival index, thus warranting appropriate intervention

A Body shape index significantly predicts MRI-defined abdominal adipose tissue depots in non-obese Asian Indians with type 2 diabetes mellitus

Introduction We aimed to determine the correlations of volumes of subcutaneous abdominal adipose tissue (SCAT) (anterior, posterior, superficial and deep), total SCAT, intraperitoneal adipose tissue, retroperitoneal abdominal adipose tissue (RPAT), total intra-abdominal adipose tissue (IAAT), pancreatic volume, liver span, total body fat (TBF) and truncal fat mass (TFM) with anthropometric indices, viz., A Body Shape Index (ABSI), Hip Index, their Z scores and Anthropometric Risk Index in non-obese (body mass index (BMI) &lt;25 kg/m2) Asian Indians with type 2 diabetes mellitus (T2DM).Research design and methods Non-obese patients with T2DM (cases; n, 85) and BMI-matched, healthy subjects (controls; n, 38) underwent anthropometry, dual energy X ray absorptiometry (DXA) for estimation of TBF, TFM and 1.5 T MRI for estimation of volumes of abdominal adipose tissue depots, pancreas and liver span. Spearman’s correlation analysis and Receiver Operator Characteristic curve analysis were applied.Results The Z score of ABSI (Z_ABSI) showed significantly positive correlation with volumes of all depots of abdominal SCAT, total IAAT and RPAT in cases. Area under the curve for Z_ABSI (0.87) showed higher sensitivity: 82.0 %, specificity: 81.5 %, at a predictive cut-off value of 0.49 for abdominal adiposity.Conclusion In non-obese Asian Indians with T2DM, the Z_ABSI showed significant correlation with IAAT and SCAT and higher predictive accuracy for abdominal adiposity.Highlights of the study This is the first MRI-based study in the context of ABSI in non-obese (BMI &lt;25 kg/m2) Asian Indians with T2DM. Findings indicate that Z_ABSI has high predictive accuracy for abdominal adiposity in non-obese Asian Indians. The Z_ABSI index showed significantly positive correlation with volumes of adipose tissue depots, viz., abdominal SCAT, total IAAT and RPAT in cases

A randomized controlled trial to evaluate the effects of high Protein Complete (lActo) VEgetaRian (PACER) diet in non-diabetic obese Asian Indians in North India

In view of the increasing prevalence of obesity in largely vegetarian Asian Indians, it is important to research a high protein, low carbohydrate vegetarian diet. The present study was designed to evaluate the effects of a “High Protein Complete (lacto) VEgetaRian Diet (Acronym; ‘PACER diet’), on weight, body composition and metabolic profiles in non-diabetic obese Asian Indians living in north India. In this 8-week randomized control trial, 102 vegetarian subjects with body mass index (BMI) >25 kg/m2 were randomized to either a test diet (PACER diet; high protein, high fat and moderately low carbohydrate, lacto-vegetarian diet) or control diet (standard vegetarian diet formulated as the dietary guidelines for Asian Indians) after 4 weeks of diet and exercise run-in period. A standard exercise protocol was followed for both groups. Body weight, BMI, waist circumference (WC), blood pressure, fasting plasma glucose (FPG), fasting serum insulin and lipid profile were assessed before and after the intervention. There was significant weight loss along with improvements in cardio-metabolic risk factors among both the groups post intervention. Percent reductions in the intervention group for weight (6.1± 2.9; p < 0.001), WC (3.9 ± 1.7; p < 0.001), FPG (5.9 ± 3.2; p < 0.001), total cholesterol (10.2 ± 6.3: p < 0.001), serum triacylglycerol (13.6 ± 10.6; p < 0.001) and low-density lipoprotein cholesterol (11.9 ± 7.1; p < 0.001]) were significantly greater than the control diet group. In summary, intervention with a PACER diet (high protein, high fat and moderately low carbohydrate, lacto-vegetarian diet) showed significant improvement in weight loss, body composition and cardio-metabolic profile as compared to a standard vegetarian diet among obese Asian Indians in north India

Body Fat Patterning, Hepatic Fat and Pancreatic Volume of Non-Obese Asian Indians with Type 2 Diabetes in North India: A Case-Control Study

