Case Control Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jan 15, 2019; 10(1): 37-46
Published online Jan 15, 2019. doi: 10.4239/wjd.v10.i1.37
Diabetes in the Kokan region of India
Patil Suvarna, Kadam Shruti, Desai Maruti, Joglekar Charudatta
Patil Suvarna, Kadam Shruti, Department of Medicine, BKL Walawalkar Hospital and Rural Medical College, Sawarde, Taluka-Chiplun, Maharashtra 415606, India
Desai Maruti, Joglekar Charudatta, Statistics Unit, Regional Centre for Adolescent Health and Nutrition, BKL Walawalkar Hospital and Rural Medical College, Taluka-Chiplun, Maharashtra 415606, India
Author contributions: Suvarna P conceptualized the study and also wrote substantial parts of the manuscript; Shruti K extracted the data from records and performed the data entry; Maruti D managed the data and also helped in the analysis; CharudattaJ performed statistical analysis and wrote some parts of the manuscript.
Institutional review board statement: The study was approved by the Institute Ethics Committee of BKL Walawalkar Hospital and Rural Medical College.
Informed consent statement: All patients gave informed consent for use of their data.
Conflict-of-interest statement: All authors have no conflicts of interest to report.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Patil Suvarna, MD, Medical Director, BKL Walawalkar Hospital and Rural Medical College, Sawarde, Taluka-Chiplun, District-Ratnagiri, Maharashtra 415606, India. dr.suvarnanpatil@gmail.com
Telephone: +91-2355-264935 Fax: +91-2355-264181
Received: November 26, 2018
Peer-review started: November 26, 2018
First decision: December 9, 2018
Revised: December 20, 2018
Accepted: January 3, 2019
Article in press: January 4, 2019
Published online: January 15, 2019
Processing time: 51 Days and 22.4 Hours
Abstract
BACKGROUND

BKL Walawalkar Hospital is situated near the village of Dervan in the Kokan region of the state of Maharashtra in India. A survey of 2200 surrounding villages showed 51.8% adults had body mass index (BMI) below <18.5 kg/m2 and only 4.5% were overweight. A survey of 11521 adolescent girls from rural schools showed 64% prevalence of thinness. In the same region, government survey reported the prevalence of diabetes around 7%, and 70% prevalence of leanness. This reinforced the fact that the overall population of Kokan is lean. Hence, we decided to investigate body composition of diabetic people from our hospital clinic by carrying out a clinic-based case control study.

AIM

To study body composition of diabetics in a rural clinic of Kokan.

METHODS

In a case-control study, 168 type 2 diabetic patients (102 men) attending the outpatient department at a rural hospital and 144 non-diabetic controls (68 men) in the Chiplun area of the Kokan region were recruited. History of diabetes (age of onset, duration), anthropometric measurements (height, weight, waist and hip circumference) were recorded. Body composition was measured by bioimpedance using the TANITA analyzer.

RESULTS

More than 45% of diabetic subjects had a 1st degree family history of diabetes, and more than 50% had macrovascular complications. The average BMI in diabetic subjects was 24.3 kg/m2. According to World Health Organization standards, prevalence of underweight was 8% and that of normal BMI was around 50%. Underweight and normal diabetic subjects (men as well as women) had significantly lower body fat percentage, higher muscle mass percentage, lower visceral fat and lower basal metabolic rate when compared to their overweight counterparts.

CONCLUSION

The diabetic population in Kokan has near normal body composition, and BMI has considerable limitations in assessing body composition and it also lacks sensitivity for assessing risk for diabetes in this population. High prevalence of family history of diabetes may point towards genetic predisposition. Leanness is an inherent characteristic of this population and its metabolic significance needs further investigations with a larger sample size.

Keywords: Body composition; Diabetes; Metabolism; Malnutrition; Kokan

Core tip: As per government survey, leanness is widespread in Kokan but diabetes is also on the rise. We studied lean body mass in diabetics in our clinic. Lean individuals had lower body mass index but better percent muscle mass compared to overweight. This could be metabolic response to less caloric intake despite heavy physical activity. This mechanism needs to be clarified. The diabetic population in Kokan has near normal body composition and body mass index has considerable limitations. Therefore, the physiological process producing these deviations in body composition and its metabolic significance need further investigations on larger scale.