Sudha Vasudevan - Academia.edu (original) (raw)
Papers by Sudha Vasudevan
The Indian Journal of Medical Research
International Journal of Food Sciences and Nutrition
ABSTRACT
The Indian Journal of Medical Research
![Research paper thumbnail of Validation of body fat measurement by skinfolds and two bioelectric impedance methods with DEXA - The Chennai Urban Rural Epidemiology Study [CURES-3]](https://attachments.academia-assets.com/42855991/thumbnails/1.jpg)
](The Journal of the Association of Physicians of India
Although Asian Indians have been shown to have increased body fat compared to Europeans, there ha... more Although Asian Indians have been shown to have increased body fat compared to Europeans, there have been very few studies in Asian Indians validating the various methods available for body fat measurement. The aim of this study was to test the validity of body fat measured by two commercial impedance analyzers (leg-to-leg and hand-held) as well as by skinfolds with Dual Energy X-ray Absorptiometry (DEXA) as the reference method in a population based study in southern India. Body fat percentage (BF%) was measured in 162 South Indian urban men (n=76) and women (n=86) randomly selected from the "Chennai Urban Rural Epidemiology Study" (CURES), an ongoing population based study of a representative population of Chennai. The mean age of the subjects was 45.1 +/- 9.0 years and the body mass index ranged from 16.4 - 34.4 kg/m2. Percentage body fat was measured using DEXA, segmental impedance (leg-to-leg: BF%IMP-LEG; and hand-held BF%IMP-HAND) using the manufacturer's software...
Diabetes Research and Clinical Practice, 2015
We sought to evaluate the contribution of various modifiable risk factors to the partial populati... more We sought to evaluate the contribution of various modifiable risk factors to the partial population attributable risk (PARp) for diabetes in an Asian Indian population. Of a cohort of 3589 individuals, representative of Chennai, India, followed up after a period of ten years, we analyzed data from 1376 individuals who were free of diabetes at baseline. A diet risk score was computed incorporating intake of refined cereals, fruits and vegetables, dairy products, and monounsaturated fatty acid. Abdominal obesity was found to contribute the most to incident diabetes [Relative Risk (RR) 1.63(95%CI 1.21-2.20)]; (PARp 41.1% (95%CI 28.1-52.6)]. The risk for diabetes increased with increasing quartiles of the diet risk score [highest quartile RR 2.14(95% CI 1.26-3.63)] and time spent viewing television [(RR 1.84(95%CI 1.36-2.49] and sitting [(RR 2.09(95%CI 1.42-3.05)]. The combination of five risk factors (obesity, physical inactivity, unfavorable diet risk score, hypertriglyceridemia and low HDL cholesterol) could explain 80.7% of all incident diabetes (95%CI 53.8-92.7). Modifying these easily identifiable risk factors could therefore prevent the majority of cases of incident diabetes in the Asian Indian population. Translation of these findings into public health practice will go a long way in arresting the progress of the diabetes epidemic in this region.
Diabetes Care, 2015
There is little data on the incidence rates of diabetes and prediabetes (dysglycemia) in Asian In... more There is little data on the incidence rates of diabetes and prediabetes (dysglycemia) in Asian Indians. This article presents the incidence of diabetes and prediabetes and the predictors of progression in a population-based Asian Indian cohort. Data on progression to diabetes and prediabetes from 1,376 individuals, a subset of 2,207 of the Chennai Urban Rural Epidemiology Study (CURES) cohort with normal glucose tolerance (NGT) or prediabetes at baseline, who were followed for a median of 9.1 years (11,629 person-years), are presented. During follow-up, 534 died and 1,077 with NGT and 299 with prediabetes at baseline were reinvestigated in a 10-year follow-up study. Diabetes and prediabetes were diagnosed based on the American Diabetes Association criteria. Incidence rates were calculated and predictors of progression to prediabetes and/or diabetes were estimated using the Cox proportional hazards model. The incidence of diabetes, prediabetes, and "any dysglycemia" were 22.2, 29.5, and 51.7 per 1,000 person-years, respectively. Among those with NGT, 19.4% converted to diabetes and 25.7% to prediabetes, giving an overall conversion rate to dysglycemia of 45.1%. Among those with prediabetes, 58.9% converted to diabetes. Predictors of progression to dysglycemia were advancing age, family history of diabetes, 2-h plasma glucose, glycated hemoglobin (HbA1c), low HDL cholesterol, and physical inactivity. Asian Indians have one of the highest incidence rates of diabetes, with rapid conversion from normoglycemia to dysglycemia. Public health interventions should target modifiable risk factors to slow down the diabetes epidemic in this population.
