Urinary metabolic modulation in human participants residing in Siachen: a 1H NMR metabolomics approach.

The main physiological challenge in high altitude environment is hypoxia which affects the aerobic metabolism reducing the energy supply. These changes may further progress toward extreme environment-related diseases. These are further reflected in changes in small molecular weight metabolites and metabolic pathways. In the present study, metabolic changes due to chronic environmental hypoxia were assessed using 1H NMR metabolomics by analysing the urinary metabolic profile of 70 people at sea level and 40 people at Siachen camp (3700 m) for 1 year. Multivariate statistical analysis was carried out, and PLSDA detected 15 metabolites based on VIP score > 1. ROC analysis detected cis-aconitate, Nicotinamide Mononucleotide, Tyrosine, Choline and Creatinine metabolites with a high range of sensitivity and specificity. Pathway analysis revealed 16 pathways impact > 0.05, and phenylalanine tyrosine and tryptophan biosynthesis was the most prominent altered pathway indicating metabolic remodelling to meet the energy requirements. TCA cycle, Glycine serine and Threonine metabolism, Glutathione metabolism and Cysteine alterations were other metabolic pathways affected during long-term high-altitude hypoxia exposure. Present findings will help unlock a new dimension for the potential application of NMR metabolomics to address extreme environment-related health problems, early detection and developing strategies to combat high altitude hypoxia.

Role of Parathyroid Hormone in Determination of Fat Mass in Patients with Vitamin D Deficiency.

BACKGROUND: Obesity has become a global epidemic and it is rising is Asia. Vitamin D deficiency (VDD) is widely prevalent in the Indian subcontinent. Studies have linked VDD to obesity and shown correlation between parathyroid hormone (PTH), 25-hydroxy Vitamin D (25(OH)D), and fat mass (FM). However, studies on the role of PTH among subjects with VDD are lacking. OBJECTIVE: The objective of this study is to study the role of PTH in the determination of FM in participants with VDD. SUBJECTS: Five hundred and fifty-one adults (m:247, f:304) were included in this study. MATERIALS AND METHODS: Total and regional (trunk, arm, and leg) FM was assessed by dual X-ray absorptometry. Biochemical and hormonal parameters such as calcium, phosphorus, alkaline phosphatase, ionic calcium, 25(OH)D, and PTH were also analyzed. RESULTS: The mean age of the study population was 58.8 ± 15.8 years (Male: [63.3 ± 13.1], Female: [55.2 ± 16.9]). FM and body mass index were significantly lower in females with higher levels of serum 25(OH)D. Total FM was negatively correlated with serum 25(OH)D (r = -0.363, P < 0.0001) and positively correlated with serum PTH (r: 0.262, P < 0.0001) in females only. Females with VDD and secondary hyperparathyroidism had higher FM than those with normal PTH. CONCLUSIONS: Females with VDD had higher total and regional FM. However, this correlation was evident only in those with high serum PTH levels, suggesting a potential role of PTH in the accumulation of FM.

Lean Body Mass and Bone Health in Urban Adolescents From Northern India.

OBJECTIVE: To prepare percentile charts of lean body mass (LBM) among Indian urban children and adolescents; and to evaluate gender differences in LBM, and its relation with pubertal status. DESIGN: Secondary data analysis. SETTING: School in city of Delhi, India. PARTICIPANTS: 1403 apparently healthy children and adolescents (826 boys) with mean (SD) age 13.2 (2.7) years. OUTCOME MEASURE: Lean body mass assessed by dual energy absorptiometry. RESULTS: Total and regional lean mass were greater in older age groups in both sexes. LBM showed rising trends up to the age of 18 years in boys, whereas it plateaued after the age of 15 years in girls. The age-associated increase in LBM was significantly higher in boys (130%) compared to girls (83%) (P<0.001). Total and regional lean mass increased with progression of pubertal staging in both genders. During pubertal development, LBM almost doubled (100% increase) from stage-2 to stage-5 in boys, as opposed to a 73% rise in girls (P<0.001). Total and regional lean mass and Appendicular skeletal muscle mass index (ASMI) was positively correlated with age, body mass index (BMI), serum 25(OH)D, total fat mass, and bone mineral content (BMC). Relation between LBM and BMC remained significant even after adjusting for age, fat mass and various biochemical parameters. CONCLUSION: Total and regional LBM rise with age and pubertal maturation in both genders, but more so in boys when compared to girls. LBM has direct bearing on BMC even after adjusting for age, fat mass and biochemical parameters.

