Geeta Trilok-Kumar

Insulin, secreted by pancreatic β-cells, regulates blood glucose levels. Insulin resistance (IR), characterized by diminished cellular responsiveness, increases insulin demand, imposing stress on β-cells. This leads to β-cell decompensation, which contributes to the development of type 2 diabetes (T2D). A growing body of evidence connects early-life exposures, such as low birth weight (LBW), to a heightened risk of developing non-communicable diseases (NCD) such as T2D in adulthood. This comprehensive review synthesizes findings from 15 observational studies identified through a PubMed search to explore the specific biological mechanisms that link LBW to IR and T2D. The paper critically examines several prominent hypotheses, theories, and models that propose how endogenous responses to intrauterine conditions initiate a programming that can lead to lasting structural and functional changes in key metabolic organs. In individuals with fetal programming, the combination of impaired insulin sensitivity and compensatory insulin action is considered a precursor to impaired glucose tolerance and T2D, particularly in those who underwent rapid catch-up growth during childhood. Regular monitoring of LBW individuals can enable early intervention, such as lifestyle changes, to reduce the risk of IR and T2D. However, improving the early environment by providing care for women of reproductive age, especially during pregnancy, is a cost-effective strategy to address LBW and curb the NCD pandemic.

Aims: The role of prior wasting malnutrition (PM) in determining insulin sensitivity and secretion in low‐ and middle‐income countries (LMICs) remains unclear. We investigated associations of insulin indices with PM and whether these were modified by current body mass index (BMI). Methods: Participants were enrolled from child and adult cohorts in Zambia, Tanzania, India and the Philippines with previously documented PM or no prior wasting malnutrition (NPM). Plasma glucose, insulin and C‐peptide were measured during an oral glucose tolerance test. Static (HOMA2 %S, HOMA2 %B) and dynamic (Matsuda index, insulinogenic index, disposition index) insulin indices were calculated. Adjusted linear regression models compared indices between PM and NPM groups. Results: In 2172 participants analysed, those with PM had lower current BMI. Children with PM had reduced insulin sensitivity (Matsuda index 20%–24% lower in PM vs. NPM). Adults with PM in early life (36–37 years before) many of whom had high adult BMI, also exhibited lower insulin sensitivity after adjustment for current BMI (Matsuda Index 18% lower in PM vs. NPM). Adults with more recent PM (3–17 years previously), many of whom remained underweight, had low insulin secretion (HOMA2 %B 10%–20% lower in PM vs. NPM) but greater insulin sensitivity associated with their lower BMI (Matsuda index 21%–47% higher in PM vs. NPM). Insulin secretion generally compensated for insulin sensitivity differences, maintaining comparable disposition index and diabetes and prediabetes prevalence between PM and NPM groups. Conclusions: PM affects glucose metabolism differently according to current BMI. Remaining underweight is associated with low insulin secretion and weight gain following PM is linked to reduced insulin sensitivity. Our results further inform understanding of the relative roles of reduced insulin secretion and sensitivity in diabetes pathogenesis in LMICs.

The usage of the manual mercury sphygmomanometer to measure blood pressure (BP) is universally regarded as the gold standard, but its use has decreased globally due to concerns about potential mercury toxicity. Automated BP devices have become more popular, though their accuracy in detecting hypertension hasn’t been studied extensively. This cross-sectional study was conducted on 301 adult female students of the University of Delhi with the aim to assess the degree of agreement between standard manual mercury sphygmomanometer and automated BP monitor (Omron JPN1). Three consecutive BP readings were taken on the left arm by a certified medical doctor using both instruments. Bland Altman plots were created to assess the degree of agreement between the two BP devices and to test the accuracy of automated BP monitor in detecting hypertensive adults. The automated BP monitor underestimated the systolic BP measurement by 4 mmHg and diastolic BP measurement by 7 mmHg as determined by Bland Altman plot. Based on international validation protocols, a mean difference of < 5 ± 8 mmHg was established to assess the level of agreement between the two devices. The automatic BP monitor did not show complete agreement with the “gold standard” mercury sphygmomanometer. With growing restrictions on the use of mercury sphygmomanometers, its replacement with an equivalent mercury-free validated device is urgently needed.

