Social and Cultural Insights into Healthy Aging: A Qualitative Study from the South Indian City of Bengaluru, India.

BACKGROUND: Qualitative methods through lived experience narratives provide relevant sociocultural insights into healthy aging. OBJECTIVES: The aim of this qualitative study was to explore social and cultural perceptions of healthy aging from older adults (OAs), their next of kin, and those involved in providing services to OAs in Bengaluru, India. MATERIALS AND METHODS: We conducted in-depth interviews with 28 participants, all purposefully selected based on specific inclusion criteria, to get as varied a sample as possible. A pilot-tested, open-ended topic guide was used for every interview which was audio recorded with the permission of the respondent. Verbatim data were transcribed, reviewed for errors, and coded using NVivo 12 software and the framework analysis method of combining deductive and inductive codes. RESULTS: In total, 794 codes covering concepts of healthy aging, enablers and threats to healthy aging, and perspectives for the future were categorized into four themes supporting healthy aging, namely emotional well-being and a sense of purpose, family and social support, financial security, and health-care access. Each of these had a bearing on the OA's physical and mental health. Across socioeconomic groups, a sense of purpose at the level of the self, family, and society emerged as a key emotional sustainer. Social and economic deprivations were key threats to healthy aging and hence required social security and governmental interventions. CONCLUSION: Sociocultural economic factors are key to healthy physical and mental aging in the context of India. The same factor could be an enabler and in its absence a threat.

Pulmonary Rehabilitation in the Management of Chronic Obstructive Pulmonary Disease among Asian Indians- Current Status and Moving Forward.

Chronic Obstructive Pulmonary Disease (COPD) is a significant public health concern in India with high prevalence and associated disability, morbidity, mortality. The progression of COPD is not confined to the lungs but includes extrapulmonary involvement that reduces the functional capacity and quality of life. Pulmonary Rehabilitation (PR) is an evidence-based intervention, targeting multiple domains of pulmonary and extrapulmonary manifestations, and therefore, is recommended as an integral part of COPD management. The practical implementation of PR in India is poor. In this review, we have summarized the latest pieces of evidence in support of PR and highlight the challenges and potential solutions for PR implementation in India.

Gut microbial dysbiosis as a limiting factor in the management of primary and secondary sarcopenia: an Asian Indian perspective.

PURPOSE OF REVIEW: The article summarizes recent research advances on the role of gut microbiome in primary and secondary sarcopenia. This article also explores the potential contribution of gut dysbiosis to suboptimal sarcopenia management with special focus on factors contributing to gut dysbiosis among Asian Indians. RECENT FINDINGS: Aging and chronic diseases contribute to gut dysbiosis and intestinal barrier dysfunction allowing enhanced microbial translocation that may negatively affect muscle strength, physical function, and frailty. Gut microbiome of Asian Indians has shown a unique composition that is affected by multiple factors, such as socioeconomic status, poor hygiene, high rate of infection and infestations, antibiotic overuse and transition towards a westernized eating pattern. Current management approach for sarcopenia (exercise and/or protein supplementation) fails to address gut dysbiosis and intestinal barrier dysfunction. Incorporating a prebiotic or probiotic element to the intervention strategy may improve gut dysbiosis, inflammation and muscle function. SUMMARY: Gut dysbiosis and intestinal barrier dysfunction appear to be a significant limitation in sarcopenia management, thus gut centric intervention may be perceived as a (co)intervention strategy to be tested in appropriate clinical trials.

Combined Lifestyle Interventions in the Prevention and Management of Asthma and COPD: A Systematic Review.

(1) Background: A healthy lifestyle has a protective role against the onset and management of asthma and chronic obstructive pulmonary disease (COPD). Therefore, combined lifestyle interventions (CLIs) are a potentially valuable prevention approach. This review aims to provide an overview of existing CLIs for the prevention and management of asthma or COPD. (2) Methods: A systematic literature search was conducted using PubMed, EMBASE, and PsycInfo. Studies were included if CLIs targeted at least two lifestyle factors. (3) Results: Among the 56 included studies, 9 addressed asthma and 47 addressed COPD management, with no studies focusing on prevention. For both conditions, the most prevalent combination of lifestyle targets was diet and physical activity (PA), often combined with smoking cessation in COPD. The studied CLIs led to improvements in quality of life, respiratory symptoms, body mass index/weight, and exercise capacity. Behavioural changes were only measured in a limited number of studies and mainly showed improvements in dietary intake and PA level. (4) Conclusions: CLIs are effective within asthma and COPD management. Next to optimising the content and implementation of CLIs, these positive results warrant paying more attention to CLIs for persons with an increased risk profile for these chronic respiratory diseases.

