Effect of a two-only-meals-a-day and exercise lifestyle on HbA1c and anti-diabetic medication in a follow-up study of subjects with type 2 diabetes attending a free clinic in a north Maharashtra city.

Background: Type 2 Diabetes (T2D) is a global challenge with rising prevalence, inadequate compliance, and poor outcomes. Aims: Assess the effect of a 2-only-daily-meals with exercise lifestyle (2-OMEX) on (a) HbA1c, (b) anti-diabetic medication count (ADMC), (c) Kcal intakes, body weight, fasting insulin, and subjective well-being. Materials and Methods: This is a single-arm follow-up study conducted in a free 2-OMEX clinic in 2019-2020. Information for two meals and exercise compliance was obtained during the clinic visit. HbA1c was tested by HPLC and fasting insulin by the CLIA/CMIA method in private laboratories. Results: Eligible subjects (f = 49, m = 116) completing two or more visits and 60 days of follow-up had a mean age of 55.92 (10.43) years, a T2D duration of 8.20 (6.28) years, and a median observation period of 140 days. Statistically significant changes included HbA1c decline from 7.69 (1.70) to 7.00 (1.20) gm% (equivalent by the LogNormal method to 1.088 gm%), average weight loss at 5%(m), and 2%(f). ADMC declined from 2.32 to 2.14, the difference being significant with the WSR test (z = 2.0087, P = 0.0223). Subjects attaining anti-diabetic medication-free and normoglycemic status (HbA1c < 6.5 gm%) were 20 (12%). The number attaining HbA1c ≤ 7 gm%) significantly rose from 73 (44%) to 101 (61%) with an ADMC of 1.9 (chi-square = 9.531, df1, P = 0.0020203). Participants reported 'feeling energetic' (79%), feeling lighter (50%), and better sleep (35%). Average energy intakes dropped by 120 Kcal to 1580/day. Fasting insulin remained unchanged, from 12.61 (11.06) to 12.34 (11.78) mlU/L. The dropout rate was 35%. Conclusions: The 2-OMEX lifestyle showed a sizeable, favorable, and significant change in HbA1c, body weight, ADMC use in five months, and subjective benefits. Studies are necessary for remission impact and pathways.

Effect of Two-Only-Meal Frequency and Exercise on HbA1C Outcomes, Weight, and Anti-Diabetic Medication in Type 2 Diabetes in a Popular Lifestyle Change Campaign in Maharashtra, Compared to Conventional Clinical Management: A Quasi-Experimental Multicenter Study in Maharashtra.

Background: Rising prevalence and poor outcomes make the twin challenges of diabetes epidemiology. This study evaluates effect of 2-only-daily-meals with exercise (2-OMEX) for its effect on HbA1c, oral hypoglycaemic agents (OHA) usage, body-weight among type-2-diabetes (T2DM) subjects, compared with conventional management. Material and Methods: A quasi-experimental, multicentre study in 2-OMEX arm, and HbA1c by HPLC method. HbA1c and body-weight changes were analyzed by 'Difference in Difference' (DID) method. Meal frequency, exercise, energy intakes were based on recall. The required sample size was 20X2 for 1.1 difference in HbA1c with 95% CL and 80% power. Results: Socio-demographic and risk profile of analysed and omitted subjects were similar. Studied arms were also similar in baseline features. The results in 2-OMEX and conventional arm are: complete records analyzed 201 and 120. Mean (sd) values as follows: observation days 234 and 236, age 52.03(8.84) and 52.45(9.48) years (P=0.6977), diabetes duration 4.6(3.05) and 4.9(2.97) years, BMI 27.28(5.27), 26.90(3.74) (P = 0.1859), baseline HbA1c gm% 7.46(1.52) and 7.55(1.58), end-line proportion of subjects attaining HbA1c ≤6.5gm% was 35.3% and 19.2% (P=0.002), bodyweight loss 2.57% and 1.26%. OHA count 1.6 (1.23) and 2.7(1.06), (P=0.0003). In 2-OMEX arm log-normal HbA1c declined significantly by 0.94 (95%CI: 1.60 to - 0.56, p=0.0333), weight loss difference 0.96 kg, and statistically not significant (P=0.595). Two subjects in 2-OMEX arm showed partial remission. Mean baseline Kcal intakes in 2-OMEX arm, were 1200.4(F) and 1437.3(M) were significantly higher than conventional arm (F) and 1430 (M). Conclusion: The 2-OMEX showed a sizeable and significant reduction in HbA1c and OHA use, in 7-months, with moderate intakes, compared to the conventional arm, possibly attributable to fewer insulin surges. More studies are required for its impact and pathways.

Nutritional assessment with skinfold thickness and body- fat proportion in tribal and urban schoolchildren in Nashik district: A cross sectional study.