Trimester specific reference intervals for thyroid function tests in normal Indian pregnant women.

CONTEXT: Accurate assessment of thyroid function during pregnancy is critical, for initiation of thyroid hormone therapy, as well as for adjustment of thyroid hormone dose in hypothyroid cases. AIMS: We evaluated pregnant women who had no past history of thyroid disorders and studied their thyroid function in each trimester. SETTINGS AND DESIGN: 86 normal pregnant women in the first trimester of pregnancy were selected for setting reference intervals. All were healthy, euthyroid and negative for thyroid peroxidase antibody (TPOAb). These women were serially followed throughout pregnancy. 124 normal nonpregnant subjects were selected for comparison. MATERIAL AND METHODS: Thyrotropin (TSH), free thyroxine (FT4), free triiodothyronine (FT3) and anti-TPO were measured using Roche Elecsys 1010 analyzer. Urinary iodine content was determined by simple microplate method. The 2.5th and 97.5th percentiles were calculated as the reference intervals for thyroid hormone levels during each trimester. STATISTICAL ANALYSIS: SPSS (version 14.0, SPSS Inc., Chicago, IL, USA) was used for data processing and analysis. RESULTS: The reference intervals for the first, second and third trimesters for the following parameters: TSH 0.09-6.65, 0.51-6.66, 0.91-4.86 µIU/mL, FT4 9.81-18.53, 8.52-19.43, 7.39-18.28 pM/L and FT3 3.1-6.35, 2.39-5.12, 2.57-5.68 pM/L respectively. Thyroid hormone concentrations significantly differed during pregnancy at different stages of gestation. The pregnant women in the study had median urinary iodine concentration of 150-200 µg/l during each trimester. CONCLUSIONS: The trimester-specific reference intervals for thyroid tests during pregnancy have been established for pregnant Indian women serially followed during pregnancy using 2.5th and 97.5th percentiles.

Relationship Between BMD and Prevalent Vertebral Fractures in Indian Women Older Than 50 Yr.

The purpose of the study was to study the relationship of morphometric vertebral fractures with bone mineral density (BMD) in Indian women older than 50 yr. Four hundred fifteen healthy Indian women older than 50 yr (mean age: 62.8 yr) underwent lateral X-rays of the lumbar and thoracic spine. Genant's semiquantitative method was used to diagnose and classify morphometric vertebral fractures. BMD was measured by DXA at lumbar spine and total hip. Recruited subjects underwent anthropometric, biochemical, and hormonal evaluation. Vertebral fractures were present in 17.1% (95% confidence interval: 13.5, 20.8) subjects. Prevalence of osteoporosis based on BMD was 35.7%. By adding those with prevalent fractures, the number of women requiring therapy for osteoporosis would increase to 46.5%. The BMD measured at femur neck, total hip, and lumbar spine (L1eL4) was not found to be lower in women with vertebral fractures as compared with those without fractures. BMD was not found to be lower in women with vertebral fractures as compared with those without fractures. Significant number of additional subjects with BMD in the normal or osteopenic range become eligible for osteoporosis treatment when presence of vertebral fracture is used as an independent indication for such treatment.

Bone mineral content has stronger association with lean mass than fat mass among Indian urban adolescents.