The Effect of Soy and Whey Protein Supplementation on Glucose Homeostasis in Healthy Normal Weight Asian Indians.

Milk and legumes are good source of protein foods used to sustain muscle mass, but their effects on postprandial glucose homeostasis and energy metabolism may be different. This is relevant, for example, in the dietetic response to obesity or diabetes, where the intake of high-quality protein is often increased significantly. The objective of this study was to characterize the acute effect of whey and soy protein (15% vs. 30%) on glucose homeostasis, energy metabolism, and satiety. Healthy, normal body mass index (BMI) Indian adult males aged 20-35 years (n = 15) received 4 test meals (2 proteins (soy vs. whey) and 2 doses (15% vs. 30% protein: energy ratio)). Blood samples were collected serially after the meal to calculate the incremental area under the curve for plasma glucose and insulin. Energy expenditure and substrate oxidation were measured after the meal. Satiety was measured with a visual analogue scale. The insulin response, represented by the incremental area under the curve, was significantly higher for the 30% whey compared to the 30% soy protein meal (p < 0.01) but was not significantly different between the 15% protein doses. There were no differences in the plasma glucose response across protein sources or doses. The mean peak fat and carbohydrate oxidation, satiety, and energy expenditure did not differ between the protein sources and doses. In conclusion, at higher doses, whey protein has a greater insulinogenic response, compared to soy protein, and exhibits a dose-response effect. However, at lower doses, whey and soy protein elicit similar insulinogenic responses, making them equally effective protein sources in relation to glucose homoeostasis.

Heart rate variability responses to standing are attenuated in drug naive depressed patients.

Depression has been linked to altered cardiac autonomic regulation. Previous studies have been inconsistent in terms of measurement of heart rate variability (HRV), selection of depressed patients with cardiac disorders and not controlling for co-morbid conditions such as substance use and anxiety disorders. The objective of this study is to compare the effect of posture on spectral measures of HRV in drug naive healthy patients with major depression with age and gender matched healthy controls. Spectral measures of HRV in supine position and with active standing were obtained (using Task force recommendations). Repeated measure ANOVA revealed an attenuated response in HRV parameters (HF normalized units & LH/HF ratio) to active standing in depressed subjects compared to healthy controls. We conclude that there is an impaired parasympathetic modulation in response to physiological maneuver (orthostatic challenge) in drug naive subjects with major depression (co-morbid medical or psychiatric conditions) compared to healthy controls.

Circulating C-Terminal Agrin Fragment: A Potential Marker for Sarcopenia Among Type 2 Diabetes.

Background: Undetected onset of sarcopenia among individuals with chronic diseases especially Type 2 Diabetes Mellitus (T2D) makes it important to be evaluated. The feasibility of diagnosing sarcopenia in a clinical setup might be a difficult task. Circulating markers including C-terminal agrin fragment (CAF) are emerging as an alternative. Hence, the objectives of the study were to compare circulating CAF levels between T2D, prediabetes (PD) and healthy controls and to study its association with sarcopenic index, muscle mass, strength and quality. Methods: Ninety-nine participants (n = 42, T2D; n = 33, PD; n = 24, healthy controls) aged 18 to 60 yrs were recruited. HOMA (homeostatic model assessment) indices were derived using plasma glucose and insulin. All participants underwent lipid profiling, muscle strength including quality (isokinetic dynamometer), body composition (Dual energy X-ray Absorptiometry (DXA)) and sarcopenic index (appendicular skeletal muscle mass/body weight) assessment. Serum samples were used to estimate CAF levelsusing enzyme-linked immunosorbent assay (ELISA). Results: Median CAF level was significantly higher among T2D group compared to PD and control groups (P < 0.0001). Circulating CAF levels correlated positively with age and glycated haemoglobin (HbA1c) (both, P < 0.001) and negatively with HOMA-B and muscle quality (both, P < 0.001), and sarcopenic index (P = 0.07). Multivariable analysis demonstrated that the odds of being in the highest tertile category was 7.67, 95% C.I. (2.10, 29.3) among T2D. Conclusion: Circulating CAF levels were significantly higher among T2D compared to PD and control study groups along with reduced skeletal muscle quality. This suggests that the circulating CAF level has the potential to be considered as a clinical marker to evaluate sarcopenia among T2D.