Ayurvedic Science of Food and Nutrition, 2013
ABSTRACT The prevalence of chronic noncommunicable diseases (NCDs) is now reaching epidemic propo... more ABSTRACT The prevalence of chronic noncommunicable diseases (NCDs) is now reaching epidemic proportions in the developing countries [ 1 ]. Indeed, India already has the highest number of diabetic and prediabetic patients in the world, reaching 62.4 million and 72.7 million, respectively [ 2 ]. A recent study from the Indian Council of Medical Research–INdia DIABetes (ICMR– INDIAB) showed that the weighted prevalence of diabetes (both known and newly diagnosed) in the urban population of Chandigarh (14.2 %) was the highest, followed by Tamil Nadu (13.7 %), Jharkhand (13.5 %), and Maharashtra (10.9 %). At every age interval, the prevalence of diabetes in urban areas was higher compared with rural areas [ 2 ]. This national estimate shows a trend of an increasing number of people with diabetes in India over the last decade [ 3 ]. The cause behind the huge epidemic is the alteration of dietary patterns with a rise in refi ned-grain consumption due to growing industrialization and the country’s economic conditions. A natural method of precaution that entails using functional foods present in foods may be one of the most benefi - cial measures in combating the growing epidemic of diabetes.
Advances in Food and Nutrition Research, 2013
Finger millet or ragi is one of the ancient millets in India (2300 BC), and this review focuses o... more Finger millet or ragi is one of the ancient millets in India (2300 BC), and this review focuses on its antiquity, consumption, nutrient composition, processing, and health benefits. Of all the cereals and millets, finger millet has the highest amount of calcium (344 mg%) and potassium (408 mg%). It has higher dietary fiber, minerals, and sulfur containing amino acids compared to white rice, the current major staple in India. Despite finger millet's rich nutrient profile, recent studies indicate lower consumption of millets in general by urban Indians. Finger millet is processed by milling, malting, fermentation, popping, and decortication. Noodles, vermicilli, pasta, Indian sweet (halwa) mixes, papads, soups, and bakery products from finger millet are also emerging. In vitro and in vivo (animal) studies indicated the blood glucose lowering, cholesterol lowering, antiulcerative, wound healing properties, etc., of finger millet. However, appropriate intervention or randomized clinical trials are lacking on these health effects. Glycemic index (GI) studies on finger millet preparations indicate low to high values, but most of the studies were conducted with outdated methodology. Hence, appropriate GI testing of finger millet preparations and short-and long-term human intervention trials may be helpful to establish evidence-based health benefits.
International Journal of Behavioral Nutrition and Physical Activity, 2015
Background: Measurement of physical activity in epidemiological studies requires tools which are ... more Background: Measurement of physical activity in epidemiological studies requires tools which are reliable, valid and culturally relevant. We attempted to develop a physical activity questionnaire (PAQ) that would measure physical activity in various domains over a year and which would be valid for use in adults of different age groups with varying levels of activity in urban and rural settings in low and middle income countries like India. The present paper aims to assess the reliability and validity of this new PAQ-termed the Madras Diabetes Research Foundation-Physical Activity Questionnaire (MPAQ). Methods: The MPAQ was administered by trained interviewers to 543 individuals of either gender aged 20 years and above from urban and rural areas in 10 states of India from May to August 2011, followed by a repeat administration within a month for assessing reliability. Relative validity was performed against the Global Physical Activity Questionnaire (GPAQ). Construct validity was tested by plotting time spent in sitting and moderate and vigorous physical activity (MVPA) against body-mass index (BMI) and waist circumference. Criterion validity was assessed using the triaxial accelerometer, in a separate subset of 103 individuals. Bland and Altman plots were used to assess the agreement between MPAQ and accelerometer.
Forum of Nutrition, 2007
The prevalence of diabetes is rising rapidly in all developing countries and India already has th... more The prevalence of diabetes is rising rapidly in all developing countries and India already has the largest number of people with diabetes. Evidence for the rising prevalence of diabetes in India comes from recent population-based studies such as the Chennai Urban Population Study (n = 1,262) and the Chennai Urban Rural Epidemiology Study (n = 26,001). These two studies revealed that the current age-standardized prevalence of diabetes in Chennai in adults >/=20 years of age is 14.3%, which is 70% higher than that seen in the year 1989 (8.3%). In the Chennai Urban Population Study, we observed that the higher-income group who consumed excess fat and calorie-rich food had an increased prevalence of diabetes compared to the lowerincome group. There was also a linear increase in the prevalence of diabetes with an increase in visible fat consumption. In addition, we observed that visible fat consumption and physical inactivity showed a cumulative effect on increasing the prevalence of diabetes. We carried out gene-diet interaction studies, which revealed that the adiponectin gene polymorphism (+10211T - G) contributed to insulin resistance and diabetes and this was exaggerated in those consuming diets with higher glycemic loads. These subjects also had an increased risk for hypoadiponectinemia. Similarly, the Ala54Thr polymorphism of the fatty acid-binding protein 2 gene showed a synergistic effect with a high glycemic load increasing the risk for hypertriglyceridemia. These studies indicate that gene-diet interactions could play a major role in increasing the risk for diabetes. However, given the imprecision in measuring dietary intake, very large sample sizes would be needed for meaningful conclusions to be drawn.