<div><p>Objective</p><p>To evaluate body fat patterning and phenotype including hepatic fat and pancreatic volume of non-obese (BMI: < 25 kg/m²) Asian Indians with type 2 diabetes residing in North India.</p><p>Methods</p><p>Non-obese patients with type 2 diabetes (<i>n</i> = 93) and non-obese, normo-glycemic subjects (<i>n</i> = 40) were recruited. BMI, waist & hip circumferences, skinfold thickness at 8 sites, body fat, lean mass and detailed abdominal fat evaluation [total abdominal fat, total subcutaneous fat (superficial, deep, anterior, and posterior), total intra-abdominal fat (intra-peritoneal, retroperitoneal)], liver span, grades of fatty liver and pancreatic volume were compared.</p><p>Results</p><p>Waist circumference, subscapular skinfolds and total truncal fat (on DEXA) were higher whereas calf, total peripheral skinfolds and total leg fat (on DEXA) lower in patients. Specifically, the following volumes were higher in cases as compared to controls; total abdominal fat (19.4%), total intra-abdominal fat (49.7%), intra-peritoneal fat (47.7%), retroperitoneal fat (70.7%), pancreatic volume (26.6%), pancreatic volume index (21.3%) and liver span (10.8%). In cases, significant positive correlations were observed for pancreatic volume with BMI, waist and hip circumferences, W-HR, subscapular, abdominal and total truncal skinfolds, truncal, total subcutaneous, total intra-abdominal, intra-peritoneal, retroperitoneal fat depots, liver span and fatty liver.</p><p>Conclusions</p><p>In non-obese Asian Indians with type 2 diabetes, subcutaneous and intra-abdominal obesity, including fatty liver, and pancreatic volume were higher and peripheral subcutaneous adiposity was lower than BMI matched non-diabetic subjects. Importantly, increased pancreatic volume in patients was highly correlated with multiple measures of abdominal obesity and liver fat.</p></div

Skinfold measurements in cases (<i>n</i> = 93, shown in black bars) <i>vs</i>. controls (<i>n</i> = 40, shown in bars filled with crossed lines).

<p>Skinfold measurements in cases (<i>n</i> = 93, shown in black bars) <i>vs</i>. controls (<i>n</i> = 40, shown in bars filled with crossed lines).</p

Correlations of anthropometry, body composition, abdominal fat compartments and liver span with pancreatic volume.

<p>* <i>p</i>< 0.05: Statistically significant.</p><p>*Total peripheral skinfolds = Sum of biceps, triceps, thigh & calf skinfolds,</p><p>*Total truncal skinfolds = Sum of sub scapular, suprailiac (horizontal & vertical) & abdominal skinfolds (diagonal & vertical).</p><p>^#Average abdominal skinfolds = Mean of abdominal skinfolds (vertical+ horizontal).</p><p>^ǂ Measured by Dual energy X ray absorptiometry.(see text for details).</p><p>^<b>€</b> Measured by MRI (1.5 Tesla) at L2/L3 region of the lumbar vertebrae (see text for details).</p><p>Correlations of anthropometry, body composition, abdominal fat compartments and liver span with pancreatic volume.</p

Abdominal fat depots, pancreatic volume & liver span measured by MRI (1.5 Tesla) in cases (<i>n</i> = 93, shown in black bars) & controls (<i>n</i> = 40, shown in box filled with crossed lines).

<p>Abdominal fat depots, pancreatic volume & liver span measured by MRI (1.5 Tesla) in cases (<i>n</i> = 93, shown in black bars) & controls (<i>n</i> = 40, shown in box filled with crossed lines).</p

Indirect calorimetry: From bench to bedside

Accurate determination of energy expenditure (EE) is vitally important yet often neglected in clinical practice. Indirect calorimetry (IC) provides one of the most sensitive, accurate, and noninvasive measurements of EE in an individual. Over the last couple of decades, this technique has been applied to clinical circumstances such as acute illness and parenteral nutrition. Beyond assessing the nutritional needs, it has also shed light on various aspects of nutrient assimilation, thermogenesis, the energetics of physical exercise, and the pathogenesis of obesity and diabetes. However, because of little or no experience with IC provided during medical education, the benefits of IC are poorly appreciated. Newer technology, cost-effectiveness, and a better understanding of how to interpret measurements should lead to more frequent use of IC. This review focuses on the physicochemical background of IC, the various indications for use, techniques and instruments, potential pitfalls in measurement, and the recent advances in technology that has adapted the technique to long-term studies in humans