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Papers by Nihal Thomas

Scientific Reports, 2022

Modelling insulin-glucose homeostasis may provide novel functional insights. In particular, simpl... more Modelling insulin-glucose homeostasis may provide novel functional insights. In particular, simple models are clinically useful if they yield diagnostic methods. Examples include the homeostasis model assessment (HOMA) and the quantitative insulin sensitivity check index (QUICKI). However, limitations of these approaches have been criticised. Moreover, recent advances in physiological and biochemical research prompt further refinement in this area. We have developed a nonlinear model based on fundamental physiological motifs, including saturation kinetics, non-competitive inhibition, and pharmacokinetics. This model explains the evolution of insulin and glucose concentrations from perturbation to steady-state. Additionally, it lays the foundation of a structure parameter inference approach (SPINA), providing novel biomarkers of carbohydrate homeostasis, namely the secretory capacity of beta-cells (SPINA-GBeta) and insulin receptor gain (SPINA-GR). These markers correlate with central parameters of glucose metabolism, including average glucose infusion rate in hyperinsulinemic glucose clamp studies, response to oral glucose tolerance testing and HbA1c. Moreover, they mirror multiple measures of body composition. Compared to normal controls, SPINA-GR is significantly reduced in subjects with diabetes and prediabetes. The new model explains important physiological phenomena of insulin-glucose homeostasis. Clinical validation suggests that it may provide an efficient biomarker panel for screening purposes and clinical research.

Indian journal of surgical oncology, 2018

We conducted this study to evaluate the demography, clinical presentation, management and outcome... more We conducted this study to evaluate the demography, clinical presentation, management and outcomes of medullary thyroid carcinoma (MTC) from the Indian context. This was a retrospective study of patients with MTC managed between January 2008 and December 2016. All pertinent data was collected and the results were analysed using STATA (v.13.1). MTC accounted for 90/2022 (4.45%) patients managed with thyroid cancer during the study period. The mean age of presentation was 40 years (range 14-70 years) with 47 males and 43 females. The most common presentation included goitre with cervical lymphadenopathy seen in 60 patients (66.7%). There were 11 patients (12.2%) with systemic metastasis at presentation. Rearranged during transfection (RET) testing was performed in 71 patients and was positive in 25 (35.2%). The mutations among these patients were seen in the following codons: 634 (12), 804 (8), 790 (3) and 618 (2). Persistent hypercalcitoninemia (calcitonin > 50 pg/ml) was observed...

International Journal of Diabetes in Developing Countries, 2016

The open rheumatology journal, 2014

To study the profile of Renal Tubular Acidosis (RTA) in Asian Indian patients with Primary Sjögre... more To study the profile of Renal Tubular Acidosis (RTA) in Asian Indian patients with Primary Sjögren's Syndrome (pSS). The Electronic medical records of patients with a diagnosis of pSS seen between 2003 and 2010 at our tertiary care teaching hospital were screened for RTA. Clinical features, immunological profile, acid-base balance and electrolyte status, 25-hydroxyvitamin D (25(OH) D3) levels, histopathological changes in minor salivary gland biopsy samples and radiological findings were retrieved. RTA was diagnosed in cases of hyperchloremic metabolic acidosis with urinary pH values higher than 5.5. Those with known features suggestive of RTA including hypokalemic paralysis, hyperchloremia and nephrocalcinosis without acidosis were defined as incomplete RTA. Of the 380 patients with clinically suspected pSS, 25 had RTA. The median age was 32 (18-60) years. Nineteen patients had complete RTA. Six had incomplete RTA. Only 10 patients (40%) had symptoms related to RTA at presentat...

Endocrine Practice, 2010

Case Presentation: A 19-year-old white man with uncontrolled type 1 diabetes mellitus (hemoglobin... more Case Presentation: A 19-year-old white man with uncontrolled type 1 diabetes mellitus (hemoglobin A1c, 12.7%) was admitted to the intensive care unit and treated for diabetic ketoacidosis. He underwent computed tomography of the abdomen and pelvis because of persistent abdominal pain. Computed tomography revealed hepatomegaly with liver span of 15 cm (Fig. 1). The patient had intermittent transaminitis over the past year with negative workup for autoimmune and infectious etiologies. He had been diagnosed with nonalcoholic steatohepatitis. He reported no alcohol or drug use; acetaminophen level was undetectable. Coagulation studies and total protein and albumin were normal. His hepatic enzyme concentrations had risen from before hospitalization: aspartate aminotransferase, from 44 IU/L to 262 IU/L; alanine aminotransferase, from 125 IU/L to 519 IU/L; alkaline phosphatase, from 113 IU/L to 161 IU/L. There were no elevations in bilirubin or creatinine kinase, nor was there a decrease in renal function. By the day of discharge, his hepatic transaminases had trended back to baseline. Ultrasonography-guided liver biopsy was performed, and diffusely pale-staining hepatocytes with excessive glycogen accumulation on periodic acid–Schiff stain were seen (Fig. 2). Glycogenated nuclei were scattered throughout the parenchyma, and rare macrovesicular fat droplets were present. What is the diagnosis?