Context: Skinfold thickness (SFT) and body-fat (BF%) are infrequently used for childhood undernutrition. Aims: (a) Estimation of SFT at peripheral and truncal sites (b) Estimation of BF% from SFTs (c) Correlate SFT estimates with MUAC, BMI and Waist. (d) Compare rural/tribal SFTs with urban schoolchildren. Settings and Design: Ashram schools in rural/tribal settings and one urban school. Methods and Material: Using three stage sampling, four tribal schools were randomly selected and an urban school was added for comparison. A sub sample of 405 students in the age group of 7 to 15 years were included. Height, weight, MUAC and SFTs were measured BF% was estimated with Slaughter equation. Statistical Analysis: Using Excel, Epi Info 7.1 and R software, appropriate t tests were applied for comparisons, and correlation was estimated between the quantitative variables. Results: Average SFT among schoolchildren (405) was 6.64 mm. Girls (n = 215) had a BF% of 13.1%, while boys (n = 190) had BF at 11.5%. Average SFT for boys (6.69) and girls (6.48) had no statistically significant difference (t = 1.3, P = 0.1929). Boys had higher average peripheral SFT than truncal SFT while girls had higher truncal SFTs. In girls subscapular SFT was higher than triceps SFT. Median BF% in rural was lower than urban schoolchildren. BF% correlated strongly with BMI (0.56), Waist (0.63), Hip (0.61) and MUAC (0.59). Conclusion: SFT and BF % can be effectively used to detect undernutrition. Geographical and Gender differences are observed. SFT and BF% correlated well with BMI and MUAC.

Mid-Upper-Arm-Circumference as a Growth Parameter and its Correlation with Body Mass Index and Heights in Ashram School Students in Nashik District in Maharashtra, India.

BACKGROUND: Under nutrition is a major problem among Indian schoolchildren. Yet, routine height and weight measurements in schools are nor used for growth monitoring. This study attempts to evaluate mid-upper-arm-circumference (MUAC) as a quick assessment tool against body mass index (BMI) in schoolchildren. OBJECTIVE: The objective of the study was to evaluate MUAC against BMI, height, and average skin fold thickness (ASFT) parameters and to estimate MUAC values across age, sex, and social categories. SUBJECTS AND METHODS: The study was conducted in 2017-2018 in four randomly selected Ashram schools and an urban school in Nashik district. Girls (1187) and boys (1083) from age 6-18 were included, and height, weight, skinfold thickness, and MUAC were measured. MUAC was done on the left arm with Shakir's tape and tailor's tape (for MUAC >25 cm). Epi Info 7.1 and Excel were used for the data analysis. RESULTS: MUAC had a consistently high correlation with BMI at all ages for boys (r = 0.8786, P < 0.0001) and girls (r = 0.8586, P < 0.0001). ASFT too was strongly correlated with MUAC (r = 0.5945, P < 0.0001). MUAC had strong but nonlinear correlation with heights in girls (r = 0.7751, P < 0.0001) and boys (r = 0.8267, P < 0.0001). MUAC was higher for girls than boys at all ages. MUAC values for scheduled tribe (ST) children were highly significantly lower than non-ST students. CONCLUSION: MUAC is a good and quick proxy tool for BMI and can serve as a sensitive nutritional indicator for school ages across socioeconomic categories. However, it is necessary to construct age-wise cutoff points and bandwidths using multicentric studies across income quintiles.

Ethnotribal Growth Differences among Schoolchildren in a Northwestern Maharashtra District: An Analytical Cross-Sectional Study.

CONTEXT: In Ashram schools, scheduled tribes (ST) children from age 6 to 17 years belonging to various ethnic groups stay under common living and dietary provisions. However, there are scant reports on ethnotribal height differences. AIMS: The aims of the study are to (a) estimate height differences between schoolchildren of three major local STs, (b) compare heights and average skinfold thickness (SFT) of ST with non-ST and urban schoolchildren, and (c) compare median heights and weights of ST and non-ST schoolchildren with the Indian Academy of Pediatrics standards. SETTINGS AND DESIGN: Four Ashram schools and one urban school in Northwest Maharashtra. SUBJECTS AND METHODS: All children from age 6 to 17 years were included for height, weight, and mid-arm circumference (n = 2106). Data were processed with Excel and Epi info software for quantitative comparisons. STATISTICAL ANALYSIS USED: Quantitative methods including ANOVA were used for statistical comparison of heights. RESULTS: There were no differences among heights between ST students (ANOVA P > 0.05). However, there were significant differences between heights of boys and girls between ST and non-ST students across age groups (ANOVA P < 0.0001). ST boys and girls were mostly below 3rd or 10th percentile of IAP height and weight charts while non-ST children were between 25th and 50th percentiles. The average SFT values for prepubertal age groups were significantly lower in ST schoolchildren. CONCLUSIONS: ST students showed a significant growth disadvantage against general and other backward classes categories, although no intertribal anthropometry differences were observed.

Protein calorie intakes and growth profiles in ashram school students in Nashik district in Maharashtra.