Background: Low birth weight (LBW) is a public health problem in India with consequences in the short and long term. It increases the risk of obesity and its related comorbidities including type 2 diabetes and cardiovascular disease (CVD) in later life. This study aimed to assess the risk markers of chronic disease in term born low birthweight Indian children aged 8–14 years.Methods: This was a cross-sectional follow-up of LBW children from DIViDS (Delhi Infant Vitamin D Supplementation) cohort and involved assessment of their anthropometric measurements, body composition, levels of adipokines and biomarkers of chronic diseases. Neighbourhood children born normal birth weight (NBW) (>2.5 kg) were enrolled for comparison.Results: The study included 667 LBW and 87 NBW children. Height-for-age, body mass index for-age (BMIZ), fat-free mass index, and waist circumference of LBW children were lower than those of NBW children. LBW children could jump farther. LBW children who were now overweight had higher leptin, triglyceride and VLDL and lower HDL, compared to NBW children in the same BMIZ category. Currently underweight LBW children had higher adiponectin and lower leptin levels than the reference group. There were no differences between LBW and NBW children in visfatin, fasting glucose and insulin, hemoglobin A1c, triglyceride, low density lipoprotein or C-reactive protein.Conclusion: At 8–14 years few children were overweight and there were few differences in some risk markers of chronic disease between LBW and NBW children. Overweight, which was associated with some increased risk markers, may increase with age, thus timely counselling and monitoring of these LBW children will be important to mitigate these risks.

Background The rollout of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines has significantly enhanced immunity against coronavirus disease 2019 (COVID-19), leading to a reduction in the severity of illness, hospitalizations, and deaths. While various side effects of the vaccine have been reported, its impact on the menstrual cycle remains unclear. Methods We conducted a cross-sectional study involving university students who had received either partial or full vaccination against SARS-CoV-2. Data was gathered through a questionnaire designed to assess the relationship between menstrual changes and the SARS-CoV-2 vaccination. Results A total of 773 participants, with a mean age of 20.6 ± 1.7 years, were included in this study. The participants reported a significant increase in the irregularity of the menstrual cycle. We observed a slight increase in the length of the menstrual cycle, from 30.0 ± 4.0 days (pre-vaccination) to 30.5 ± 5.6 days (post-vaccination), which was statistically significant (p<0.001). The duration of menstruation also increased, from 4.9 ± 1.7 days (pre-vaccination) to 5.0 ± 1.7 days (post-vaccination). However, this increase in menstrual length due to vaccination was not statistically significant (p = 0.898). Notably, there was a significant increase in pain reported by the participants after receiving the SARS-CoV-2 vaccine (p = 0.004). Conclusion The SARS-CoV-2 vaccination significantly impacted the regularity of the menstrual cycle, length of the menstrual cycle, and pain during menstruation, though temporarily. Our study found no significant differences in menstrual changes or the type of vaccine administered (Covishield and Covaxin).

There is an increasing burden of noncommunicable diseases (NCDs) in India which may be related to changing dietary patterns. We aimed to assess dietary patterns in children since they have time to change unhealthy patterns before NCDs develop. Participants were 665 children, 9-12 years old, born with low birth weight and 77 similarly aged normal birth weight controls. We collected data on sociodemography, anthropometry, body composition, and markers of risk for NCDs: grip strength, long jump, hemoglobin A1c (HbA1c). A food frequency questionnaire was used to collect dietary data from which dietary patterns were derived using principal component analysis (PCA). Fourteen food groups were included in the PCA analysis, resulting in three components: 'fruits and vegetables', 'protein', and 'sugar and fat'. Higher socioeconomic status and maternal education were associated with lower adherence to the fruit and vegetable pattern and higher adherence to the protein and sugar and fat patterns. Adherence to the fruits and vegetables pattern was associated with lower height-for-age, whereas the fat and sugar pattern was associated with higher indicators of body fat. In linear regression analyses adjusted for age, sex, religion, socioeconomic status, maternal education, and season of data collection, adherence to the 'fruits and vegetables' pattern was associated with lower grip strength, shorter long jump, and lower HbA1c. Adherence to the other patterns was not associated with NCD risk factors. Higher consumption of fruits and vegetables, achievable even by poorer families in the cohort, may lower HbA1c, a risk factor for diabetes.

Journal of Clinical and Diagnostic Research aims to publish findings of doctors at grass root level and post graduate students, so that all unique medical experiences are recorded in literature.

Vitamin E is a lipid soluble antioxidant which mainly circulates as α-tocopherol in the human plasma. Its deficiency is associated with ataxia, neuropathy, anaemia and several other health conditions. Although substantial data on vitamin E status has been published worldwide, there is paucity of data on the extent of deficiency from most Asian countries, including India. Part of the problem is lack of validated biomarkers for vitamin E and no consensus on cut offs for defining deficiency and sufficiency. Thus, interpretation of the data on the vitamin E status is difficult. Limited available data from 31 studies on vitamin E status in healthy people from Asia, the most populated continent, has been collated for the purpose of this review. Broadly, the results suggest inadequate vitamin E status in most age groups, with the prevalence of deficiency reaching 67%, 80%, 56% and 72% in infants, children and adolescents, adults, elderly and pregnant women, respectively, based on varying cut offs. The findings are not surprising as both, vitamin E intakes and its status have not received too much attention in the past. Lack of conclusive data accentuates the need for more research on the vitamin E status across all age groups and to define age, gender and physiological state specific cut offs for vitamin E levels.