Annals of the New York Academy of Sciences, 2008

Clinical Epidemiology and Global Health, 2021

To correlate the waist-to-height ratio (WHt-R) with Matsuda index of the Oral Glucose Tolerance T... more To correlate the waist-to-height ratio (WHt-R) with Matsuda index of the Oral Glucose Tolerance Test (OGTT) and other surrogate indices of fasting insulin resistance/sensitivity and to derive a cutoff value for the WHt-R in lean, normoglycaemic males from Southern India. Methods: A cohort of 105 lean, normoglycaemic males (mean BMI: 19.2 ± 2.6 kg/m 2) underwent OGTT. Surrogate indices of insulin resistance viz, the Homeostatic model assessment of Insulin Resistance (HOMA-IR), the Quantitative Insulin sensitivity Check Index (QUICKI), the Fasting glucose to insulin ratio (FG-IR), the McAuley's index and the Triglyceride/HDL-C ratio were correlated with the Matsuda and the Insulinogenic indices. The cutoff value for WHt-R to predict insulin resistance was obtained using Receiver operating characteristics (ROC) with Area under curve (AUC) at 95% confidence interval (CI). The P value < 0.05 was considered statistically significant. Results: The ROC analysis at 95% confidence interval (CI), showed an AUC of 0.58 for the WHt-R cutoff value ≥ 0.39 with 69.4% sensitivity and 57.1% specificity. On pooled ROC analysis, significantly higher AUC was observed for the WHt-R (0.90) when compared to BMI (0.83) and waist-to-hip ratio (0.83). Paired wise comparison analysis of ROC curves revealed significant differences for AUC of WHt-R when compared to waist circumference (p < 0.01), but not for BMI and WHR. Conclusion: The WHt-R can be used as a potential anthropometric index to screen for insulin resistance, when compared to BMI and WC in lean, normoglycaemic males from Southern India.

Endocrine Abstracts, 2014

Age and Ageing, 1999

Background: dehydro-epiandrosterone sulphate (DHEAS) has been reported to ameliorate diabetes mel... more Background: dehydro-epiandrosterone sulphate (DHEAS) has been reported to ameliorate diabetes mellitus in rats. Aim: we investigated the relationships between plasma glucose, age, serum DHEAS and weight in healthy men. Methods: we measured the serum DHEAS, fasting plasma glucose, plasma cortisol and body mass index in 169 subjects (mean age 46.5 years). Results: there was a significant decline in serum DHEAS with age (P < 0.0001). Multiple linear regression showed significant relationships with plasma glucose for all measured variables. Age was not a significant determinant of plasma glucose after adjusting for log serum DHEAS, body mass index and log serum cortisol. Conclusions: a lowered serum DHEAS is paralleled by an elevated plasma glucose within the normal reference interval, and this may contribute to the rise in fasting plasma glucose which occurs with ageing.

Journal of Nutritional Science

Obesity indicators are known to predict the presence of type 2 diabetes mellitus (T2DM); however,... more Obesity indicators are known to predict the presence of type 2 diabetes mellitus (T2DM); however, evidence for which indicator best identifies undiagnosed T2DM in the Indian population is still very limited. In the present study we examined the utility of different obesity indicators to identify the presence of undiagnosed T2DM and determined their appropriate cut point for each obesity measure. Individuals were recruited from the large-scale population-based Kerala Diabetes Prevention Program. Oral glucose tolerance tests was performed to diagnose T2DM. Receiver operating characteristic (ROC) curve analyses were used to compare the association of different obesity indicators with T2DM and to determine the optimal cut points for identifying T2DM. A total of 357 new cases of T2DM and 1352 individuals without diabetes were identified. The mean age of the study participants was 46⋅4 (sd 7⋅4) years and 62 % were men. Waist circumference (WC), waist:hip ratio (WHR), waist:height ratio (W...