Diabetes Technology & Therapeutics, 2014
Improving the carbohydrate quality of the diet by replacing the common cereal staple white rice (... more Improving the carbohydrate quality of the diet by replacing the common cereal staple white rice (WR) with brown rice (BR) could have beneficial effects on reducing the risk for diabetes and related complications. Hence we aimed to compare the effects of BR, WR, and BR with legumes (BRL) diets on 24-h glycemic and insulinemic responses among overweight Asian Indians. Fifteen overweight (body mass index, ≥23 kg/m(2)) Asian Indians without diabetes who were 25-45 years old participated in a randomized crossover study. Test meals (nonisocaloric, ad libitum) were identical except for the type of rice and the addition of legumes (50 g/day) and were provided for 5 consecutive days. Glucose profiles were assessed using the Medtronic MiniMed (Northridge, CA) iPro™2 continuous glucose monitoring device. The mean positive change from baseline glucose concentration was calculated as the daily incremental area under the curve (IAUC) on each test day for 5 days and averaged. Fasting serum insulin was measured prior to and at the end of each test diet. The percentage difference in 5-day average IAUC was 19.8% lower in the BR group than in the WR group (P=0.004). BRL further decreased the glycemic response (22.9% lower compared with WR (P=0.02). The 5-day percentage change in fasting insulin was 57% lower (P=0.0001) for the BR group and 54% lower for the BRL group compared with the 5-day percentage change observed in the WR group. The glycemic and insulinemic responses to the BR and BRL diets were not significantly different. Consumption of BR in place of WR can help reduce 24-h glucose and fasting insulin responses among overweight Asian Indians.
Wheat and Rice in Disease Prevention and Health, 2014
Diabetes Technology & Therapeutics, 2011
India is undergoing rapid nutritional transition, resulting in excess consumption of calories, sa... more India is undergoing rapid nutritional transition, resulting in excess consumption of calories, saturated fats, trans fatty acids, simple sugars, salt and low intake of fiber. Such dietary transition and a sedentary lifestyle have led to an increase in obesity and diet-related non-communicable diseases (type 2 diabetes mellitus [T2DM], cardiovascular disease [CVD], etc.) predominantly in urban, but also in rural areas. In comparison with the previous guidelines, these consensus dietary guidelines include reduction in the intake of carbohydrates, preferential intake of complex carbohydrates and low glycemic index foods, higher intake of fiber, lower intake of saturated fats, optimal ratio of essential fatty acids, reduction in trans fatty acids, slightly higher protein intake, lower intake of salt, and restricted intake of sugar. While these guidelines are applicable to Asian Indians in any geographical setting, they are particularly applicable to those residing in urban and in semi-urban areas. Proper application of these guidelines will help curb the rising ''epidemics'' of obesity, the metabolic syndrome, hypertension, T2DM, and CVD in Asian Indians. Affiliations and group members are given in Appendix 1.
British Journal of Nutrition, 2008
British Journal of Nutrition, 2010
To compare the glycaemic index (GI) of newly developed 'atta mix' roti with whole wheat flour rot... more To compare the glycaemic index (GI) of newly developed 'atta mix' roti with whole wheat flour roti. Eighteen healthy non-diabetic subjects consumed 50 g available carbohydrate portions of a reference food (glucose) and two test foods (whole wheat flour roti and atta mix roti) in random order after an overnight fast. The reference food was tested on three separate occasions, while the test foods were each tested once. Capillary blood samples were measured from finger-prick samples in fasted subjects (25 and 0 min) and at 15, 30, 45, 60, 90 and 120 min from the start of each food. No significant difference was observed between roti prepared from whole wheat flour and atta mix in terms of appearance, texture, flavour, taste or acceptability. For each test food, the incremental area under the curve and GI values were determined. The GI of atta mix roti (27·3 (SEM 2·2)) was considerably lower than the whole wheat flour roti (45·1 (SEM 3·5), P, 0·001). Development of foods with lower dietary glycaemic load such as the atta mix roti could help in the prevention and control of diabetes in South Asian populations, which habitually consume very high glycaemic load diets.
British Journal of Nutrition, 2009
The aim of the study was to examine the association of dietary carbohydrates and glycaemic load w... more The aim of the study was to examine the association of dietary carbohydrates and glycaemic load with the risk of type 2 diabetes among an urban adult Asian Indian population. Adult subjects aged .20 years (n 1843) were randomly selected from the Chennai Urban Rural Epidemiology Study, in Chennai city in southern India. Dietary carbohydrates, glycaemic load and food groups were assessed using FFQ. Oral glucose tolerance tests were performed using 75 g glucose in all subjects. Diagnosis of diabetes was based on WHO Consulting Group criteria. OR for newly detected diabetes were calculated for carbohydrates, glycaemic load and specific food groups comparing subjects in the highest with those in the lowest quartiles, after adjustment for potential confounders such as age, sex, BMI, family history of diabetes, physical activity, current smoking, alcohol consumption and relevant dietary factors. We identified 156 (8·5 %) newly diagnosed cases of type 2 diabetes. Refined grain intake was positively associated with the risk of type 2 diabetes (OR 5·31 (95 % CI 2·98, 9·45); P,0·001). In the multivariate model, after adjustment for potential confounders, total carbohydrate (OR 4·98 (95 % CI 2·69, 9·19), P,0·001), glycaemic load (OR 4·25 (95 % CI 2·33, 7·77); P, 0·001) and glycaemic index (OR 2·51 (95 % CI 1·42, 4·43); P¼ 0·006) were associated with type 2 diabetes. Dietary fibre intake was inversely associated with diabetes (OR 0·31 (95 % CI 0·15, 0·62); P, 0·001). In urban south Indians, total dietary carbohydrate and glycaemic load are associated with increased, and dietary fibre with decreased, risk of type 2 diabetes.
