Effect of dulaglutide on liver fat in patients with type 2 diabetes and NAFLD: randomised controlled trial (D-LIFT trial).

AIMS/HYPOTHESIS: Liraglutide, a daily injectable glucagon-like peptide-1 receptor (GLP-1r) agonist, has been shown to reduce liver fat content (LFC) in humans. Data regarding the effect of dulaglutide, a once-weekly GLP-1r agonist, on human LFC are scarce. This study examined the effect of dulaglutide on LFC in individuals with type 2 diabetes and non-alcoholic fatty liver disease (NAFLD). METHODS: Effect of dulaglutide on liver fat (D-LIFT) was a 24 week, open-label, parallel-group, randomised controlled trial to determine the effect of dulaglutide on liver fat at a tertiary care centre in India. Adults (n = 64), who had type 2 diabetes and MRI-derived proton density fat fraction-assessed LFC of ≥6.0% at baseline, were randomly assigned to receive dulaglutide weekly for 24 weeks (add-on to usual care) or usual care, based on a predefined computer-generated number with a 1:1 allocation that was concealed using serially numbered, opaque, sealed envelopes. The primary endpoint was the difference of the change in LFC from 0 (baseline) to 24 weeks between groups. The secondary outcome measures included the difference of the change in pancreatic fat content (PFC), change in liver stiffness measurement (LSM in kPa) measured by vibration-controlled transient elastography, and change in liver enzymes. RESULTS: Eighty-eight patients were screened; 32 were randomly assigned to the dulaglutide group and 32 to the control group. Overall, 52 participants were included for per-protocol analysis: those who had MRI-PDFF data at baseline and week 24. Dulaglutide treatment resulted in a control-corrected absolute change in LFC of -3.5% (95% CI -6.6, -0.4; p = 0.025) and relative change of -26.4% (-44.2, -8.6; p = 0.004), corresponding to a 2.6-fold greater reduction. Dulaglutide-treated participants also showed a significant reduction in γ-glutamyl transpeptidase (GGT) levels (mean between-group difference -13.1 U/l [95% CI -24.4, -1.8]; p = 0.025) and non-significant reductions in aspartate aminotransferase (AST) (-9.3 U/l [-19.5, 1.0]; p = 0.075) and alanine aminotransferase (ALT) levels (-13.1 U/l [-24.4, 2.5]; p = 0.10). Absolute changes in PFC (-1.4% [-3.2, 0.3]; p = 0.106) and LSM (-1.31 kPa [-2.99, 0.37]; p = 0.123) were not significant when comparing the two groups. There were no serious drug-related adverse events. CONCLUSIONS/INTERPRETATION: When included in the standard treatment for type 2 diabetes, dulaglutide significantly reduces LFC and improves GGT levels in participants with NAFLD. There were non-significant reductions in PFC, liver stiffness, serum AST and serum ALT levels. Dulaglutide could be considered for the early treatment of NAFLD in patients with type 2 diabetes. TRIAL REGISTRATION: ClinicalTrials.gov NCT03590626 FUNDING: The current study was supported by an investigator-initiated study grant from Medanta-The Medicity's departmental research fund and a grant from the Endocrine and Diabetes Foundation (EDF), India. Graphical abstract.

Diagnostic Accuracy and Optimal Cut-off of Controlled Attenuation Parameter for the Detection of Hepatic Steatosis in Indian Population.