Indian Journal of Medical Research

Journal of Biosocial Science

Obesity indicators are useful clinical tools in the measurement of obesity, but it is important f... more Obesity indicators are useful clinical tools in the measurement of obesity, but it is important for clinicians to appropriately interpret their values in individuals with different ethnicities. Future research is needed to identify optimal cut-offs that can predict the occurrence of cardio-metabolic comorbidities in individuals of different ethnic descent. Assessment of more recently developed indicators like the Edmonton Obesity Staging System and visceral adipose tissue are able to appropriately identify metabolically at-risk individuals.

Indian journal of endocrinology and metabolism

The aim of the study is to examine the adequacy and accuracy of ultrasound-guided fine-needle asp... more The aim of the study is to examine the adequacy and accuracy of ultrasound-guided fine-needle aspiration cytology (US-FNAC) in thyroid nodules ≥1 cm and to analyze the clinical, sonological, and cytological features in predicting thyroid malignancy. US-FNAC was done on 290 patients from December 2013 to December 2014 by the radiologist. The Thyroid Imaging Reporting and Data System (TIRADS) was used to record the sonological features. FNAC samples were reported by a dedicated cytopathologist. Accuracy was calculated by comparing US-FNAC, clinical features and ultrasound (US) features for those who had final histopathology till April 2017. The adequacy of US-FNAC in this study was 80.2%. Thyroidectomy was performed in 128/290 (44.1%). The sensitivity and specificity of US-FNAC in this study is 83.9 and 76.3%, respectively, with a positive predictive value of 85.2%, negative predictive value of 74.4%, and an accuracy of 81% in predicting malignancy in thyroid nodules ≥1 cm. The malign...

Journal of Family Medicine and Primary Care

Archives of Osteoporosis

Referral patterns for bone mineral density testing by dual energy X-ray absorptiometry (DXA) scan... more Referral patterns for bone mineral density testing by dual energy X-ray absorptiometry (DXA) scanning are seldom studied. In our study, the overall proportion of referrals from specialties remained low. This highlights the need for adequate utilisation of DXA by specialties treating subjects at risk for osteoporosis. The knowledge of referral patterns for DXA scanning (dual energy X-ray absorptiometry) for bone mineral density (BMD) measurement is relevant in a developing country like India. We studied the referral source and clinical and densitometric profile of patients referred for DXA scanning at a south Indian tertiary care centre. We conducted a cross-sectional study over 3 months and included subjects referred during this period for BMD assessment (lumbar spine and femoral neck) by DXA scan. Details regarding referring departments and reasons for referral were collected. The number of patients seen in individual departments was obtained during the study period and respective proportions of patients referred were calculated. Of the 1932 subjects included in the study, we observed a definite female preponderance (90.2%), with a mean (SD) age of 51.6 (13.3) years. The greatest number of referrals came from the departments of rheumatology (37%; n = 724) and endocrinology (20%; n = 382). Overall, 36% were referred for inflammatory arthritis or systemic inflammatory disorders (n = 696) and 34% for postmenopausal state screening (n = 657). In relation to the individual outpatient strength, the departments who referred the highest proportion of their patients were rheumatology (6.8%), endocrinology (1.76%) and geriatrics (1.05%). A diagnosis of osteoporosis at any one site was made in 41% (448 of 1107) and the BMD was below the expected range for age in 37% (304 of 825) of the referrals. Most referrals for DXA scanning were from rheumatology. Among the referred patients, about two fifth had osteoporosis and over one third had BMD below expected range for age. Although referrals by rheumatology were relatively higher, overall referrals from all departments remained low. This underscores the need for adequate utilisation of DXA by specialties treating subjects at risk for osteoporosis.