Public Health Nutrition, 2011
Objective: Few dietary surveys have been done with reference to chronic diseases, such as diabete... more Objective: Few dietary surveys have been done with reference to chronic diseases, such as diabetes, in India, which is considered to be the diabetes capital of the world. We report on the dietary intake of urban adults living in Chennai, South India. Design: A population-based cross-sectional study. Setting: A representative population of urban Chennai in southern India. Subjects: The study population comprised 2042 individuals aged $20 years selected from the Chennai Urban Rural Epidemiological Study (CURES). Dietary intake was measured using a validated and previously published interviewer-administered semi-quantitative meal-based FFQ. Results: The mean daily energy intake was 10 393 (SD 2347) kJ (male: 10 953 (SD 2364) kJ v. female: 9832 (SD 233) kJ). Carbohydrates were the major source of energy (64 %), followed by fat (24 %) and protein (12 %). Refined cereals contributed to the bulk of the energy (45?8 %), followed by visible fats and oils (12?4 %) and pulses and legumes (7?8 %). However, energy supply from sugar and sweetened beverages was within the recommended levels. Intake of micronutrient-rich foods, such as fruit and vegetable consumption (265 g/d), and fish and seafoods (20 g/d), was far below the FAO/WHO recommendation. Dairy and meat products intake was within the national recommended intake. Conclusions: The diet of this urban South Indian population consists mainly of refined cereals with low intake of fish, fruit and vegetables, and all of these could possibly contribute to the risk of non-communicable diseases such as diabetes in this population.
Nutrition Research, 1992
ABSTRACT We examined the relation of fruit and vegetable intake with dietary fat intake under con... more ABSTRACT We examined the relation of fruit and vegetable intake with dietary fat intake under conditions in which individuals consume recommended number of portions of dairy, meat and grain foods, using 24-hour dietary recall data from the NHANES II of 1976–80. Only recalls that included at least 2 servings each of dairy foods and meat and 4 servings of grains, but variable servings of fruits and vegetables (ranging from 0 to 2 or more) were examined, yielding a total of 9 food group patterns (possible combinations of food group servings) as reported by 1,490 respondents. In patterns ranging from 0 to 2 servings each of fruits and vegetables, the mean percent of energy as fat varied from 39% to 36%. We observed a slight trend for decreasing energy from fat with increasing number of fruit-but not vegetable-servings. Consumption of fruits and vegetables was not associated with selection of lower-fat foods in the meat, dairy or grain groups. The percent of daily fat contributed by the miscellaneous food group (containing visible fats, sweeteners, and baked products with a high fat or sugar content) increased with increasing vegetable-but not fruit-servings. These results suggest that without conscious effort to reduce fat intake, an increase in fruit and vegetable intake may have a relatively minor impact on reduction of dietary fat.
Metabolism, 2009
The objective of the study was to evaluate the association of refined grains consumption with ins... more The objective of the study was to evaluate the association of refined grains consumption with insulin resistance and the metabolic syndrome in an urban south Indian population. The study population comprised 2042 individuals aged ≥20 years randomly selected from the Chennai Urban Rural Epidemiology Study (CURES), a cross-sectional study on a representative population of Chennai, southern India. The metabolic syndrome was defined according to modified Adult Treatment Panel III guidelines; and insulin resistance, by the homeostasis assessment model. The mean refined grain intake was 333 g/d (46.9% of total calories) in this population. After adjustment for age, sex, body mass index, metabolic equivalent, total energy intake, and other dietary factors, higher refined grain intake was significantly associated with higher waist circumference (8% higher for the highest vs the lowest quartile, P for trend b .0001), systolic blood pressure (2.9%, P for trend b .0001), diastolic blood pressure (1.7%, P for trend = .03), fasting blood glucose (7.9%, P for trend = .007), serum triglyceride (36.5%, P for trend b .0001), low high-density lipoprotein cholesterol (−10.1%, P for trend b .0001), and insulin resistance (13.6%, P b .001). Compared with participants in the bottom quartile, participants who were in the highest quartile of refined grain intake were significantly more likely to have the metabolic syndrome (odds ratio, 7.83; 95% confidence interval, 4.72-12.99). Higher intake of refined grains was associated with insulin resistance and the metabolic syndrome in this population of Asian Indians who habitually consume high-carbohydrate diets.