Background and aims: Ultrasound of the liver is not good to pick up mild steatosis. Controlled attenuation parameter (CAP) evaluated in transient elastography (FibroScan) is widely available in India. However, data regarding the diagnostic accuracy and optimal cut-off values of CAP for diagnosing hepatic steatosis are scarce in Indian population. MRI-PDFF is an accurate technique for quantifying hepatic steatosis. Thus, this study examined the diagnostic accuracy and optimal cut-off values of CAP for diagnosing steatosis with MRI-PDFF as reference standard. Methods: A total of 137 adults underwent CAP and MRI-PDFF measurements prospectively. A subset of participants (n = 23) underwent liver biopsy as part of liver transplantation evaluation. The optimal cut-off values, area under the receiver operating characteristic (AUROC) curves, sensitivity, and specificity for CAP in detecting MRI-PDFF ≥5% and ≥10% were assessed. Results: The mean age and body mass index (BMI) were 44.2 ±10.4 years and 28.3 ±3.9 kg/m2, respectively. The mean hepatic steatosis was 13.0 ±7.7% by MRI-PDFF and 303 ±54 dB/m by CAP. The AUROC of CAP for detecting hepatic steatosis (MRI-PDFF ≥5%) was 0.93 (95% CI, 0.88-0.98) at the cut-off of 262 dB/m, and of MRI-PDFF ≥10% was 0.89 (95% CI, 0.84-0.94) at the cut-off of 295 dB/m. The CAP of 262 dB/m had 90% sensitivity and 91% specificity for detecting MRI-PDFF ≥5%, while the CAP of 295 dB/m had 86% sensitivity and 77% specificity for detecting MRI-PDFF ≥10%. Conclusions: The optimal cut-off of CAP for the presence of liver steatosis (MRI-PDFF ≥5%) was 262 dB/m in Indian individuals. This CAP cut-off was associated with good sensitivity and specificity to pick up mild steatosis.

Imbalanced dietary profile, anthropometry, and lipids in urban Asian Indian adolescents and young adults.

OBJECTIVE: To analyze the macronutrient, micronutrient, food intake pattern, anthropometry, and lipid profile of urban Asian Indian adolescents and young adults and compare it with the nutrient profile of rural Asian Indian and American adolescents. METHODS: This was a cross-sectional, epidemiologic descriptive study. Body mass index (BMI), percentage body fat, waist and hip circumferences, skinfold thickness, serum lipids, and dietary intake were assessed in 1236 subjects (607 males, 629 females) aged 13-25 years from schools and colleges of a metropolitan city of India. RESULTS: The mean age and BMI of study subjects were 17.6 +/- 2.4 years (range 13-25 years) and 19.8 +/- 3.3 kg/m(2) (range 11.9-35.9 kg/m(2)), respectively. The mean daily percentages of total energy contributed by carbohydrates, total fats, proteins, saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), omega-3 PUFAs, omega-6 PUFAs, and trans-fatty acids for all subjects were 53%, 34%, 11%, 11%, 10%, 9%, 1%, 8%, and 0.3%, respectively. The absolute daily intake of total fat was 84 +/- 29 g/d in males and 72 +/- 21 g/d in females, which was approximately 4 times the recommended dietary allowance for Asian Indians (20-22 g/d). Among food groups, a high intake of milk, milk products, roots, and tubers was observed. In these young individuals, the prevalence of hypercholesterolemia (males > or =169 mg/dl; females > or =181 mg/dl) and overweight (BMI > or =23.1 kg/m(2)) was 14.4% and approximately 16%, respectively. On comparison with rural Asian Indian adolescents, an inappropriately high intake of total fat was observed in our subjects. On the other hand, the percentage of energy intake of SFAs in Asian Indian and American adolescents was at par. CONCLUSIONS: High total fat and SFA intake and a low intake of MUFAs and omega-3 PUFAs showed imbalanced nutrition, which could be responsible for the increasing prevalence of obesity and insulin resistance in urban Asian Indian adolescents and young adults. Nutritional strategies for reducing SFA intake and balancing the omega-3/omega-6 PUFAs ratio should be urgently applied in Asian Indian adolescents and are also presented in this paper.

Identification of insulin resistance in Asian Indian adolescents: classification and regression tree (CART) and logistic regression based classification rules.