INTRODUCTION: There are conflicting reports on the relationship of lean mass (LM) and fat mass (FM) with bone mineral content (BMC). Given the high prevalence of Vitamin D deficiency in India, we planned the study to evaluate the relationship between LM and FM with BMC in Indian children and adolescents. The objective of the study was to evaluate the relationship of BMC with LM and FM. MATERIALS AND METHODS: Total and regional BMC, LM, and FM using dual energy X-ray absorptiometry and pubertal staging were assessed in 1403 children and adolescents (boys [B]: 826; girls [G]: 577). BMC index, BMC/LM and BMC/FM ratio, were calculated. RESULTS: The age ranged from 5 to 18 years, with a mean age of 13.2 ± 2.7 years. BMC adjusted for height (BMC index and BMC/height ratio) was comparable in both genders. There was no difference in total BMC between genders in the prepubertal group but were higher in more advanced stages of pubertal maturation. The correlation of total as well as regional BMC was stronger for LM (B: Total BMC - 0.880, trunk - 0.715, leg - 0.894, arm - 0.891; G: Total BMC - 0.827, leg - 0.846, arm - 0.815 (all value indicate r (2), P < 0.0001 for all) when compared with FM (B: Total BMC - 0.776, trunk - 0.676, leg - 0.772, arm - 0.728; G: Total BMC - 0.781, leg - 0.741, arm - 0.689; all P < 0.0001) except at trunk BMC (LM - 0.682 vs. FM - 0.721; all P < 0.0001), even after controlling for age, height, pubertal stage, and biochemical parameters. CONCLUSIONS: BMC had a stronger positive correlation with LM than FM.

Assessment and relation of total and regional fat mass with bone mineral content among Indian urban adolescents.

BACKGROUND: Fat mass (FM) has been shown to have an effect on bone mass accrual. Though gender and ethnic differences in body composition and bone accrual during puberty have been reported, there are limited data available for Indian children and adolescents. OBJECTIVE: To generate age and gender based percentile charts of FM among urban Indian children and adolescents and to evaluate the relationship with pubertal status and bone mineral content (BMC). SUBJECTS: There were 1403 children and adolescents (boys: 826; girls: 577) in the study. METHODS: Total and regional FM, BMC, and pubertal staging were assessed. Fat mass index (FMI), FM/height ratio and BMC/FM ratio, were calculated. RESULTS: The age of the study population ranged from 5 to 18 years, with a mean age of 13.2 ± 2.7 years (boys: 13.0 ± 2.7; girls: 13.4 ± 2.8 years). Total and regional FM as well as FMI increased with increasing age in both genders. The highest percent increase in mean total FM occurred in the age group > 8-11 years and decreased thereafter. The total and regional FM was higher in more advanced stages of pubertal maturation. There was no difference in total and regional FM between genders in prepubertal group. The age and pubertal associated increase in FM was significantly higher in girls than boys (p < 0.0001). Total as well as regional FM and FMI were positively correlated with age, body mass index, total lean mass, and BMC even after adjusting for age, lean mass, and biochemical parameters. CONCLUSIONS: Total and regional FM increased with age and pubertal maturation in both genders. FM was positively correlated with BMC.

Assessment of lean (muscle) mass and its distribution by dual energy X-ray absorptiometry in healthy Indian females.