The Indian Journal of Medical Research
International Journal of Food Sciences and Nutrition
ABSTRACT
The Indian Journal of Medical Research
The Journal of the Association of Physicians of India
Although Asian Indians have been shown to have increased body fat compared to Europeans, there ha... more Although Asian Indians have been shown to have increased body fat compared to Europeans, there have been very few studies in Asian Indians validating the various methods available for body fat measurement. The aim of this study was to test the validity of body fat measured by two commercial impedance analyzers (leg-to-leg and hand-held) as well as by skinfolds with Dual Energy X-ray Absorptiometry (DEXA) as the reference method in a population based study in southern India. Body fat percentage (BF%) was measured in 162 South Indian urban men (n=76) and women (n=86) randomly selected from the "Chennai Urban Rural Epidemiology Study" (CURES), an ongoing population based study of a representative population of Chennai. The mean age of the subjects was 45.1 +/- 9.0 years and the body mass index ranged from 16.4 - 34.4 kg/m2. Percentage body fat was measured using DEXA, segmental impedance (leg-to-leg: BF%IMP-LEG; and hand-held BF%IMP-HAND) using the manufacturer's software...
Diabetes Research and Clinical Practice, 2015
We sought to evaluate the contribution of various modifiable risk factors to the partial populati... more We sought to evaluate the contribution of various modifiable risk factors to the partial population attributable risk (PARp) for diabetes in an Asian Indian population. Of a cohort of 3589 individuals, representative of Chennai, India, followed up after a period of ten years, we analyzed data from 1376 individuals who were free of diabetes at baseline. A diet risk score was computed incorporating intake of refined cereals, fruits and vegetables, dairy products, and monounsaturated fatty acid. Abdominal obesity was found to contribute the most to incident diabetes [Relative Risk (RR) 1.63(95%CI 1.21-2.20)]; (PARp 41.1% (95%CI 28.1-52.6)]. The risk for diabetes increased with increasing quartiles of the diet risk score [highest quartile RR 2.14(95% CI 1.26-3.63)] and time spent viewing television [(RR 1.84(95%CI 1.36-2.49] and sitting [(RR 2.09(95%CI 1.42-3.05)]. The combination of five risk factors (obesity, physical inactivity, unfavorable diet risk score, hypertriglyceridemia and low HDL cholesterol) could explain 80.7% of all incident diabetes (95%CI 53.8-92.7). Modifying these easily identifiable risk factors could therefore prevent the majority of cases of incident diabetes in the Asian Indian population. Translation of these findings into public health practice will go a long way in arresting the progress of the diabetes epidemic in this region.
Diabetes Care, 2015
There is little data on the incidence rates of diabetes and prediabetes (dysglycemia) in Asian In... more There is little data on the incidence rates of diabetes and prediabetes (dysglycemia) in Asian Indians. This article presents the incidence of diabetes and prediabetes and the predictors of progression in a population-based Asian Indian cohort. Data on progression to diabetes and prediabetes from 1,376 individuals, a subset of 2,207 of the Chennai Urban Rural Epidemiology Study (CURES) cohort with normal glucose tolerance (NGT) or prediabetes at baseline, who were followed for a median of 9.1 years (11,629 person-years), are presented. During follow-up, 534 died and 1,077 with NGT and 299 with prediabetes at baseline were reinvestigated in a 10-year follow-up study. Diabetes and prediabetes were diagnosed based on the American Diabetes Association criteria. Incidence rates were calculated and predictors of progression to prediabetes and/or diabetes were estimated using the Cox proportional hazards model. The incidence of diabetes, prediabetes, and "any dysglycemia" were 22.2, 29.5, and 51.7 per 1,000 person-years, respectively. Among those with NGT, 19.4% converted to diabetes and 25.7% to prediabetes, giving an overall conversion rate to dysglycemia of 45.1%. Among those with prediabetes, 58.9% converted to diabetes. Predictors of progression to dysglycemia were advancing age, family history of diabetes, 2-h plasma glucose, glycated hemoglobin (HbA1c), low HDL cholesterol, and physical inactivity. Asian Indians have one of the highest incidence rates of diabetes, with rapid conversion from normoglycemia to dysglycemia. Public health interventions should target modifiable risk factors to slow down the diabetes epidemic in this population.