OBJECTIVE: Biochemical measures for assessment of insulin resistance are not cost-effective in resource-constrained developing countries. Using classification and regression tree (CART) and multivariate logistic regression, we aimed to develop simple predictive decision models based on routine clinical and biochemical parameters to predict insulin resistance in apparently healthy Asian Indian adolescents. DESIGN: Community based cross-sectional study. SUBJECTS AND PATIENTS: Data of apparently healthy 793 adolescents (aged 14-19 years) were used for analysis. WHO's multistage cluster sampling design was used for data collection. METHODS AND MEASUREMENTS: Homeostasis Model of Assessment value > 75th centile was used as cut-off for defining the main outcome variable insulin resistance. CART was used to develop the decision tree models and multivariate logistic regression used to develop the clinical prediction score. RESULTS: Three classification trees and an equation for prediction score were developed and internally validated. The three decision trees were termed as CART I, CART II and CART III, respectively. CART I based on anthropometric parameters alone has sensitivity 88.2%, specificity 50.1% and area under receiver operating characteristic curve (aROC) 77.8%. CART II based on anthropometric and routine biochemical parameters has sensitivity 94.5%, specificity 38.3% and aROC 73.6%. CART III based on all anthropometric, biochemical and clinical parameters together has sensitivity 70.7%, specificity 79.2% and aROC 77.4%. Prediction score for insulin resistance = 1 x (waist circumference) + 1.1 x (percentage body fat) + 1.6 x (triceps skin-fold thickness) - 1.9 x (gender). A score cut-off of > 0 (using values marked for each) was a marker of insulin resistance in the study population (sensitivity 82.4%, specificity 56.7%, and aROC 73.4%). CONCLUSION: These simple and cost-effective classification rules may be used to predict insulin resistance and implement population based preventive interventions in Asian Indian adolescents.

Dietary nutrients and insulin resistance in urban Asian Indian adolescents and young adults.

BACKGROUND: Asian Indians have a high prevalence of insulin resistance that may underlie their higher tendency to develop type 2 diabetes mellitus and early-onset atherosclerosis. OBJECTIVE: To investigate the relationship between dietary nutrients and insulin resistance in Asian Indian adolescents and young adults. DESIGN: Dietary nutrient intake values (24-hour dietary recall and monthly consumption data) and fasting serum insulin levels were studied in 352 (311 males and 41 females) healthy adolescents and young adults (mean age 18.0 +/- 2.3 years; range 14-25 years). Bivariate and multivariate logistic regression analyses were performed with hyperinsulinemia as the outcome variable and various dietary nutrients and anthropometric variables as covariates. RESULTS: Mean fasting serum insulin levels were 107.4 +/- 35.0 pmol/l (36.5-230.4 pmol/l). The intake of polyunsaturated fatty acids (PUFAs) was higher, saturated fat and the omega-6 to omega-3 PUFA ratio were in the upper limit, and omega-3 PUFAs (% caloric intake, En) were lower than the recommended dietary allowance for Asian Indians. The PUFAs (% En), BMI, percent body fat and waist circumference were significantly higher in the hyperinsulinemic group compared with the normoinsulinemic group (p = 0.021, 0.0021, 0.0006, and 0.0041, respectively). Multiple regression analysis showed that the lowest tertile of omega-6 (< 3% En) PUFA intake [adjusted OR (95% CI) = 0.3 (0.1-0.7)] and BMI [adjusted OR (95% CI) = 2.9 (1.4-6.0)] were the significant independent predictors of fasting hyperinsulinemia. CONCLUSION: For prevention and amelioration of insulin resistance in Asian Indian adolescents and young adults, it is prudent to have normal BMI and low intake of omega-6 PUFAs.

Once Weekly Dulaglutide Therapy in Type 2 Diabetic Subjects, Real-world Evidence from a Tertiary Care Diabetes Center in India.

AIMS: To evaluate the real-world efficacy, durability, and side-effect profile of once weekly GLP1RA: dulaglutide in Indian type 2 diabetes mellitus (T2DM) patients. MATERIALS AND METHODS: A retrospective observational study. Data for efficacy (HbA1c and weight), adherence/discontinuation and patient reported side-effects, of 117 patients who were prescribed dulaglutide were analyzed. RESULTS: Final analysis was done on complete data of 74 patients (6 months follow-up), this indicated that dulaglutide is effective (mean-reduction at 6 months of: HbA1c; 0.87% and weight; 3.8 kg). Subjects with a poorer glycemic control (greater HbA1c) or greater weight at initiation had a better fall in HbA1c and weight reduction at the end of the study. The most common side-effects were gastrointestinal (15% nausea and 6% loose motions). Also, 25% (n = 19) of our study subjects discontinued dulaglutide because of gastrointestinal side-effects. CONCLUSION: Our real-world experience is well aligned to systematic data of the randomized controlled trials (RCTs) regarding the efficacy of dulaglutide in the treatment of T2DM (our study vs. RCTs; HbA1c reduction: 0.87% vs. 0.78% to 1.64%, weight reduction: 3.8 vs. 0.3 to 3 kg). The most common side-effects and reason for discontinuation were gastrointestinal side-effects. Finally, by virtue of their observed benefit, we expect a superior cardiovascular risk-reduction with dulaglutide use in our population.