SUMMARY: Mean appendicular lean mass increased from the second decade to reach maximum in the fourth decade in Indian women. Post-menopausal females with LMM were significantly older, leaner, and had lower bone mineral density (BMD). Lean mass and ASMI were negatively correlated with age and positively with BMI and BMD at all sites. INTRODUCTION: Sarcopenia is defined by low muscle mass (LMM), strength, and performance. Lean mass can be precisely measured by dual-energy X-ray absorptiometry (DXA). There is no uniform definition of LMM. We undertook this study to prepare percentile charts for lean mass, which serves as a surrogate for muscle mass, in apparently healthy Indian females and correlate it with anthropometric and bone mineral density (BMD) parameters. METHODS: This cross-sectional study included 1,045 apparently healthy females who participated in a general health examination. They were evaluated for anthropometry, lean mass, and BMD. LMM was defined by appendicular skeletal muscle mass index (ASMI) of <5.5 kg/m(2) (European cutoff) and <5.11 kg/m(2) (<20th centile of this study population cutoff). The study subjects were categorized as pre-menopausal (<50 years) or post-menopausal (>50 years). RESULTS: Mean age and BMI were 44.0 ± 17.1 years and 25.0 ± 5.2 kg/m(2), respectively. Mean total and appendicular lean mass (arm and leg) increased from the second decade to reach maximum in the fourth decade, and then declined. LMM was present in 341 (32.6%) and 157 (15%), respectively, with European and study-based cutoff (ASMI 5.11 kg/m(2)). Twenty percent of post-menopausal females had LMM. Post-menopausal females with LMM were significantly older, leaner, and had lower BMD. Lean mass and ASMI were negatively correlated with age and positively with BMI and BMD at all sites. CONCLUSIONS: Peak muscle mass among Indian females is achieved in the fourth decade, and they have lower total and regional lean mass than other ethnic groups.

Relationship of lipid parameters with bone mineral density in Indian population.

INTRODUCTION: Cardiovascular disease and osteoporosis share common risk factors including dyslipidemia. There are conflicting reports of differential relation of various lipid parameters on bone mineral density (BMD). Hence, we studied the correlation between lipid parameters and BMD in healthy adult. MATERIALS AND METHODS: A total of 2347 participants (male 39.4%; female 60.6%) included in this cross-sectional study were divided according to sex and age. Fasting blood samples were drawn for biochemical parameters. BMD at lumbar spine, femur, and forearm were measured by dual energy X-ray absorptiometry (DXA). RESULTS: In males, BMD at femur and lumbar spine decreased significantly with increasing quartiles of total cholesterol (TC) (P < 0.0001, and 0.004) and low-density lipoprotein cholesterol (LDL-c) (P = 0.001, and 0.01). In premenopausal women, BMD at femoral neck (P = 0.001) and lumbar spine (P = 0.029) showed declining trend with LDL-c (P = 0.007). In postmenopausal women, only BMD at total femur decreased significantly with TC (P = 0.024) and LDL-c (P = 0.036). All above findings were confirmed in correlation studies. In multiple regression analysis after adjusting for age, body mass index, ionized calcium, alkaline phosphatase, 25 hydroxy vitamin D, and parathyroid hormone levels correlation of BMD with TC and LDL-c persisted. TC, LDL-c was higher in subjects with low bone density compared those with normal bone density in both sexes. CONCLUSIONS: TC and LDL-c had weak but significant negative correlation with BMD at femur and lumbar spine.

Normative data of body fat mass and its distribution as assessed by DXA in Indian adult population.

Dual-energy X-ray absorptiometry (DXA) assessment of body fat mass is precise and highly correlated with under water weighing. In view of ethnic differences, we undertook this study to prepare normative data for body fat mass in apparently healthy adult Indians and correlate it with body mass index (BMI). This cross-sectional population-based study included 2347 subjects (male: 924; female: 1423) aged >20 yr who participated in a general health examination. They were evaluated for anthropometry and body fat mass by DXA. All subjects were categorized as overweight and obese based on standard BMI criteria. Mean age and BMI were 49.1 ± 18.2yr and 25.0 ± 4.7kg/m(2), respectively. Mean percent total and regional fat (trunk, arm, and leg) reached maximum in the age group of 30-40yr in males and 50-60yr in females. Females had significantly higher total and regional fat mass compared with males. Fat mass was positively correlated with age (r = 0.224; p < 0.00001) and BMI (r = 0.668; p < 0.00001). Prevalence of overweight and obesity was seen in 2119 (46.1%) and 536 (13.8%), respectively, according to World Health Organization definition and 64.0% and 31.1%, respectively, as per Indian guidelines. Percent total body fat mass (PTBFM) of 25% in males and 30% in females corresponds to BMI of 22.0kg/m(2) with sensitivity of >80% and specificity of >70% in receiver operating characteristic curve analysis. Body fat mass in Indians is higher than that in Western populations for a given age and BMI. PTBFM of 25% in males and 30% in females corresponds to BMI of 22kg/m(2) in Indians.