The Lancet Global Health

Background The burden of diabetes is increasing rapidly in India but a systematic understanding o... more Background The burden of diabetes is increasing rapidly in India but a systematic understanding of its distribution and time trends is not available for every state of India. We present a comprehensive analysis of the time trends and heterogeneity in the distribution of diabetes burden across all states of India between 1990 and 2016. Methods We analysed the prevalence and disability-adjusted life-years (DALYs) of diabetes in the states of India from 1990 to 2016 using all available data sources that could be accessed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, and assessed heterogeneity across the states. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We assessed the contribution of risk factors to diabetes DALYs and the relation of overweight (body-mass index 25 kg/m² or more) with diabetes prevalence. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings The number of people with diabetes in India increased from 26•0 million (95% UI 23•4-28•6) in 1990 to 65•0 million (58•7-71•1) in 2016. The prevalence of diabetes in adults aged 20 years or older in India increased from 5•5% (4•9-6•1) in 1990 to 7•7% (6•9-8•4) in 2016. The prevalence in 2016 was highest in Tamil Nadu and Kerala (high ETL) and Delhi (higher-middle ETL), followed by Punjab and Goa (high ETL) and Karnataka (higher-middle ETL). The age-standardised DALY rate for diabetes increased in India by 39•6% (32•1-46•7) from 1990 to 2016, which was the highest increase among major non-communicable diseases. The age-standardised diabetes prevalence and DALYs increased in every state, with the percentage increase among the highest in several states in the low and lowermiddle ETL state groups. The most important risk factor for diabetes in India was overweight to which 36•0% (22•6-49•2) of the diabetes DALYs in 2016 could be attributed. The prevalence of overweight in adults in India increased from 9•0% (8•7-9•3) in 1990 to 20•4% (19•9-20•8) in 2016; this prevalence increased in every state of the country. For every 100 overweight adults aged 20 years or older in India, there were 38 adults (34-42) with diabetes, compared with the global average of 19 adults (17-21) in 2016. Interpretation The increase in health loss from diabetes since 1990 in India is the highest among major noncommunicable diseases. With this increase observed in every state of the country, and the relative rate of increase highest in several less developed low ETL states, policy action that takes these state-level differences into account is needed urgently to control this potentially explosive public health situation.

The Lancet

BACKGROUND: Alcohol use is a leading risk factor for death and disability, but its overall associ... more BACKGROUND: Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. METHODS: Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. FINDINGS: Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2•2% (95% uncertainty interval [UI] 1•5-3•0) of age-standardised female deaths and 6•8% (5•8-8•0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3•8% (95% UI 3•2-4•3) of female deaths and 12•2% (10•8-13•6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2•3% (95% UI 2•0-2•6) and male attributable DALYs were 8•9% (7•8-9•9). The three leading causes of attributable deaths in this age group were tuberculosis (1•4% [95% UI 1•0-1•7] of total deaths), road injuries (1•2% [0•7-1•9]), and self-harm (1•1% [0•6-1•5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27•1% (95% UI 21•2-33•3) of total alcohol-attributable female deaths and 18•9% (15•3-22•6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0•0-0•8) standard drinks per week. INTERPRETATION: Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.

Journal of obstetrics and gynaecology of India, 2018

Diabetes is the most common condition in pregnancy with a worldwide prevalence of 16.9%. To deter... more Diabetes is the most common condition in pregnancy with a worldwide prevalence of 16.9%. To determine the adequacy of the nutrient intake of pregnant women with diabetes mellitus. This is a cross-sectional study of 85 pregnant women who met the diagnostic inclusion criteria for diabetes mellitus (gestational and pre-gestational diabetes mellitus) and who were being managed at the outpatient clinic of a tertiary care teaching hospital. Their demography, clinical characteristics (from updated medical records), anthropometric measures (using standard procedures), nutrient intake and meal pattern (obtained using 24 h recall, food frequency and their log diaries) were collected. The mean age of the group was 29.9 + 4.5 years, 54% were in the second trimester of pregnancy with a mean glycosylated haemoglobin level of 6.3 + 1.4%. The mean BMI indicated that 47% of them were in the obese grade 1 category. Insulin was used in one-third of the population. The overall macronutrient and micronu...

Indian journal of endocrinology and metabolism

Currently available DXA (Dual energy X-ray Absorptiometry) scanners utilise bone mineral density ... more Currently available DXA (Dual energy X-ray Absorptiometry) scanners utilise bone mineral density (BMD) of Caucasian population to calculate T scores and categorise BMD. We studied the influence of various databases on classification of BMD in south-Indian postmenopausal women aged above 50 years. This was a cross-sectional study. Hologic DXA scanner was used to estimate BMD at lumbar spine (LS) and femoral neck (FN). T scores of ≤-2.5, -2.4 to -1, -0.9 to +1 were diagnostic of osteoporosis, osteopenia and normal respectively. Three reference databases(Italian, Korean and north Indian) were used to recalculate T scores. The agreement (K=kappa) between manufacturer provided database and the other databases was studied. The impact of different databases in diagnosing osteoporosis in subjects with FN fracture was assessed. A total of 1956 postmenopausal women with mean (SD) age of 62 (4.3) years and 211 femoral neck(FN) fracture subjects with mean(SD) age of 68 (7.2) years were recruite...