Metabolic syndrome in children: current issues and South Asian perspective.

OBJECTIVE: The objective of this review is to discuss definition, determinants, and management issues of the metabolic syndrome in children with a focus on South Asians. METHODS: The literature search was done using the PubMed search engine (National Library of Medicine, Bethesda, MD, USA). Manual searches for other important references and medical databases were also done. RESULTS: There is a need for an integrated definition of the metabolic syndrome in children and adolescents, taking cognizance of the ethnic-specific variations. Obesity and body fat patterning are important determinants of insulin resistance and the metabolic syndrome in children and ethnic variations in these parameters are seen. Excess body fat and thicker truncal subcutaneous fat are important predisposing factors for development of insulin resistance in South Asian children. Because the metabolic syndrome tracks into adulthood, its manifestations need to be recognized early for prevention of diabetes and coronary heart disease. Therapeutic lifestyle changes, maintenance of high levels of physical activity and normal weight are most important strategies; pharmacologic therapy for individual components of the metabolic syndrome is occasionally needed. CONCLUSION: The metabolic syndrome in children is an important clinical marker of diabetes and coronary heart disease in adults. In view of the rapid increase in the metabolic syndrome in most populations, high-risk screening and effective public-intervention educational programs are urgently needed.

Heterogeneous phenotypes of insulin resistance and its implications for defining metabolic syndrome in Asian Indian adolescents.

OBJECTIVE: To assess the phenotypic correlations of insulin resistance with obesity and its relationship with the metabolic syndrome in Asian Indian adolescents. DESIGN AND SUBJECTS: We analyzed clinical, anthropometric (body mass index [BMI], waist circumference [WC]) and laboratory (fasting blood glucose [FBG], lipids and fasting serum insulin) data from 793 subjects (401 males and 392 females) aged 14-19 years randomly selected from Epidemiological Study of Adolescents and Young (ESAY) adults (n=1447). The percentile cut-offs for 14-19 years age from ESAY cohort were used for defining abnormal values of variables. We devised three sets of definitions of metabolic syndrome by including BMI and fasting insulin levels with other defining variables. RESULTS: Nearly 28.9% of adolescents had fasting hyperinsulinemia despite normal values of BMI, WC, FBG, lipids, and blood pressure. Remarkably, NCEP criteria with appropriate percentile cut-off points for Asian Indian adolescents identified metabolic syndrome in only six (0.8%) subjects. Inclusion of both BMI and WC in the definition resulted in increase in the prevalence of metabolic syndrome to 4.3%. With inclusion of hyperinsulinemia, the prevalence of metabolic syndrome increased to 4.2% (from 0.8%) in the modified NCEP definition, 5.2% (from 0.9%) when BMI was substituted for WC, and 10.2 (from 4.3%) when both BMI and WC were included. CONCLUSIONS: Our data show marked heterogeneity of phenotypes of insulin resistance and poor value of NCEP definition to identify metabolic syndrome. We propose that BMI and fasting insulin should be evaluated in candidate definitions of metabolic syndrome in Asian Indian adolescents.

Waist circumference criteria for the diagnosis of abdominal obesity are not applicable uniformly to all populations and ethnic groups.