Relationship of body fat and its distribution with bone mineral density in Indian population.

Obesity has been associated with increased bone mineral density (BMD). There is evidence of differential effect of regional fat on BMD. Hence, we undertook this study to evaluate the correlation between total body fat and its distribution with BMD in nonobese (mean body mass index: 25.0 ± 4.7 kg/m²) Indian adult volunteers. A total of 2347 participants (men: 39.4% and women: 60.6%) included in this cross-sectional study were divided according to sex and age. Fasting blood samples were drawn for biochemical parameters. Percent total body, truncal, and leg fat and BMD at lumbar spine, femur, and forearm were measured by dual-energy X-ray absorptiometry. The BMD at all sites (radius, femur, and spine) increased from lowest to highest quartiles of percent body fat. Percent truncal fat was positively correlated with BMD at all sites in both sexes, except for femoral neck in men, where it had negative correlation. Percent leg fat was positively related with BMD at all sites in premenopausal women, and spine and radius BMD in postmenopausal women. However, in men, it had negative correlation with femoral neck BMD. On multiple regression analysis, regional fat had positive association with BMD at all sites after adjusting for age, sex, lean mass index, 25-hydroxyvitamin D, and intact parathyroid hormone levels. Leg-to-total body fat ratio was negatively associated with BMD at all sites in men and pre- and postmenopausal women. Percent total body and regional fat have positive association with BMD at all sites in men and women.

Correlation between bone mineral density measured by peripheral and central dual energy X-ray absorptiometry in healthy Indian children and adolescents aged 10-18 years.

There are few large-scale studies on the utility of peripheral dual energy X-ray absorptiometry (pDXA) in children. As central dual energy X-ray absorptiometry (cDXA) equipment is not commonly available in the developing world, we assessed the correlation of bone mineral density (BMD) with cDXA and pDXA in children to determine the optimal Z-score thresholds of pDXA for predicting two predefined Z-score cutoffs (≤-1, ≤-2) of cDXA in 844 subjects (441 boys, 403 girls) aged 10-18 years. The BMD of antero-posterior lumbar spine (L1-L4), proximal femur and forearm was measured by cDXA, while the peripheral BMD of forearm and calcaneus was estimated using pDXA. The correlation was statistically significant at all sites (p<0.01). The coefficients ranged from 0.56 to 0.79 in boys and 0.17 to 0.32 in girls. A significant positive correlation was observed between BMD by pDXA and cDXA in Indian children, with a strong gender difference in both the extent of correlation and the ability of peripheral BMD to predict central BMD.

Glutamic acid decarboxylase (anti-GAD) & tissue transglutaminase (anti-TTG) antibodies in patients with thyroid autoimmunity.