BACKGROUND: Tribal ashram schools provide accommodation, food, and other services from 1st to 12th standards to children from marginalized sections of the society. Nutrition and growth are important aspects of this age group. OBJECTIVES: This study aims to estimate average macronutrient intakes in private and public ashram schools and to compare the growth of tribal with urban children and national standards. METHODS: This is a cross-sectional cluster-based study in Nashik district of Maharashtra in ashram schools with an urban day school for comparison. The study was conducted from November 2017 to February 2018. The study includes 1510 students in four rural ashram schools and 322 urban school day scholars. Daily food amounts used by the school kitchens were analyzed. Height and weight of students were recorded with standard methods. Excel was used to estimate nutrient intakes and Epi Info for analysis of growth parameters. RESULTS: Protein intakes were 76.5 g/student (2.9-3.1 g/kg body weight), with staples contributing 42%-50% and legumes and pulses contributing 22%-25%. Energy intakes were 2519 kcal/student (100-120 kcal/kg body weight) with oils contributing 13%. Boys ate 1.5-2 times than girls going by average intake of Chapattis. Height and weight of students at entry and exit age, respectively, of 7 and 15 years were significantly lower than urban students, ICMR and IAP standards. However, entry-level stunting had reduced by 15 years by 40%-50% in girls and boys. CONCLUSIONS: Macronutrient intakes in the ashram schoolchildren were sufficient, but growth gap persisted till adolescence. Protein quality in private schools needs improvement.

Intervention Study for Reducing Schoolbag Weights in Two Rural Schools in Maharashtra.

CONTEXT: Heavy schoolbags are reported worldwide including India. The prescribed safe upper limit was 10% of student bodyweight. AIMS: This intervention study explored (a) impact of awareness measures among stakeholders and (b) any systemic constraints for reducing bag loads. SETTINGS AND DESIGN: This is a two-stage intervention study following a 2016-2017 baseline study of schoolbag weights in two rural schools. SUBJECTS AND METHODS: The study involved 175 students (male: 79 and female: 96) from 8th to 9th standards. The intervention consisted of sharing the baseline findings of schoolbag weight, guidelines, and necessary measures for the same. Thefirst intervention involved creating awareness among teachers regarding the harmful effects and the second intervention involved students. Bag weights were recorded on digital luggage scale in prelunch sessions in the following weeks after the intervention. STATISTICAL ANALYSIS: The impact of interventions was tested with (a) Paired t-test for mean bag weights and (b) Chi-square test for the proportion of heavy schoolbags. RESULTS: The mean baseline bag weight of 3.77 kg declined statistically significantly after successive interventions to 3.4 and 3.2 kg. The baseline proportion of 51% of heavy bags (>10% of body weight) declined to 38% and 29%. Despite interventions, 19% students in 8th carried heavier bags than the 3.4 kg cap set by Government guidelines. Subjects taught in 8th standard were above 6/day. CONCLUSIONS: Awareness programs for stakeholders only partially succeeded in reducing bag weights. Hence, reducing the daily subject load is necessary.

Emergency Obstetric Care in a Rural Hospital: On-call Specialists Can Manage C-sections.

BACKGROUND: Institutional birth and Emergency Obstetric Care (EmOC) are important strategies of the National Rural Health Mission (NRHM). While the Community Health Center (CHC) is expected to serve EmOC needs in NRHM, the CHCs are hamstrung due to chronic shortage of specialist doctors. Alternative strategies are therefore needed for ensuring EmOC. OBJECTIVES: This study aims to estimate the EmOC needs in a private rural hospital from case records and find some useful predictors for caesarian section (C-section) and to assess C-section needs in the context of on-call specialist support. MATERIALS AND METHODS: We analyzed a two-decade series of 2587 obstetric cases in a private rural hospital for normal deliveries and EmOC including C-section. RESULTS: About 80% of the obstetric cases were normal deliveries. Of the remaining 20% cases that required EmOC, nearly one-third required C-section. In the series, two maternal deaths occurred due to hemorrhage. About 13% case records showed past abortion, which adds to EmOC workload. Primipararous mothers with higher age had a greater incidence (23%) of C-section. The C-section rate shows a steady rise from 3% to above 10% in the series. CONCLUSIONS: This rural hospital required C-section in 6.4% cases. This C-section workload was managed with the help of on-call specialists. The local hospital team could manage 93.6% of the cases and abortions with only two maternal deaths. This strategy of an on-call specialist team can be an option for CHCs till resident specialists are adequately available.

Analysis of birth weights of a rural hospital.

BACKGROUND: Low birth weight remains a major reason behind childhood malnutrition. The NFHS findings show no dent in this problem. OBJECTIVE: This study was undertaken to explore change in birth weights in a period from 1989 to 2007 and any associations thereof. MATERIALS AND METHODS: All birth records of a private rural hospital spanning two decades (1989-2007) were analyzed for birth weight, age of mother, gender, birth order of the baby, proportion of pre-term babies and low birth weight babies. RESULTS: No change was observed in the average birth weights (average 2.71 kg) over the period. Although the birth weight shows some expected variance with the age of mother, it was found to have no relation with the baby's birth order and gender. The low birth weight proportion is about 24% and shows little difference before and after the series midpoint of year 1998. CONCLUSION: The birth weights have hardly changed in this population in the two decades.