Determination of cutoff points of waist circumference is of paramount importance for prevention, optimum management, and prognostication of obesity, the metabolic syndrome, type 2 diabetes mellitus, and coronary heart disease. Heterogeneity of composition of abdominal tissues, in particular adipose tissue and skeletal muscle, and their location-specific and changing relations with metabolic factors and cardiovascular risk factors in different ethnic groups do not allow a simple definition of abdominal obesity that could be applied uniformly. In particular, Asians appear to have higher morbidity at lower cutoff points for waist circumference than do white Caucasians. International health agencies that deal with obesity (World Health Organization, International Obesity Task Force) should take cognizance of these data and consider formulating new cutoff points for waist circumference to define abdominal obesity for Asian populations.

Centile values for serum lipids and blood pressure for Asian Indian adolescents.

BACKGROUND: Reference data for plasma lipids and blood pressure are not available for Asian Indian adolescents. This study aimed to develop representative age- and sex- specific percentile reference data for serum lipids [total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-HDL cholesterol] and blood pressure for urban Asian Indian adolescents aged 14-18 years. The sample consisted of 680 boys and 521 girls aged 14-18 years from the cross-sectional population survey, Epidemiological Study of Adolescents and Young Adults (ESAY) for whom the data for serum lipid levels and blood pressure were recorded. Smoothed age- and sex- specific 5th, 10th, 25th, 50th, 75th, 85th, 90th and 95th percentiles where derived using LMS regression. RESULTS: Percentile-based reference data for serum lipids and blood pressure are presented for adolescent Asian Indian boys and girls for the first time. Asian Indian adolescents had lower levels of serum TC, LDL-C and HDL-C and higher TG than their counterparts in the USA. Interesting trends in TC and HDL-C levels where observed, which might reflect changes in dietary pattern and physical activity in this age group in India. CONCLUSION: These reference data could be used to identify adolescents with an elevated risk of developing dyslipidemia, hypertension and cardiovascular disorders, to plan and implement preventive policies, and to study temporal trends.

Usage of pioglitazone at Medanta, the Medicity.

Pioglitazone improves glycemic control by acting as an insulin sensitizer and is used in the management of Type 2 diabetes mellitus. Pioglitazone has recently been at the center of a controversy with regards to its safety. There is no clear consensus on how, when and in what dose the drug should be used in the management of diabetes. We have summarized our strategy on pioglitazone use in Type 2 diabetes in a large private tertiary care center - Medanta, the Medicity- which may help in generating further thought about positioning of this anti-diabetic molecule. We use pioglitazone as the fourth in the pecking order of oral anti-diabetic agents. We typically use pioglitazone in a dose of 15 mg/day. We avoid using pioglitazone with insulin. We do not use pioglitazone under following situations: In the presence of significant or proven cardiac disease, in patients who are struggling with their weight or need to lose weight, in patients at high risk for osteoporotic fractures, in patients with macular edema, in patients with pre-existing bladder cancer and would discontinue in case hematuria or any other symptom of bladder cancer develops. We continue to use the drug in patients well controlled on it without any evident side-effects or contraindications.

Clinical experience with exenatide in obese North Indian patients with type 2 diabetes mellitus.

