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
ARTICLE HIGHLIGHTS
Research background

Recent years have seen a considerable increase in the burden of diabetes, hypertension and coronary heart disease in clinical practice in urban India. Recent studies in urban populations have shown an unexpectedly high prevalence of diabetes, and the prevalence is rising rapidly.

Research motivation

BKL Walawalkar Hospital carried out house-to-house surveys of 2200 villages in 2003-2010. In that survey, 51.8% of the subjects hadbody mass index (BMI) < 18.5 kg/m2 and only 4.5% were overweight, with BMI > 25 kg/m2. Another survey of 11521 adolescent girls from rural schools that was conducted in 2011-2017 showed that 64% of the girls had grade 1 to 3 thinness, based on the International Obesity Task Force standards, and stunting was seen in 22% to 28% of the girls. Thus, the overall population of Kokan is lean in their body stature. The same survey also found a more than 70% prevalence of leanness based on BMI among men as well as women. This, again, reinforced the leanness of the population of Kokan.

Research objectives

In order to investigate body composition of diabetic people from the BKL Walawalkar Hospital Clinic, a clinic-based case control study was carried out.

Research methods

One hundred sixty-eight 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 and anthropometric measurements were recorded, and body composition was measured by bioimpedance using the TANITA analyzer. All analyses were performed using SPSS 16.0 statistical software.

Research results

In this study, 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 the diabetic subjects was 24.3 kg/m2. 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 compared to their overweight counterparts. Our data pave the way for a new theory of undernutrition as a risk factor in predisposing the Kokan population to diabetes.

Research conclusions

Undernutrition should also be considered as a risk factor for diabetes in lean patients. The molecular basis and physiological adaptations to undernutrition need to be explored.

Research perspectives

Lean diabetics had significantly lower body fat percentage, higher muscle mass percentage, lower visceral fat and lower basal metabolic rate compared to overweight diabetics. This could indicate a metabolic response to less caloric intake despite heavy physical activity, and this mechanism needs to be investigated. The diabetic population in Kokan has near-normal body composition and BMI has considerable limitations. Therefore, the physiological process producing these deviations in body composition and its metabolic significance need further investigations on a larger scale.