BACKGROUND & OBJECTIVES: Several autoimmune disorders have been reported to be associated with autoimmune thyroiditis and may coexist with other organ-specific autoantibodies. The aim of the present study was to evaluate the presence of tissue transglutaminase (anti-TTG) and glutamic acid decarboxylase (anti-GAD) antibodies in patients suffering from autoimmune thyroiditis as diagnosed by anti-thyroid peroxidase (anti-TPO) antibodies, which may indicate high risk for developing celiac disease or type 1 diabetes mellitus. METHODS: Five thousand children and 2800 adults were screening as part of a general health examination done on a voluntary basis in four different parts of Delhi. A total of 577 subjects positive for anti-TPO antibody constituted the cases. Equal number of age and sex matched anti-TPO antibody negative controls were randomly selected from the same cohort to form paired case control study. The cases and controls were further divided into two groups as follows: group-1 (children and adolescent <18 yr), group-2 (adults >18 yr). Serum samples of cases and controls were analysed for thyroid function test (FT3, FT4, and TSH), anti-TTG and anti-GAD antibodies. RESULTS: A total of 1154 subjects (577 cases and 577 controls) were included in this study. Hypothyroidism was present in 40.2 per cent (232) cases compared to only 4.7 per cent (27) in controls (P<0.001). Anti-TTG and anti-GAD antibodies were present in 6.9 and 12.5 per cent subjects among cases compared to 3.5 per cent (P=0.015) and 4.3 per cent (P=0.001) in controls, respectively. Only anti-GAD antibody were significantly positive in cases among children and adolescents (P =0.0044) and adult (P=0.001) compared to controls. Levels of anti-TTG and anti-GAD antibodies increased with increasing titre of anti-TPO antibody. INTERPRETATION & CONCLUSIONS: Our findings showed high positivity of anti-GAD and anti-TTG antibodies among subjects with thyroid autoimmunity. It is, therefore, important to have high clinical index of suspicion for celiac disease or type 1 diabetes mellitus in patients with autoimmune thyroiditis.

Impact of body mass index on thyroid functions in Indian children.

OBJECTIVE: There is controversy about the relation of thyroid functions and body mass index. The present study was aimed to assess the relationship between thyroid function and body mass index in Indian school children. DESIGN: Population survey. PATIENTS: Data were collected from 25 schools in 19 cities across five different geographical zones of India. Children, who consented, were evaluated for anthropometry and blood tests. Children were categorized as overweight and obese based on standard BMI criteria. MEASUREMENTS: Serum samples were analysed for free T3, free T4, TSH and anti-TPO antibodies. RESULTS: A total of 13,691 children in the age group of 5-18 years formed the study population. The mean age and mean BMI were 11·9 ± 3·0 years and 18·48 ± 3·89 kg/m² respectively. Among these, 2119 (15·5%) children were overweight and 536 (3·9%) were obese. Subclinical hypothyroidism was present in 943 (6·9%) children.FT3 and TSH levels increased and FT4 levels decreased with increasing BMI in euthyroid boys and girls. Prevalence of SCH was significantly higher in obese/overweight children (9·0%, vs 6·5%; P = 0·034) as compared with normal BMI children. CONCLUSIONS: Serum FT3 and TSH were positively while FT4 was negatively associated with BMI in apparently healthy euthyroid children.

Reference range of thyroid function (FT3, FT4 and TSH) among Indian adults.

OBJECTIVES: To generate thyroid hormone reference norms using electro-chemiluminescence technique. DESIGN AND METHODS: Cross sectional study on apparently normal 4349 Delhi adults (18-86 years). Predetermined exclusion criteria (goiter, hypoechogenicity or nodularity on ultrasound, elevated anti-thyroid peroxidase antibody, hypo or hyperthyroidism and family history of thyroid dysfunction) excluded 2433 subjects leaving 1916 (916 males and 1000 females) as the reference population. RESULTS: Mean age and BMI of the reference population were 41.2 ± 18.1 years and 24.5 ± 4.4 kg/m(2) respectively. Median urinary iodine excretion was 233.6 µg/L (79-458;3rd-97th centile). The population was categorized into various age groups (18-30, 31-40, 41-50, 51-60, 61-70 and ≥ 70 years). Overall FT3 and FT4 values in the reference population irrespective of age, ranged from 2.4-8.8 (mean 4.6 ± 0.9) pmol/L and 10.1-24.8 (mean 15.40 ± 2.0) pmol/L, respectively. Mean TSH value in the reference population was 2.2 ± 0.9 mIU/L which was significantly lower than that of total population (3.8 ± 6.1; p<0.001). CONCLUSION: FT3 values were observed to be significantly higher in men than women (p=0.001). The centiles (3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th and 97th) of FT3, FT4 and TSH were derived for reference purposes in Indian adults. This community based study in Indian adults has established mean reference intervals for FT3, FT4 and TSH for different age groups for both sexes separately using strict exclusion criteria. These can be used as reference norms for Indian adults.