OBJECTIVE: To share our clinical experience with exenatide in obese North Indian subjects with type 2 diabetes. MATERIALS AND METHODS: We share our experience with use of exenatide in 74 patients treated at Indraprastha Apollo Hospital, a tertiary care centre in New Delhi, India Subjects included obese / overweight subjects (mean weight and BMI; 97.67 ± 5.6 kg and 34.56 kg/m(2)) with known history of type 2 DM (Mean: 9 ± 5.6 years) and maintaining suboptimal glycemic control (HbA1c >7%) on oral antidiabetic agents, with or without basal insulin. Metformin and sulphonylureas were continued (with dose adjustment if indicated), as was basal insulin (glargine / detemir). TZDs and DPP4 inhibitors were discontinued. The dose of exenatide was increased to 10 mcg twice a day after 4-12 weeks. 56 patients completed minimum 3 month therapy. 42 patients completed 6 months, 32, 9 months and 25 completed 12 months. Data of patients who had completed at-least 3 months of therapy was included for analysis. RESULTS AND DISCUSSION: 69.77, 67.44, and 13.95% of the patients were receiving metformin, secretagogues or thiazolidinediones alone or in combination; 17.76% of the patients were on basal insulin. The change in fasting and post-prandial blood glucose levels were significant at 3, 6, 9 and 12 months with p-value <0.05. The mean weight loss at one, three, and six months and one year was 1.7 ± 1.3, 3.8 ± 2.5, 6.3 ± 3.4, and 8.3 ± 4.3 kg, respectively (P <0.05). The mean HbA1c (baseline: 8.8 ± 1.3%) at 3, 6 months and at one year was 7.8 ± 0.9, 7.7 ± 0.8 and 7.2 ± 0.8 (P <0.05). Thirty-five percent of the patients had a 'good' A1c value (< 7%) at the end of 12 months. 13 patients discontinued exenatide (three due to lack of response, six due to cost of therapy and four due to severe nausea). Nausea was the most common side effect, occurring in 95% patients within 1 month, although the incidence declined with passage of time. CONCLUSIONS: Clinical use of Exenatide is associated with significant improvement in glycemic control and major weight loss (8.3±4.3 kg at 1 year) in obese subjects with type 2 diabetes. Nausea is the most common side effect. In conclusion, exenatide is a effective and useful option for treatment of type 2 diabetes in obese Indian subjects.

Appropriate values of adiposity and lean body mass indices to detect cardiovascular risk factors in Asian Indians.

OBJECTIVES: The objective of this study was to determine the gender-specific appropriate values of direct measurements of adiposity and lean body mass in Asian Indians. METHODS: Data was collected cross-sectionally in 168 healthy urban Asian Indian individuals. Dual-energy X-ray absorptiometry and anthropometry were used to measure various body composition and fat distribution parameters. Blood pressure, serum lipids, fasting blood glucose, and 2-h glucose in an oral glucose tolerance test were used to identify the cardiovascular risk factors. Subjects were classified according to the presence of two or more of these cardiovascular risk factors. RESULTS: Appropriate cutoff values for total body fat (%), fat mass (kg), total lean mass (%), lean mass (kg), and fat free mass (kg) were 25.5, 15.1, 73.7, 46.3, and 48.8 for males and 38.0, 20.3, 59.0, 32.6, and 34.8 for females. Corresponding values for fat arm (%), fat mass arm (kg), fat leg (%), fat mass leg (kg), fat trunk (%), and fat mass trunk (kg) were 19.8, 1.4, 21.9, 4.1, 30.1, and 8.8 for males and 43.3, 3.1, 38.9, 6.9, 38.5, and 9.5 for females. Stepwise logistic regression analysis confirmed the relatively strong and independent association of fat mass trunk in men and fat mass arm in women with the clustering of cardiovascular risk factors. CONCLUSIONS: Gender-specific cutoffs of direct indices of adiposity and lean body mass are presented in this article, which could be used for clinical and research purpose to detect cardiovascular risk and for categorizing obesity and truncal adiposity in urban Asian Indians.

Cutoffs of abdominal adipose tissue compartments as measured by magnetic resonance imaging for detection of cardiovascular risk factors in apparently healthy adult Asian Indians in North India.

BACKGROUND: We aimed to define cutoffs of abdominal adipose tissue depots [total abdominal adipose tissue (TAAT), intraabdominal adipose tissue (IAAT), and abdominal subcutaneous adipose tissue (SCAT)] in adult Asian Indians in North India. METHODS: We carried out a cross-sectional study that included 100 healthy adult Asian Indians. Anthropometric measurement (waist circumference, body mass index), metabolic profile [oral glucose tolerance test (OGTT), lipid profile], and imaging (for quantification of area of abdominal adipose tissue components using single slice magnetic resonance imaging) were done. Odds ratios (ORs) for detecting presence of greater than one cardiovascular (CV) risk factor were computed using tertiles of adipose tissue compartments and cutoffs were generated using receiver operating characteristics curve analysis. RESULTS: The gender-specific cutoff limits for of TAAT, IAAT, and SCAT were 245.6 cm(2) (male) and 203.46 cm(2) (female), 135.3 cm(2) (male) and 75.73 cm(2) (female), and 110.74 cm(2) (male) and 134.02 cm(2) (female), respectively. For detection of CV risk factors, distinct gender differences were seen in ORs for SCAT [3.54 (95% confidence interval [CI], 1.10-11.46) and 6.6 (95% CI, 1.75-24.85) in males and females, respectively] but not for IAAT. CONCLUSIONS: The cutoffs of TAAT, IAAT, and SCAT generated for the first time in Asian Indians could be used for metabolic research, interethnic comparisons of adiposity and CV risk factors, and optimal selection of anthropometric parameters.

