DR.MANJUNATH PATIL
PG IN GENERAL MEDICINE,DR.B.R.AMBEDKARMEDICALCOLLEGE,
BANGALORE560045
2 / NAME OF THE INSTITUTION / DR.B.R.AMBEDKARMEDICALCOLLEGE,
BANGALORE.
3 / COURSE OF THE STUDY AND SUBJECT / MD GENERAL MEDICINE
4 / DATE OF ADMISSION TO COURSE / 01-06-2010
5 / TITLE OF THE TOPIC /
A STUDY OF CORRELATION OF BODY MASS INDEX , WAIST HIP RATIO AND LIPID PROFILE IN TYPE II DIABETES MELLITUS SUBJECTS.
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
6 / BRIEF RESUME OF THE INTENDED WORK6.1 NEED FOR THE STUDY
6.2 REVIEW OF LITERATURE
6.3 OBJECTIVE OF THE STUDY
MATERIAL AND METHODS
6.4 SOURCE OF DATA
6.5 MATERIAL AND METHOD OF COLLECTION OF DATA
6.6 INCLUSION CRITERIA
6.7 EXCLUSION CRITERIA
6.8 REFERENCES / REFER ANNEXURE I
REFER ANNEXURE II
REFER ANNEXURE III
REFER ANNEXURE IV(4.1)
REFER ANNEXURE IV(4.2)
REFER ANNEXURE IV(4.3)
REFER ANNEXURE IV(4.4)
REFER ANNEXURE V
7 / HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION
8 / SIGNATURE OF CANDIDATE
9 / REMARKS OF THE GUIDE / ANNEXURE VI
10 / NAME AND DESIGNATION
1. GUIDE
2. SIGNATURE
3.PROFESSOR AND HEAD OF DEPARTMENT
4. SIGNATURE
5. CO-GUIDE
6. SIGNATURE /
DR.N.BHAKTAVATCHALAM
PROFESSOR,DEPT.OF MEDICINE
DR.P.L.BINDUMATHI,
PROFESSOR,
DEPT.OF MEDICINE,
DR.B.R.A.M.C,
BANGALORE.
11 / REMARKS OF THE CHAIRMAN AND
PRINCIPAL
SIGNATURE
ANNEXURE I
NEED FOR THE STUDY
The prevalence of diabetes is rapidly rising all over the world1.current estimates are that there are at least 150 million people living with diabetes worldwide of which two third are in developing countries2.the total number of people with diabetes is predicted to rise above 300 million by 2025.The largest increase of the diabetic population occurs in the most economically productive age group3.Over the past tree decades,diabetes has become a major cause for morbidity and mortality affecting the youth and the middle aged.Although the prevalence of type 1 diabetes is also increasing, type 2 diabetes accounts for more than 90% of all the diabetes cases.
India is being called the diabetic capital of the world ,with over 30 million diabetic individuals.population-based studies showing the prevalence of type 2 diabetes in different parts of India have recently been revieved4 and shows that the prevalence has risen five-fold from 2.1% in 1975 to 12.1% in 20005.
According to diabetes atlas published by the International diabetes federation(IDF) and The World Health Organization (WHO) has predicted that by the year 2025, the maximum prevalence of diabetes would be in India and every 4th diabetic will be an Indian5.
The relationship between alteration of serum lipids and vascular complications is more significant in diabetics than in the general population. It is clear from the population based studies that type – 2 diabetes generally is associated with a 50% to100% elevation in the plasma levels of total and VLDL triglycerides6
The most common alteration of lipoprotein in type-2 diabetes mellitus is hypertryglyceridemia caused by an elevation in VLDL concentration In type – 2 diabetes mellitus with severe hyperglycemia, the clearance rate for
LDL apo-B is reduced . Mildly hyperglycemic individuals with type-2 diabetesmellitus may have increased LDL production as well6,7.
The above mentioned lipid abnormalities will lead to microvascular and
macrovascular diseases in diabetic patients.
The most important vascular complication among diabetics are coronary artery disease. Diabetes is associated with a marked increase by a factor of two to four times increased risk of coronary artery disease. The plasma cholesterol level is a strong predictor of the risk of cardiovascular events both in patients with diabetes and in patients with coronary heart disease.
The high risk status of these groups of patients and their need for more aggressive lipid lowering therapy have been recognized by both the National Cholesterol Education Program13 and American Diabetes Associations9.