Scientific Reports, 2022

Modelling insulin-glucose homeostasis may provide novel functional insights. In particular, simpl... more Modelling insulin-glucose homeostasis may provide novel functional insights. In particular, simple models are clinically useful if they yield diagnostic methods. Examples include the homeostasis model assessment (HOMA) and the quantitative insulin sensitivity check index (QUICKI). However, limitations of these approaches have been criticised. Moreover, recent advances in physiological and biochemical research prompt further refinement in this area. We have developed a nonlinear model based on fundamental physiological motifs, including saturation kinetics, non-competitive inhibition, and pharmacokinetics. This model explains the evolution of insulin and glucose concentrations from perturbation to steady-state. Additionally, it lays the foundation of a structure parameter inference approach (SPINA), providing novel biomarkers of carbohydrate homeostasis, namely the secretory capacity of beta-cells (SPINA-GBeta) and insulin receptor gain (SPINA-GR). These markers correlate with central parameters of glucose metabolism, including average glucose infusion rate in hyperinsulinemic glucose clamp studies, response to oral glucose tolerance testing and HbA1c. Moreover, they mirror multiple measures of body composition. Compared to normal controls, SPINA-GR is significantly reduced in subjects with diabetes and prediabetes. The new model explains important physiological phenomena of insulin-glucose homeostasis. Clinical validation suggests that it may provide an efficient biomarker panel for screening purposes and clinical research.

Indian journal of surgical oncology, 2018

We conducted this study to evaluate the demography, clinical presentation, management and outcome... more We conducted this study to evaluate the demography, clinical presentation, management and outcomes of medullary thyroid carcinoma (MTC) from the Indian context. This was a retrospective study of patients with MTC managed between January 2008 and December 2016. All pertinent data was collected and the results were analysed using STATA (v.13.1). MTC accounted for 90/2022 (4.45%) patients managed with thyroid cancer during the study period. The mean age of presentation was 40 years (range 14-70 years) with 47 males and 43 females. The most common presentation included goitre with cervical lymphadenopathy seen in 60 patients (66.7%). There were 11 patients (12.2%) with systemic metastasis at presentation. Rearranged during transfection (RET) testing was performed in 71 patients and was positive in 25 (35.2%). The mutations among these patients were seen in the following codons: 634 (12), 804 (8), 790 (3) and 618 (2). Persistent hypercalcitoninemia (calcitonin > 50 pg/ml) was observed...

International Journal of Diabetes in Developing Countries, 2016

The open rheumatology journal, 2014

To study the profile of Renal Tubular Acidosis (RTA) in Asian Indian patients with Primary Sjögre... more To study the profile of Renal Tubular Acidosis (RTA) in Asian Indian patients with Primary Sjögren's Syndrome (pSS). The Electronic medical records of patients with a diagnosis of pSS seen between 2003 and 2010 at our tertiary care teaching hospital were screened for RTA. Clinical features, immunological profile, acid-base balance and electrolyte status, 25-hydroxyvitamin D (25(OH) D3) levels, histopathological changes in minor salivary gland biopsy samples and radiological findings were retrieved. RTA was diagnosed in cases of hyperchloremic metabolic acidosis with urinary pH values higher than 5.5. Those with known features suggestive of RTA including hypokalemic paralysis, hyperchloremia and nephrocalcinosis without acidosis were defined as incomplete RTA. Of the 380 patients with clinically suspected pSS, 25 had RTA. The median age was 32 (18-60) years. Nineteen patients had complete RTA. Six had incomplete RTA. Only 10 patients (40%) had symptoms related to RTA at presentat...

Endocrine Practice, 2010

Case Presentation: A 19-year-old white man with uncontrolled type 1 diabetes mellitus (hemoglobin... more Case Presentation: A 19-year-old white man with uncontrolled type 1 diabetes mellitus (hemoglobin A1c, 12.7%) was admitted to the intensive care unit and treated for diabetic ketoacidosis. He underwent computed tomography of the abdomen and pelvis because of persistent abdominal pain. Computed tomography revealed hepatomegaly with liver span of 15 cm (Fig. 1). The patient had intermittent transaminitis over the past year with negative workup for autoimmune and infectious etiologies. He had been diagnosed with nonalcoholic steatohepatitis. He reported no alcohol or drug use; acetaminophen level was undetectable. Coagulation studies and total protein and albumin were normal. His hepatic enzyme concentrations had risen from before hospitalization: aspartate aminotransferase, from 44 IU/L to 262 IU/L; alanine aminotransferase, from 125 IU/L to 519 IU/L; alkaline phosphatase, from 113 IU/L to 161 IU/L. There were no elevations in bilirubin or creatinine kinase, nor was there a decrease in renal function. By the day of discharge, his hepatic transaminases had trended back to baseline. Ultrasonography-guided liver biopsy was performed, and diffusely pale-staining hepatocytes with excessive glycogen accumulation on periodic acid–Schiff stain were seen (Fig. 2). Glycogenated nuclei were scattered throughout the parenchyma, and rare macrovesicular fat droplets were present. What is the diagnosis?