Ayurvedic Science of Food and Nutrition, 2013
ABSTRACT The prevalence of chronic noncommunicable diseases (NCDs) is now reaching epidemic propo... more ABSTRACT The prevalence of chronic noncommunicable diseases (NCDs) is now reaching epidemic proportions in the developing countries [ 1 ]. Indeed, India already has the highest number of diabetic and prediabetic patients in the world, reaching 62.4 million and 72.7 million, respectively [ 2 ]. A recent study from the Indian Council of Medical Research–INdia DIABetes (ICMR– INDIAB) showed that the weighted prevalence of diabetes (both known and newly diagnosed) in the urban population of Chandigarh (14.2 %) was the highest, followed by Tamil Nadu (13.7 %), Jharkhand (13.5 %), and Maharashtra (10.9 %). At every age interval, the prevalence of diabetes in urban areas was higher compared with rural areas [ 2 ]. This national estimate shows a trend of an increasing number of people with diabetes in India over the last decade [ 3 ]. The cause behind the huge epidemic is the alteration of dietary patterns with a rise in refi ned-grain consumption due to growing industrialization and the country’s economic conditions. A natural method of precaution that entails using functional foods present in foods may be one of the most benefi - cial measures in combating the growing epidemic of diabetes.
Advances in Food and Nutrition Research, 2013
Finger millet or ragi is one of the ancient millets in India (2300 BC), and this review focuses o... more Finger millet or ragi is one of the ancient millets in India (2300 BC), and this review focuses on its antiquity, consumption, nutrient composition, processing, and health benefits. Of all the cereals and millets, finger millet has the highest amount of calcium (344 mg%) and potassium (408 mg%). It has higher dietary fiber, minerals, and sulfur containing amino acids compared to white rice, the current major staple in India. Despite finger millet's rich nutrient profile, recent studies indicate lower consumption of millets in general by urban Indians. Finger millet is processed by milling, malting, fermentation, popping, and decortication. Noodles, vermicilli, pasta, Indian sweet (halwa) mixes, papads, soups, and bakery products from finger millet are also emerging. In vitro and in vivo (animal) studies indicated the blood glucose lowering, cholesterol lowering, antiulcerative, wound healing properties, etc., of finger millet. However, appropriate intervention or randomized clinical trials are lacking on these health effects. Glycemic index (GI) studies on finger millet preparations indicate low to high values, but most of the studies were conducted with outdated methodology. Hence, appropriate GI testing of finger millet preparations and short-and long-term human intervention trials may be helpful to establish evidence-based health benefits.
International Journal of Behavioral Nutrition and Physical Activity, 2015
Background: Measurement of physical activity in epidemiological studies requires tools which are ... more Background: Measurement of physical activity in epidemiological studies requires tools which are reliable, valid and culturally relevant. We attempted to develop a physical activity questionnaire (PAQ) that would measure physical activity in various domains over a year and which would be valid for use in adults of different age groups with varying levels of activity in urban and rural settings in low and middle income countries like India. The present paper aims to assess the reliability and validity of this new PAQ-termed the Madras Diabetes Research Foundation-Physical Activity Questionnaire (MPAQ). Methods: The MPAQ was administered by trained interviewers to 543 individuals of either gender aged 20 years and above from urban and rural areas in 10 states of India from May to August 2011, followed by a repeat administration within a month for assessing reliability. Relative validity was performed against the Global Physical Activity Questionnaire (GPAQ). Construct validity was tested by plotting time spent in sitting and moderate and vigorous physical activity (MVPA) against body-mass index (BMI) and waist circumference. Criterion validity was assessed using the triaxial accelerometer, in a separate subset of 103 individuals. Bland and Altman plots were used to assess the agreement between MPAQ and accelerometer.
Forum of Nutrition, 2007
The prevalence of diabetes is rising rapidly in all developing countries and India already has th... more The prevalence of diabetes is rising rapidly in all developing countries and India already has the largest number of people with diabetes. Evidence for the rising prevalence of diabetes in India comes from recent population-based studies such as the Chennai Urban Population Study (n = 1,262) and the Chennai Urban Rural Epidemiology Study (n = 26,001). These two studies revealed that the current age-standardized prevalence of diabetes in Chennai in adults >/=20 years of age is 14.3%, which is 70% higher than that seen in the year 1989 (8.3%). In the Chennai Urban Population Study, we observed that the higher-income group who consumed excess fat and calorie-rich food had an increased prevalence of diabetes compared to the lowerincome group. There was also a linear increase in the prevalence of diabetes with an increase in visible fat consumption. In addition, we observed that visible fat consumption and physical inactivity showed a cumulative effect on increasing the prevalence of diabetes. We carried out gene-diet interaction studies, which revealed that the adiponectin gene polymorphism (+10211T - G) contributed to insulin resistance and diabetes and this was exaggerated in those consuming diets with higher glycemic loads. These subjects also had an increased risk for hypoadiponectinemia. Similarly, the Ala54Thr polymorphism of the fatty acid-binding protein 2 gene showed a synergistic effect with a high glycemic load increasing the risk for hypertriglyceridemia. These studies indicate that gene-diet interactions could play a major role in increasing the risk for diabetes. However, given the imprecision in measuring dietary intake, very large sample sizes would be needed for meaningful conclusions to be drawn.