Nutrition in the prevention and management of sarcopenia - A special focus on Asian Indians.

Sarcopenia, characterized by loss of muscle mass and strength, is common in advanced old age but can be accelerated by chronic disease, malnutrition and physical inactivity. Early initiation of intervention to achieve and maintain a higher peak muscle mass and strength may allow for prevention or delay of sarcopenia and facilitate independent living even in old age. In this context, malnutrition, a significant contributor to sarcopenia, is often overlooked among the Indian population. Maintenance of an optimal energy and protein balance with adequate physical activity level is essential to preserve physical function in the aging population. However, research on the role of micronutrients in muscle maintenance, is still in its infancy. This narrative review, therefore, aims to explore the current status of International and Indian research on the role of nutrition in sarcopenia mitigation and the way forward.

Acute Effect of a Protein Supplement on Targeted Plasma Amino Acid Profile among Healthy Asian Indians: A Randomized Controlled Trial.

BACKGROUND: Indians have a poor protein intake in terms of quantity as well as quality because of their predominantly cereal-based diet. However, there is limited information on circulatory amino acid levels in healthy Indians. Herein, we evaluated the acute effect of a protein supplement on the plasma levels of essential amino acids (EAAs) in healthy Indian adults, using targeted EAA analysis. METHODS: In this double-blind, randomized, crossover study, 20 healthy Indian adults were randomized to receive the test protein supplement (treatment arm, n = 10) or placebo (control arm, n = 10) with milk, after overnight fasting. After 7 days, the participants returned for the crossover treatment. Blood samples were collected at baseline and at 60 and 120 min after protein/placebo consumption. Plasma EAA levels were estimated using liquid chromatography-tandem mass spectrometry. Repeated measures ANOVA was performed to assess the effect of treatment on EAA levels. P values < 0.05 were considered statistically significant. RESULTS: At baseline, mean plasma levels did not differ significantly between the two arms for any of the EAAs. In the treatment arm, the mean levels of all EAAs increased significantly from baseline to 60 min (P < 0.01), with no significant change from 60 to 120 min. There was no significant change in amino acid levels in the control arm. The magnitude as well as percentage of increase from baseline to 60 min was significantly greater in the treatment arm than in the control arm for all EAAs. CONCLUSION: Compared to placebo, protein supplement increased circulatory amino acid levels in healthy Indians. The observed increase in EAA levels and its role in conjunction with exercise in both healthy and diseased states need to be further evaluated. This is the first dataset exploring targeted EAA profiles and the effect of a protein supplement among healthy Indians. The clinical trial is registered with CTRI/2018/12/016777.

Asian Indians With Prediabetes Have Similar Skeletal Muscle Mass and Function to Those With Type 2 Diabetes.