Obesity is associated with an adverse cardiovascular risk profile and consequently with excess cardiovascular morbidity and mortality. The prevalence of obesity has increased dramatically in industrialized and developing countries. The world Health Organization (WHO) has recently defined obesity as a disease8
Abdominal or central adiposity is considered the most important determinant of cardiovascular disease (CVD) and type 2 diabetes mellitus (DM) . While precise, sophisticated techniques for measuring body fat distribution and body composition are available, they are generally not appropriate outside specific research settings. The use of simple anthropometric measurements seems to diagnose obesity in early stages. As a result, many attempts have been made to find out the most appropriate anthropometric index in different studies. Body mass index (BMI), which relates weight to height,is the most widely used and simple measure of body size,and is frequently used to estimate the prevalence of obesity within a population. A BMI ≥ 25 is associatedwith increased morbidity, primarily from DM and CVD ,while a BMI >30 is associated with increased risk for both morbidity and mortality, the latter mainly from diabetes, coronary heart disease (CHD), and stroke8,9.
BMI does not reflect body fat distribution, whereas the intra abdominal deposition of adipose tissue is a major contributor to the development of hypertension, insulin resistance, DM and dyslipidemia. Thus, other anthropometric indices such as waist circumference (WC), and waist-to-hip ratio (WHR) have been used as alternatives to BMI. Waist circumference is increasingly being accepted as the best anthropometric indicator of abdominal adiposity and metabolic risk7,8,.
REVIEW OF LITERATURE
1.Correlation of dyslipidemia with waist to height ratio,
waist circumference, and body mass index in Iranian
adults.
Obesity is associated with many metabolic risks; study proved that waist to height ratio (W/Ht) andwaist circumference (WC) could be used as simple andnon-invasive methods for detection of dyslipidemia as animportant cardiovascular risk factor, in Iranian adultpopulation and we suggest using these indices as simpleand inexpensive methods in clinical and epidemiologicalfields.6
2.A Study of Correlation between Lipid Profile and Waist to Hip
Ratios in Patients with Diabetes Mellitus.
The association between lipid profile andbody fat distribution had been much discussedduring the past decades (Despres et al., 1985;Denke et al., 1993; Dongsheng et al., 2000 andPihl and Jurimae, 2001). Both lipid profile andbody fat have been shown to be the importantpredictors for metabolic disturbances includingdyslipidaemia, hypertension, diabetes, cardiovascular
diseases, hyperinsulinaemia etc.7
3.A study conducted in Dombivili by S R Iyer 23 in a sample subject of 520subjects aged over 20 years that the prevalence of diabetes was 4.61% as per theWHO criteria and was 7.5% as per the American Diabetological Association Criteria,the prevalence after 2-hour post glucose load was 6.15%. The mean glucose level
increased with age and the BMI.
4.A Study of Correlation between Derived and Basic
Anthropometric Indices in Type 2 Diabetes Mellitus
waist circumference as measure of intraabdominal obesity had a
poor correlation with BMI among the obese diabetic patients compared to a strong correlation amongthe non-obese, while WC and WHR had a good correlation in both the obese and non-obese diabetics,Adediran et al26 also found a strong correlation between BMI and WC, and WC and WHR in both
diabetic patients with and without metabolic syndrome. Wei et al investigated the predictive powerof waist circumference, BMI, WHR and other anthropometric indices for type 2 diabetes in MexicanAmericans and found that although BMI, WHR, and waist were independent predictors for type 2diabetes, waist circumference was the strongest and most consistent.8
ANNEXURE III
(6.3)AIMS AND OBJECTIVES
To study the occourence of body mass index (BMI) and waist hip ratio (WHR) in type II diabetes mellitus subjects.
To know the lipid pattern (Serum cholesterol,triglicerides,HDL,and LDL) in type II diabetes mellitus subjects.
To correlate the body mass index and waist hip ration with lipid patterns in type II diabetes mellitus subjects.
ANNEXURE IV
(6.4)SOURCE OF DATA
Sample size 100.
Patients with diabetes mellitus, both freshly diagnosed as well as previously detected, both admitted in medical wards or attending the outpatient clinic and diabetic clinic of Dr.B.R.Ambedkar Medical College and Hospital Will be selected.
(6.5)MATERIAL AND METHOD OF COLLECTION OF DATA
Anthropometric measurements to be done to calculate Body mass index(BMI) and waist hip ratio(WHR) .Waist to be measured at the midpoint between lower costal margin and superior illiac crest in the mid axillary line
Hip circumference measured at the level of greater trochanter of femur
FBS and PPBS to be determined by using glucose oxidase peroxidase test
Lipid profile to be done by enzymatic method like Zak's method
BMI>=25 for males and females to be taken to indicate generalised obesity WHR>=0.9 for males and >=0.8 for females to be taken to indicate
(6.6)INCLUSION CRITERI:
Type 2 Diabetes mellitus of at least 6months duration, able to give informed
consent.