Diabetes Technology & Therapeutics, 2014
Improving the carbohydrate quality of the diet by replacing the common cereal staple white rice (... more Improving the carbohydrate quality of the diet by replacing the common cereal staple white rice (WR) with brown rice (BR) could have beneficial effects on reducing the risk for diabetes and related complications. Hence we aimed to compare the effects of BR, WR, and BR with legumes (BRL) diets on 24-h glycemic and insulinemic responses among overweight Asian Indians. Fifteen overweight (body mass index, ≥23 kg/m(2)) Asian Indians without diabetes who were 25-45 years old participated in a randomized crossover study. Test meals (nonisocaloric, ad libitum) were identical except for the type of rice and the addition of legumes (50 g/day) and were provided for 5 consecutive days. Glucose profiles were assessed using the Medtronic MiniMed (Northridge, CA) iPro™2 continuous glucose monitoring device. The mean positive change from baseline glucose concentration was calculated as the daily incremental area under the curve (IAUC) on each test day for 5 days and averaged. Fasting serum insulin was measured prior to and at the end of each test diet. The percentage difference in 5-day average IAUC was 19.8% lower in the BR group than in the WR group (P=0.004). BRL further decreased the glycemic response (22.9% lower compared with WR (P=0.02). The 5-day percentage change in fasting insulin was 57% lower (P=0.0001) for the BR group and 54% lower for the BRL group compared with the 5-day percentage change observed in the WR group. The glycemic and insulinemic responses to the BR and BRL diets were not significantly different. Consumption of BR in place of WR can help reduce 24-h glucose and fasting insulin responses among overweight Asian Indians.
Wheat and Rice in Disease Prevention and Health, 2014
Diabetes Technology & Therapeutics, 2011
India is undergoing rapid nutritional transition, resulting in excess consumption of calories, sa... more India is undergoing rapid nutritional transition, resulting in excess consumption of calories, saturated fats, trans fatty acids, simple sugars, salt and low intake of fiber. Such dietary transition and a sedentary lifestyle have led to an increase in obesity and diet-related non-communicable diseases (type 2 diabetes mellitus [T2DM], cardiovascular disease [CVD], etc.) predominantly in urban, but also in rural areas. In comparison with the previous guidelines, these consensus dietary guidelines include reduction in the intake of carbohydrates, preferential intake of complex carbohydrates and low glycemic index foods, higher intake of fiber, lower intake of saturated fats, optimal ratio of essential fatty acids, reduction in trans fatty acids, slightly higher protein intake, lower intake of salt, and restricted intake of sugar. While these guidelines are applicable to Asian Indians in any geographical setting, they are particularly applicable to those residing in urban and in semi-urban areas. Proper application of these guidelines will help curb the rising ''epidemics'' of obesity, the metabolic syndrome, hypertension, T2DM, and CVD in Asian Indians. Affiliations and group members are given in Appendix 1.
British Journal of Nutrition, 2008
British Journal of Nutrition, 2010
To compare the glycaemic index (GI) of newly developed 'atta mix' roti with whole wheat flour rot... more To compare the glycaemic index (GI) of newly developed 'atta mix' roti with whole wheat flour roti. Eighteen healthy non-diabetic subjects consumed 50 g available carbohydrate portions of a reference food (glucose) and two test foods (whole wheat flour roti and atta mix roti) in random order after an overnight fast. The reference food was tested on three separate occasions, while the test foods were each tested once. Capillary blood samples were measured from finger-prick samples in fasted subjects (25 and 0 min) and at 15, 30, 45, 60, 90 and 120 min from the start of each food. No significant difference was observed between roti prepared from whole wheat flour and atta mix in terms of appearance, texture, flavour, taste or acceptability. For each test food, the incremental area under the curve and GI values were determined. The GI of atta mix roti (27·3 (SEM 2·2)) was considerably lower than the whole wheat flour roti (45·1 (SEM 3·5), P, 0·001). Development of foods with lower dietary glycaemic load such as the atta mix roti could help in the prevention and control of diabetes in South Asian populations, which habitually consume very high glycaemic load diets.
British Journal of Nutrition, 2009
The aim of the study was to examine the association of dietary carbohydrates and glycaemic load w... more The aim of the study was to examine the association of dietary carbohydrates and glycaemic load with the risk of type 2 diabetes among an urban adult Asian Indian population. Adult subjects aged .20 years (n 1843) were randomly selected from the Chennai Urban Rural Epidemiology Study, in Chennai city in southern India. Dietary carbohydrates, glycaemic load and food groups were assessed using FFQ. Oral glucose tolerance tests were performed using 75 g glucose in all subjects. Diagnosis of diabetes was based on WHO Consulting Group criteria. OR for newly detected diabetes were calculated for carbohydrates, glycaemic load and specific food groups comparing subjects in the highest with those in the lowest quartiles, after adjustment for potential confounders such as age, sex, BMI, family history of diabetes, physical activity, current smoking, alcohol consumption and relevant dietary factors. We identified 156 (8·5 %) newly diagnosed cases of type 2 diabetes. Refined grain intake was positively associated with the risk of type 2 diabetes (OR 5·31 (95 % CI 2·98, 9·45); P,0·001). In the multivariate model, after adjustment for potential confounders, total carbohydrate (OR 4·98 (95 % CI 2·69, 9·19), P,0·001), glycaemic load (OR 4·25 (95 % CI 2·33, 7·77); P, 0·001) and glycaemic index (OR 2·51 (95 % CI 1·42, 4·43); P¼ 0·006) were associated with type 2 diabetes. Dietary fibre intake was inversely associated with diabetes (OR 0·31 (95 % CI 0·15, 0·62); P, 0·001). In urban south Indians, total dietary carbohydrate and glycaemic load are associated with increased, and dietary fibre with decreased, risk of type 2 diabetes.