Annals of the New York Academy of Sciences, 2008

Clinical Epidemiology and Global Health, 2021

To correlate the waist-to-height ratio (WHt-R) with Matsuda index of the Oral Glucose Tolerance T... more To correlate the waist-to-height ratio (WHt-R) with Matsuda index of the Oral Glucose Tolerance Test (OGTT) and other surrogate indices of fasting insulin resistance/sensitivity and to derive a cutoff value for the WHt-R in lean, normoglycaemic males from Southern India. Methods: A cohort of 105 lean, normoglycaemic males (mean BMI: 19.2 ± 2.6 kg/m 2) underwent OGTT. Surrogate indices of insulin resistance viz, the Homeostatic model assessment of Insulin Resistance (HOMA-IR), the Quantitative Insulin sensitivity Check Index (QUICKI), the Fasting glucose to insulin ratio (FG-IR), the McAuley's index and the Triglyceride/HDL-C ratio were correlated with the Matsuda and the Insulinogenic indices. The cutoff value for WHt-R to predict insulin resistance was obtained using Receiver operating characteristics (ROC) with Area under curve (AUC) at 95% confidence interval (CI). The P value < 0.05 was considered statistically significant. Results: The ROC analysis at 95% confidence interval (CI), showed an AUC of 0.58 for the WHt-R cutoff value ≥ 0.39 with 69.4% sensitivity and 57.1% specificity. On pooled ROC analysis, significantly higher AUC was observed for the WHt-R (0.90) when compared to BMI (0.83) and waist-to-hip ratio (0.83). Paired wise comparison analysis of ROC curves revealed significant differences for AUC of WHt-R when compared to waist circumference (p < 0.01), but not for BMI and WHR. Conclusion: The WHt-R can be used as a potential anthropometric index to screen for insulin resistance, when compared to BMI and WC in lean, normoglycaemic males from Southern India.

Endocrine Abstracts, 2014

Age and Ageing, 1999

Background: dehydro-epiandrosterone sulphate (DHEAS) has been reported to ameliorate diabetes mel... more Background: dehydro-epiandrosterone sulphate (DHEAS) has been reported to ameliorate diabetes mellitus in rats. Aim: we investigated the relationships between plasma glucose, age, serum DHEAS and weight in healthy men. Methods: we measured the serum DHEAS, fasting plasma glucose, plasma cortisol and body mass index in 169 subjects (mean age 46.5 years). Results: there was a significant decline in serum DHEAS with age (P < 0.0001). Multiple linear regression showed significant relationships with plasma glucose for all measured variables. Age was not a significant determinant of plasma glucose after adjusting for log serum DHEAS, body mass index and log serum cortisol. Conclusions: a lowered serum DHEAS is paralleled by an elevated plasma glucose within the normal reference interval, and this may contribute to the rise in fasting plasma glucose which occurs with ageing.

Journal of Nutritional Science

Obesity indicators are known to predict the presence of type 2 diabetes mellitus (T2DM); however,... more Obesity indicators are known to predict the presence of type 2 diabetes mellitus (T2DM); however, evidence for which indicator best identifies undiagnosed T2DM in the Indian population is still very limited. In the present study we examined the utility of different obesity indicators to identify the presence of undiagnosed T2DM and determined their appropriate cut point for each obesity measure. Individuals were recruited from the large-scale population-based Kerala Diabetes Prevention Program. Oral glucose tolerance tests was performed to diagnose T2DM. Receiver operating characteristic (ROC) curve analyses were used to compare the association of different obesity indicators with T2DM and to determine the optimal cut points for identifying T2DM. A total of 357 new cases of T2DM and 1352 individuals without diabetes were identified. The mean age of the study participants was 46⋅4 (sd 7⋅4) years and 62 % were men. Waist circumference (WC), waist:hip ratio (WHR), waist:height ratio (W...