The prevalence of and risk factors for radiographic vertebral fractures in older Indian women and men: Delhi Vertebral Osteoporosis Study (DeVOS).

UNLABELLED: High prevalence of vertebral fractures (17.9 % over all; 18.8 % male and 17.1 % female) was observed in 808 free-living residents of Delhi, India, aged more than 50 years. The prevalence rates were comparable to that reported in Caucasian populations. While there was an increase in fracture prevalence with age in females, the same was not observed in males. INTRODUCTION: The aim of this paper is to study the prevalence of and risk factors for morphometric vertebral fractures in elderly Indian men and women over 50 years of age. METHODS: We recruited 808 healthy subjects aged 50 years or more, residing in three residential colonies in Delhi, India who voluntarily agreed to participate in this study. All subjects underwent lateral X-rays of the lumbar and thoracic spine according to a standardized protocol. All X-rays were blindly evaluated by a single trained person using an advanced semi-automated software (Optasia Medical) based on Genant's semiquantitative method. Recruited subjects underwent anthropometric, biochemical, and hormonal evaluation. RESULTS: With a mean age of 64.9 (±6.7) years, 345 males and 415 females were evaluated. Vertebral fractures were present in 17.9 % (95 % CI 15.2, 20.6) subjects [males, 18.8 % (95 % CI 14.6, 23), females 17.1 % (95 % CI 13.5, 20.8)]. Prevalence of vertebral fractures increased with age in females from 14.7 % in 50-59 years age group to 22.4 % in those ≥70 years, but not in men. Overweight subjects had significantly lower risk [OR, 0.63 (95 % CI 0.41, 0.97), p = 0.035] of vertebral fractures. Serum 25 hydroxyvitamin D levels, intake of calcium and vitamin D, or history of previous fractures were not statistically different between patients with or without prevalent vertebral fractures. CONCLUSIONS: The prevalence of vertebral fractures among older Indians was comparable to that reported in Caucasian populations. Prevalence of vertebral fractures increased with age in females, but not in males. Overweight individuals were protected against vertebral fractures.

Status of thyroid function in Indian adults: two decades after universal salt iodization.

OBJECTIVES: The aim was to find impact of two decades of universal salt iodization on the prevalence of goiter, thyroid autoimmunity and thyroid dysfunction in Indian adults. METHODS: This was a cross sectional study from Delhi, India. The subject population included 4409 adult members of resident welfare associations of 5 residential colonies, from 18-90 years of age, who participated in general health check-up camps. The subjects underwent a detailed evaluation including history, anthropometry, goiter grading, USG thyroid, thyroid auto-antibodies and thyroid function tests. All these subjects were regularly consuming iodized salt. RESULTS: Overall, 9.6% of subjects had clinical goiter (13.3% women and 3.3% in men). Prevalence of nodules on palpation was found to be in 1.6% which was lower in men. The nodule prevalence increased to 4.6% in men and 5.6% in women on ultrasonography. Thyroid hypoechogenicity was seen in 30.6% of subjects with severe hypoechogenicity higher in women (5.7% men and 15.5% women). TPO antibody was positive in 13.3% adults and it showed a positive correlation with age, female sex and hypothyroidism. Subclinical hypothyroidism was the commonest abnormality encountered and affected 19.3% subjects (15.9% men; 21.4% women). Thyroid dysfunction showed a rising trend with age in both genders. CONCLUSIONS: Normal UIE and low goiter prevalence, especially in males, suggest success of the universal salt iodization program in the region under review. High prevalence of subclinical hypothyroidism was not correlated with either thyroid autoimmunity or iodine intake, as reflected in urinary iodine excretion.

Thyroid function and bone mineral density among Indian subjects.