(6.7) EXCLUSION CRITERIA
Chronic alcoholics
CRF patients
Patients using Lipid lowering agents
Hypothyroidism
Family dyslipidaemias
INVESTIGATIONS REQUIRED
1.Complete blood count
2.FBS and PPBS to be determined by using glucose oxidase peroxidase test
3.HBA1C
4.Fasting Lipid profile to be done by enzymatic method like Zak's method
5.Thyroid profile
6.Serum urea and creatinine
7.Liver function test
DOES THE STUDY REQUIRE ANY INVESTIGATION S OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS AND ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.
Yes,it requires the following investigation to be done
1.Complete blood count
2.FBS and PPBS to be determined by using glucose oxidase peroxidase test
3.HBA1C
4.Fasting Lipid profile to be done by enzymatic method like Zak's method
5.Thyroid profile
6.Serum urea and creatinine
7.Liver function test
HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF THE ABOVE.
(6.8) REFERENCES
1.Huizinga MM,Rothman RL.Addressing the diabetes pandemic:Acomprehensive approach.Indian J Med Res 2006;124:481-4
2.Wild s,Roglic G,Green A,Sicree R,king h.Global prevalence of diabetes:estimates for the year 2000 and projections for 2030.Diabetes care2004;27:1047-53.
3.Mohan V Sandeep S Deepa R Shah B Vargese CEpidemiology of Type 2 Diabetes Indian scenario Indian J med RES 2007;125:217-30
4Ramachandran A Jali MV Mohan V Snehalatha C Vishwanathan M .High prevalence of Diabetes In urban population in south India BMJ1988;297;587-90.
5.Pan XR Li GW Hu Yh Wang Jx Yang Wy An Zx et al.Effect of diet and exercise in preventing NIDDMin population with impaired glucose tolerance:the da qing IGT and diabetes study.Diabetic care 1997;20:537-44.
6.Correlation of dyslipidemia with waist to height ratio,
waist circumference, and body mass index in Iranian
adults,Ali Chehrei MD1, Saeid Sadrnia MD2, Ammar Hassanzadeh Keshteli MS3, MohammadAli Daneshmand MD4 and Jalal Rezaei MD4
Asia Pac J Clin Nutr 2007;16 (2):248-253
7..A Study of Correlation between Lipid Profile and Waist to Hip
Ratios in Patients with Diabetes Mellitus,Hardev Singh Sandhu1, Shyamal Koley2 and Karanjit Singh Sandh
8.A Study of Correlation between Derived and Basic
Anthropometric Indices in Type 2 Diabetes Mellitus,European Journal of Scientific ResearchISSN 1450-216X Vol.36 No.3 (2009), pp 437-444
© EuroJournals Publishing, Inc. 2009
9.Howard BV, et al. Integrated study of low density lipoprotein metabolism and VLDL metabolism in non-insulin dependent diabetes mellitus. Metabolism 1998 ; 36 : 870-877.
10.Chaturvedi N, John H. Fuller and Marja-Ritta Taskinen. Differing associations of lipid and lipoprotein disturbances with the macrovascular and microvascular complications of type 1 diabetes. Diabetes care 2001 ; 24 (12) :2071-2076.7. Mazzone T. Current
11..S.R Iyer , Revati R Iyer, S.V Upashi, M.N Baithule. “Diabetes mellitus in Dombivili – An Urban Population Study” JAPI 2001 ; 49 : 713- 716
12.Arora, M.: A Study of Correlation Between Lipid Profile and Body Fat in Patients With Hypertension, Diabetes Mellitus and Various Heart Disease in Amritsar. Dissertation of Masters in Sports Physiotherapy (Unpublished), Guru Nanak De University, Amritsar (2006)
13.Janssen, I., Heymsfield, S.B., Allison, D.B., Kotler, D.P. and Ross, R.: Body mass index and weist circumference independently contribute to the prediction of non abdominal, abdominal subcutaneous, and visceral fat. Am. J Clin. Nutr., 75: 683-688 (2002).
ANNEXURE VI
REMARKS OF THE GUIDE
I will be the guide for Dr.Manjunath Patil, PG General Medicine and the thesis work will be done under my supervision.
Signatureof the guide