Indian Journal of Medical Research

Journal of Biosocial Science

Obesity indicators are useful clinical tools in the measurement of obesity, but it is important f... more Obesity indicators are useful clinical tools in the measurement of obesity, but it is important for clinicians to appropriately interpret their values in individuals with different ethnicities. Future research is needed to identify optimal cut-offs that can predict the occurrence of cardio-metabolic comorbidities in individuals of different ethnic descent. Assessment of more recently developed indicators like the Edmonton Obesity Staging System and visceral adipose tissue are able to appropriately identify metabolically at-risk individuals.

Indian journal of endocrinology and metabolism

The aim of the study is to examine the adequacy and accuracy of ultrasound-guided fine-needle asp... more The aim of the study is to examine the adequacy and accuracy of ultrasound-guided fine-needle aspiration cytology (US-FNAC) in thyroid nodules ≥1 cm and to analyze the clinical, sonological, and cytological features in predicting thyroid malignancy. US-FNAC was done on 290 patients from December 2013 to December 2014 by the radiologist. The Thyroid Imaging Reporting and Data System (TIRADS) was used to record the sonological features. FNAC samples were reported by a dedicated cytopathologist. Accuracy was calculated by comparing US-FNAC, clinical features and ultrasound (US) features for those who had final histopathology till April 2017. The adequacy of US-FNAC in this study was 80.2%. Thyroidectomy was performed in 128/290 (44.1%). The sensitivity and specificity of US-FNAC in this study is 83.9 and 76.3%, respectively, with a positive predictive value of 85.2%, negative predictive value of 74.4%, and an accuracy of 81% in predicting malignancy in thyroid nodules ≥1 cm. The malign...

Journal of Family Medicine and Primary Care

Archives of Osteoporosis

Referral patterns for bone mineral density testing by dual energy X-ray absorptiometry (DXA) scan... more Referral patterns for bone mineral density testing by dual energy X-ray absorptiometry (DXA) scanning are seldom studied. In our study, the overall proportion of referrals from specialties remained low. This highlights the need for adequate utilisation of DXA by specialties treating subjects at risk for osteoporosis. The knowledge of referral patterns for DXA scanning (dual energy X-ray absorptiometry) for bone mineral density (BMD) measurement is relevant in a developing country like India. We studied the referral source and clinical and densitometric profile of patients referred for DXA scanning at a south Indian tertiary care centre. We conducted a cross-sectional study over 3 months and included subjects referred during this period for BMD assessment (lumbar spine and femoral neck) by DXA scan. Details regarding referring departments and reasons for referral were collected. The number of patients seen in individual departments was obtained during the study period and respective proportions of patients referred were calculated. Of the 1932 subjects included in the study, we observed a definite female preponderance (90.2%), with a mean (SD) age of 51.6 (13.3) years. The greatest number of referrals came from the departments of rheumatology (37%; n = 724) and endocrinology (20%; n = 382). Overall, 36% were referred for inflammatory arthritis or systemic inflammatory disorders (n = 696) and 34% for postmenopausal state screening (n = 657). In relation to the individual outpatient strength, the departments who referred the highest proportion of their patients were rheumatology (6.8%), endocrinology (1.76%) and geriatrics (1.05%). A diagnosis of osteoporosis at any one site was made in 41% (448 of 1107) and the BMD was below the expected range for age in 37% (304 of 825) of the referrals. Most referrals for DXA scanning were from rheumatology. Among the referred patients, about two fifth had osteoporosis and over one third had BMD below expected range for age. Although referrals by rheumatology were relatively higher, overall referrals from all departments remained low. This underscores the need for adequate utilisation of DXA by specialties treating subjects at risk for osteoporosis.