BACKGROUND: Thyroid hormones affect bone remodeling in patients with thyroid disease by acting directly or indirectly on bone cells. In view of limited information on correlation of thyroid function with bone mineral density (BMD) in euthyroid subjects, we undertook this study to evaluate the correlation between thyroid function with BMD in subjects with normal thyroid function and subclinical hypothyroidism. MATERIAL AND METHODS: A total of 1290 subjects included in this cross sectional study, were divided in Group-1 with normal thyroid function and Group-2 with subclinical hypothyroidism. Fasting blood samples were drawn for the estimation of serum 25(OH)D, intact parathyroid hormone, total and ionized calcium, inorganic phosphorus, and alkaline phosphatase. BMD at lumbar spine, femur, and forearm was measured. RESULTS: BMD at all sites (radius, femur, and spine) were comparable in both groups. There was no difference in BMD when subjects were divided in tertiles of TSH in either group. In group-1, FT4 and TSH were positively associated with BMD at 33% radius whereas FT3 was negatively associated with BMD at femoral neck in multiple regression analysis after adjustment for age, sex, BMI, 25(OH)D and PTH levels. In group-2, there was no association observed between TSH and BMD at any site. Amongst all study subjects FT4 and FT3 were positively correlated with BMD at lumbar spine and radius respectively among all subjects. CONCLUSION: TSH does not affect BMD in euthyroid subjects and subjects with subclinical hypothyroidism. Thyroid hormones appear to have more pronounced positive effect on cortical than trabecular bone in euthyroid subjects.

Establishment of age-specified bone mineral density reference range for Indian females using dual-energy X-ray absorptiometry.

We undertook this study to establish age-specified bone mineral density (BMD) reference range for Indian females using dual-energy X-ray absorptiometry. BMD at multiple skeletal sites was measured in 2034 healthy women aged 18--85yr. The effect of anthropometry and biochemical parameters on BMD was determined. Peak BMD was observed between 30 and 35yr at the hip, lumbar spine, and radius. Significant positive correlation of height and weight with BMD was observed at 33% radius, femur neck, and lumbar spine, whereas significant negative correlation was seen between serum alkaline phosphatase (ALP) and serum parathyroid hormone levels with BMD at aforementioned sites. On multivariate regression analysis, age, weight, and serum ALP were the most consistent contributors to variance in the BMD. Compared with age-matched US females, BMD of lumbar spine was significantly lower for our subjects in all age groups. Prevalence of osteoporosis among women aged older than 50yr was significantly higher based on Caucasian T-scores as opposed to using peak BMD/standard deviation values from the population under review at lumbar spine but not at femoral neck.

Thyroid status two decades after salt iodization: country-wide data in school children from India.

OBJECTIVE: Country-wide evaluation of thyroid disorders in school children following two decades of universal salt iodization (USI) has not been carried out till date. This study was planned with aim to assess thyroid status of school children two decades after the launch of USI programme. DESIGN: Population survey. PATIENTS: We collected data from 25 schools in 19 cities across five different geographical zones of India. Those children who were evaluated for anthropometry, and goitre status by palpation formed 'total population'. Children who consented to give blood samples were defined as 'study population'. MEASUREMENTS: Serum free T3, free T4, TSH, anti-TPO antibody and thyroid ultrasound. RESULTS: A total of 38,961 children aged 5-15 years formed total population. Goitre rate was 15.5% while thyroid hypoechogenicity was found in 4404 (11.3%) children. In the study population (13,790 children), 2258 (16.4%) had goitre, 505 (3.7%) had positive anti-TPO antibody titres, 1001 (7.3%) had hypothyroidism (TSH > 5.2 µIU/ml) and 41 (0.3%) had thyrotoxicosis (TSH < 0.1 µIU/ml). Among goitrous children, 203 (9.0%) had anti-TPO positivity, 365 (16.1%) had hypoechogenicity of thyroid and either of these were present in 488 (21.6%) children. CONCLUSIONS: Endemic goitre in school children persisted nationwide, despite more than two decades of USI programme. Thyroid autoimmunity only partially explains the increase in goitre prevalence.