Public Health Nutrition, 2011
Objective: Few dietary surveys have been done with reference to chronic diseases, such as diabete... more Objective: Few dietary surveys have been done with reference to chronic diseases, such as diabetes, in India, which is considered to be the diabetes capital of the world. We report on the dietary intake of urban adults living in Chennai, South India. Design: A population-based cross-sectional study. Setting: A representative population of urban Chennai in southern India. Subjects: The study population comprised 2042 individuals aged $20 years selected from the Chennai Urban Rural Epidemiological Study (CURES). Dietary intake was measured using a validated and previously published interviewer-administered semi-quantitative meal-based FFQ. Results: The mean daily energy intake was 10 393 (SD 2347) kJ (male: 10 953 (SD 2364) kJ v. female: 9832 (SD 233) kJ). Carbohydrates were the major source of energy (64 %), followed by fat (24 %) and protein (12 %). Refined cereals contributed to the bulk of the energy (45?8 %), followed by visible fats and oils (12?4 %) and pulses and legumes (7?8 %). However, energy supply from sugar and sweetened beverages was within the recommended levels. Intake of micronutrient-rich foods, such as fruit and vegetable consumption (265 g/d), and fish and seafoods (20 g/d), was far below the FAO/WHO recommendation. Dairy and meat products intake was within the national recommended intake. Conclusions: The diet of this urban South Indian population consists mainly of refined cereals with low intake of fish, fruit and vegetables, and all of these could possibly contribute to the risk of non-communicable diseases such as diabetes in this population.
Nutrition Research, 1992
ABSTRACT We examined the relation of fruit and vegetable intake with dietary fat intake under con... more ABSTRACT We examined the relation of fruit and vegetable intake with dietary fat intake under conditions in which individuals consume recommended number of portions of dairy, meat and grain foods, using 24-hour dietary recall data from the NHANES II of 1976–80. Only recalls that included at least 2 servings each of dairy foods and meat and 4 servings of grains, but variable servings of fruits and vegetables (ranging from 0 to 2 or more) were examined, yielding a total of 9 food group patterns (possible combinations of food group servings) as reported by 1,490 respondents. In patterns ranging from 0 to 2 servings each of fruits and vegetables, the mean percent of energy as fat varied from 39% to 36%. We observed a slight trend for decreasing energy from fat with increasing number of fruit-but not vegetable-servings. Consumption of fruits and vegetables was not associated with selection of lower-fat foods in the meat, dairy or grain groups. The percent of daily fat contributed by the miscellaneous food group (containing visible fats, sweeteners, and baked products with a high fat or sugar content) increased with increasing vegetable-but not fruit-servings. These results suggest that without conscious effort to reduce fat intake, an increase in fruit and vegetable intake may have a relatively minor impact on reduction of dietary fat.
Metabolism, 2009
The objective of the study was to evaluate the association of refined grains consumption with ins... more The objective of the study was to evaluate the association of refined grains consumption with insulin resistance and the metabolic syndrome in an urban south Indian population. The study population comprised 2042 individuals aged ≥20 years randomly selected from the Chennai Urban Rural Epidemiology Study (CURES), a cross-sectional study on a representative population of Chennai, southern India. The metabolic syndrome was defined according to modified Adult Treatment Panel III guidelines; and insulin resistance, by the homeostasis assessment model. The mean refined grain intake was 333 g/d (46.9% of total calories) in this population. After adjustment for age, sex, body mass index, metabolic equivalent, total energy intake, and other dietary factors, higher refined grain intake was significantly associated with higher waist circumference (8% higher for the highest vs the lowest quartile, P for trend b .0001), systolic blood pressure (2.9%, P for trend b .0001), diastolic blood pressure (1.7%, P for trend = .03), fasting blood glucose (7.9%, P for trend = .007), serum triglyceride (36.5%, P for trend b .0001), low high-density lipoprotein cholesterol (−10.1%, P for trend b .0001), and insulin resistance (13.6%, P b .001). Compared with participants in the bottom quartile, participants who were in the highest quartile of refined grain intake were significantly more likely to have the metabolic syndrome (odds ratio, 7.83; 95% confidence interval, 4.72-12.99). Higher intake of refined grains was associated with insulin resistance and the metabolic syndrome in this population of Asian Indians who habitually consume high-carbohydrate diets.