The Lancet Global Health

Background The burden of diabetes is increasing rapidly in India but a systematic understanding o... more Background The burden of diabetes is increasing rapidly in India but a systematic understanding of its distribution and time trends is not available for every state of India. We present a comprehensive analysis of the time trends and heterogeneity in the distribution of diabetes burden across all states of India between 1990 and 2016. Methods We analysed the prevalence and disability-adjusted life-years (DALYs) of diabetes in the states of India from 1990 to 2016 using all available data sources that could be accessed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, and assessed heterogeneity across the states. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We assessed the contribution of risk factors to diabetes DALYs and the relation of overweight (body-mass index 25 kg/m² or more) with diabetes prevalence. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings The number of people with diabetes in India increased from 26•0 million (95% UI 23•4-28•6) in 1990 to 65•0 million (58•7-71•1) in 2016. The prevalence of diabetes in adults aged 20 years or older in India increased from 5•5% (4•9-6•1) in 1990 to 7•7% (6•9-8•4) in 2016. The prevalence in 2016 was highest in Tamil Nadu and Kerala (high ETL) and Delhi (higher-middle ETL), followed by Punjab and Goa (high ETL) and Karnataka (higher-middle ETL). The age-standardised DALY rate for diabetes increased in India by 39•6% (32•1-46•7) from 1990 to 2016, which was the highest increase among major non-communicable diseases. The age-standardised diabetes prevalence and DALYs increased in every state, with the percentage increase among the highest in several states in the low and lowermiddle ETL state groups. The most important risk factor for diabetes in India was overweight to which 36•0% (22•6-49•2) of the diabetes DALYs in 2016 could be attributed. The prevalence of overweight in adults in India increased from 9•0% (8•7-9•3) in 1990 to 20•4% (19•9-20•8) in 2016; this prevalence increased in every state of the country. For every 100 overweight adults aged 20 years or older in India, there were 38 adults (34-42) with diabetes, compared with the global average of 19 adults (17-21) in 2016. Interpretation The increase in health loss from diabetes since 1990 in India is the highest among major noncommunicable diseases. With this increase observed in every state of the country, and the relative rate of increase highest in several less developed low ETL states, policy action that takes these state-level differences into account is needed urgently to control this potentially explosive public health situation.

The Lancet

BACKGROUND: Alcohol use is a leading risk factor for death and disability, but its overall associ... more BACKGROUND: Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. METHODS: Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. FINDINGS: Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2•2% (95% uncertainty interval [UI] 1•5-3•0) of age-standardised female deaths and 6•8% (5•8-8•0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3•8% (95% UI 3•2-4•3) of female deaths and 12•2% (10•8-13•6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2•3% (95% UI 2•0-2•6) and male attributable DALYs were 8•9% (7•8-9•9). The three leading causes of attributable deaths in this age group were tuberculosis (1•4% [95% UI 1•0-1•7] of total deaths), road injuries (1•2% [0•7-1•9]), and self-harm (1•1% [0•6-1•5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27•1% (95% UI 21•2-33•3) of total alcohol-attributable female deaths and 18•9% (15•3-22•6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0•0-0•8) standard drinks per week. INTERPRETATION: Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.

Journal of obstetrics and gynaecology of India, 2018

Diabetes is the most common condition in pregnancy with a worldwide prevalence of 16.9%. To deter... more Diabetes is the most common condition in pregnancy with a worldwide prevalence of 16.9%. To determine the adequacy of the nutrient intake of pregnant women with diabetes mellitus. This is a cross-sectional study of 85 pregnant women who met the diagnostic inclusion criteria for diabetes mellitus (gestational and pre-gestational diabetes mellitus) and who were being managed at the outpatient clinic of a tertiary care teaching hospital. Their demography, clinical characteristics (from updated medical records), anthropometric measures (using standard procedures), nutrient intake and meal pattern (obtained using 24 h recall, food frequency and their log diaries) were collected. The mean age of the group was 29.9 + 4.5 years, 54% were in the second trimester of pregnancy with a mean glycosylated haemoglobin level of 6.3 + 1.4%. The mean BMI indicated that 47% of them were in the obese grade 1 category. Insulin was used in one-third of the population. The overall macronutrient and micronu...

Indian journal of endocrinology and metabolism

Currently available DXA (Dual energy X-ray Absorptiometry) scanners utilise bone mineral density ... more Currently available DXA (Dual energy X-ray Absorptiometry) scanners utilise bone mineral density (BMD) of Caucasian population to calculate T scores and categorise BMD. We studied the influence of various databases on classification of BMD in south-Indian postmenopausal women aged above 50 years. This was a cross-sectional study. Hologic DXA scanner was used to estimate BMD at lumbar spine (LS) and femoral neck (FN). T scores of ≤-2.5, -2.4 to -1, -0.9 to +1 were diagnostic of osteoporosis, osteopenia and normal respectively. Three reference databases(Italian, Korean and north Indian) were used to recalculate T scores. The agreement (K=kappa) between manufacturer provided database and the other databases was studied. The impact of different databases in diagnosing osteoporosis in subjects with FN fracture was assessed. A total of 1956 postmenopausal women with mean (SD) age of 62 (4.3) years and 211 femoral neck(FN) fracture subjects with mean(SD) age of 68 (7.2) years were recruite...