Waist circumference measurement by site, posture, respiratory phase, and meal time: implications for methodology.

Waist circumference (WC) has been advocated as a simple, reliable, and cost-effective measure to understand an individual's cardio-metabolic risk. Although several protocols exist for measuring WC, the variation induced by a few factors has not been investigated. We compared several established and experimental WC measurement protocols to identify factors that may cause variations in WC measurement. In this cross-sectional study, we examined the variations in the measurement of waist circumference (WC) measures carried out in 11 ways differing by anatomical site, posture, respiratory phase, and time since last meal, using repeated measure analysis of variance (using mixed models) after Tukey-Kramer adjustment. We estimated the proportion of variance in percentage of body fat (%BF) and fat-free mass (FFM) explained by each of the WC measures. We studied 123 apparently healthy Asian Indians (75 females), with mean (s.d.) age of 34 (8.7) years and BMI of 23.9 (4.8) kg/m(2). Overall, the mean of WCs measured using the 11 protocols were statistically different. Further, post hoc analysis showed statistically significant, yet mostly small, differences between most of the pairs. No single WC measure explained highest variance in %BF or FFM for both genders. Although, the National Institute of Health (NIH), USA, protocol was convenient and may be less prone to errors, at present it does not control for many variables tested in this study. Measures of WC measured using different protocols were statistically different. We suggest that the site of measurement, posture, phase of respiration, and time since last meal should be standardized for the development of a protocol for measurement of WC for worldwide use.

Predictive equations for body fat and abdominal fat with DXA and MRI as reference in Asian Indians.

OBJECTIVE: To develop accurate and reliable equations from simple anthropometric parameters that would predict percentage of total body fat (%BF), total abdominal fat (TAF), subcutaneous abdominal adipose tissue (SCAT), and intra-abdominal adipose tissue (IAAT) with a fair degree of accuracy. METHODS AND PROCEDURES: Anthropometry, %BF by dual-energy X-ray absorptiometry (DXA) in 171 healthy subjects (95 men and 76 women) and TAF, IAAT, and SCAT by single slice magnetic resonance imaging (MRI) at L3-4 intervertebral level in 100 healthy subjects were measured. Mean age and BMI were 32.2 years and 22.9 kg/m(2), respectively. Multiple regression analysis was used on the training data set (70%) to develop equations, by taking anthropometric and demographic variables as potential predictors. Predicted equations were applied on validation data set (30%). RESULTS: Multiple regression analysis revealed the best equation for predicting %BF to be: %BF = 42.42 + 0.003 x age (years) + 7.04 x gender (M = 1, F = 2) + 0.42 x triceps skinfold (mm) + 0.29 x waist circumference (cm) + 0.22 [corrected] x weight (kg) - 0.42 x height (cm) (R (2) = 86.4%). The most precise predictive equation for estimating IAAT was: IAAT (mm(2)) = -238.7 + 16.9 x age (years) + 934.18 x gender (M = 1, F = 2) + 578.09 x BMI (kg/m(2)) - 441.06 x hip circumference (cm) + 434.2 x waist circumference (cm) (R (2) = 52.1%). SCAT was best predicted by: SCAT (mm(2)) = -49,376.4 - 17.15 x age (years) + 1,016.5 x gender (M = 1, F = 2) +783.3 x BMI (kg/m(2)) + 466 x hip circumference (cm) (R (2) = 67.1). DISCUSSION: We present predictive equations to quantify body fat and abdominal adipose tissue sub-compartments in healthy Asian Indians. These equations could be used for clinical and research purposes.