Background: Type 2 Diabetes (T2D) is a major concern among Asian Indians, not least because many develop T2D at despite having a normal BMI (body mass index), and with relatively low body fat. Asian Indians are also generally considered to have relatively low skeletal muscle mass and strength, this has not been explored in the context of T2D. Aim: The present study aimed to compare skeletal muscle mass, function and contractile quality (strength/mass) between healthy controls, those with prediabetes (PD) as well as T2D middle-aged non-obese Asian Indians. Methods: Adult males between the age of 20-50 years, consisting of healthy controls (n = 44), PD (n = 125) and T2D (n = 55) were studied. Skeletal muscle mass was measured using Dual X-ray Absorptiometry (DXA). Isometric and dynamic muscle function was measured using an isokinetic dynamometer (at 0, 60, 120, 180 degree/s). Muscle contractile quality was derived by dividing the peak muscle torque with the respective LMM (lower limb muscle mass). Fasting blood glucose (FBG) and insulin were used to derive insulin resistance (HOMA-IR). Results: The control group was on average 10 years younger than the other two groups (p < 0.01). The LMM was similar across the three study groups. However, the age-adjusted mean muscle torque was significantly lower in both absolute and normalized isometric and isokinetic strength in PD and T2D groups compared to controls (p ≤ 0.01), with the difference persisting even after adjusting for age and other covariates. However, there was no difference in muscle strength and contractile quality between the PD and T2D study groups. Conclusions: Muscle strength and contractile quality would appear to be sensitive and early indices of the trajectory toward diabetes in Asian Indians and more so than skeletal muscle mass. It is thus important to recognize the importance of functional measurements among this population when considering the role of muscle in diabetes. The data also would suggest that specific muscle conditioning (e.g., resistance training) might have efficacy in improving function as well as muscle mass, and thus aiding in the prevention of the trajectory toward the development of T2D.

Effect of increasing protein content at the evening meal followed by exercise on overnight nocturnal total energy expenditure, fat and carbohydrate oxidation in healthy young Indian men.

BACKGROUND AND OBJECTIVES: Indians are more prone to develop diabetes at a younger age, with normal BMI, and this might partly be due to their higher body fat content. Increase in fat mass in the body might be because of the reduction in fat oxidizing capability. Given the fact that Indians consume high carbohydrate diets, effective fat oxidation is likely to be delayed. Simple preventive weight loss strategies like exercise or change in diet regimen are needed to reduce their body fat. This study investigated the effect of exercise with a high protein dinner on overnight thermogenesis and fat oxidation. METHODS AND STUDY DESIGN: Nine healthy normal subjects aged 18 - 30 years participated in randomised cross over study. They underwent 6 sessions of overnight whole body indirect calorimetry on separate nights with the following experimental conditions: (i) standard (habitual) meal (ii) standard meal with exercise (iii) 20% protein meal (iv) 20% protein meal with exercise (v) 50% protein meal and (vi) 50% protein meal with exercise. Oxygen consumption (VO2) and carbon dioxide production (VCO2) were measured overnight, from which energy expenditure, non-protein respiratory quotient (RQ), and fat oxidation were estimated. RESULTS: The estimated marginal means of fat oxidation and energy expenditure were significantly different for protocols with exercise compared to those without exercise (p=0.02). There was no acute effect of protein on nocturnal fat or carbohydrate oxidation, with or without exercise. CONCLUSIONS: Post-dinner exercise increase nocturnal fat oxidation and energy expenditure in young active Indian men.

The effect of a controlled 8-week metabolic ward based lysine supplementation on muscle function, insulin sensitivity and leucine kinetics in young men.

BACKGROUND & AIMS: The 2007 FAO/WHO/UNU lysine requirement is 30 mgkg(-1)d(-1). Developing country populations may be at risk of lysine deficiency, with effects on muscle and its function. The effect of an 8 wk lysine supplementation diet on muscle mass and function was assessed. METHODS: Healthy, under and well-nourished men were studied before and after 8 wk, during which low (n=20) and high (n=20) lysine diets were consumed. The low lysine diets (∼25 and ∼40 mgkg(-1)d(-1) for under and well-nourished respectively) were based on the subjects' habitual lysine intake, while the high lysine diet supplied 80 mgkg(-1)d(-1). Anthropometry, muscle function, insulin sensitivity (IS) and leucine kinetics were measured before and after the experimental period. RESULTS: The high lysine diet had a small positive effect (about +7.5%) on muscle strength, but no effect on other parameters. Over the 8 wk period in the whole group, the change in muscle strength correlated with the change in muscle mass (r=0.5, P=0.001), while the change in muscle mass correlated with the change in IS (r=0.3, P=0.04), but there were no intake specific differences. CONCLUSION: Over an 8 wk controlled feeding period, an intake of 80 mg lysine kg(-1)d(-1) had a small positive effect on muscle strength, but no other effects.