RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

NAME OF THE CANDIDATE AND ADDRESS

DR.MANJUNATH PATIL PG IN GENERAL MEDICINE, DR.B.R.AMBEDKAR MEDICAL COLLEGE, BANGALORE 560045 DR.B.R.AMBEDKAR MEDICAL COLLEGE, BANGALORE. MD GENERAL MEDICINE 01!06!2010 A STUDY OF CORRELATION OF BODY MASS INDEX , WAIST HIP RATIO AND LIPID PROFILE IN TYPE II DIABETES MELLITUS SUBJECTS.

NAME OF THE INSTITUTION COURSE OF THE STUDY AND SUBJECT DATE OF ADMISSION TO COURSE TITLE OF THE TOPIC

4 5

BRIEF RESUME OF THE INTENDED "ORK 6.1 NEED FOR THE STUDY 6.2 REVIE" OF LITERATURE 6. 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.# E$CLUSION CRITERIA 6.% REFERENCES REFER ANNE$URE IV&4.1' REFER ANNE$URE IV&4.2' REFER ANNE$URE IV&4. ' REFER ANNE$URE IV&4.4' REFER ANNE$URE V REFER ANNE$URE I REFER ANNE$URE II REFER ANNE$URE III

# % (

HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION SIGNATURE OF CANDIDATE REMARKS OF THE GUIDE ANNE$URE VI

10

NAME AND DESIGNATION 1. GUIDE DR.N.BHAKTAVATCHALAM PROFESSOR, DEPT.OF MEDICINE

2. SIGNATURE

.PROFESSOR AND HEAD OF DEPARTMENT

DR.P.L.BINDUMATHI, PROFESSOR, DEPT.OF MEDICINE, DR.B.R.A.M.C, BANGALORE.

4. SIGNATURE 5. CO!GUIDE 6. SIGNATURE 11 REMARKS OF THE CHAIRMAN AND PRINCIPAL SIGNATURE

ANNE$URE 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 ma or cause for morbidity and mortality affecting the youth and the middle aged.!lthough the prevalence of type 1 diabetes is also increasing, type 2 diabetes accounts for more than "0# of all the diabetes cases. $ndia 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 $ndia have recently been revieved& and shows that the prevalence has risen five%fold from 2.1# in 1"'5 to 12.1# in 20005. !ccording to diabetes atlas published by the $nternational diabetes federation($)*+ and The ,orld -ealth Organi.ation (,-O+ has predicted that by the year 2025, the ma/imum prevalence of diabetes would be in $ndia and every &th diabetic will be an $ndian5. The relationship between alteration of serum lipids and vascular complications is more significant in diabetics than in the general population. $t is clear from the population based studies that type 0 2 diabetes generally is associated with a 50# to100# elevation in the plasma levels of total and 12)2 triglycerides3 The most common alteration of lipoprotein in type%2 diabetes mellitus is hypertryglyceridemia caused by an elevation in 12)2 concentration $n type 0 2 diabetes mellitus with severe hyperglycemia, the clearance rate for 2)2 apo%4 is reduced . 5ildly hyperglycemic individuals with type%2 diabetesmellitus may have increased 2)2 production as well3,'. 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. )iabetes is associated with a mar6ed increase by a factor of two to four times increased ris6 of coronary artery disease. The plasma cholesterol level is a strong predictor of the ris6 of cardiovascular events both in patients with diabetes and in patients with coronary heart disease. The high ris6 status of these groups of patients and their need for more aggressive lipid lowering therapy have been recogni.ed by both the 7ational 8holesterol 9ducation :rogram13 and !merican )iabetes !ssociations". Obesity is associated with an adverse cardiovascular ris6 profile and conse;uently with e/cess cardiovascular morbidity and mortality. The prevalence of obesity has increased dramatically in industriali.ed and developing countries. The world -ealth Organi.ation (,-O+ has recently defined obesity as a disease< !bdominal or central adiposity is considered the most important determinant of cardiovascular disease (81)+ and type 2 diabetes mellitus ()5+ . ,hile precise, sophisticated techni;ues 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. !s a result, many attempts have been made to find out the most appropriate anthropometric inde/ in different studies. 4ody mass inde/ (45$+, which relates weight to height,is the most widely used and simple measure of body si.e,and is fre;uently used to estimate the prevalence of obesity within a population. ! 45$ = 25 is associated with increased morbidity, primarily from )5 and 81) ,while a 45$ >30 is associated with increased ris6 for both morbidity and mortality, the latter mainly from diabetes, coronary heart disease (8-)+, and stro6e<,". 45$ does not reflect body fat distribution, whereas the intra abdominal deposition of adipose tissue is a ma or contributor to the development of hypertension, insulin resistance, )5 and dyslipidemia. Thus, other anthropometric indices such as waist circumference (,8+, and waist%to%hip ratio (,-?+ have been used as alternatives to 45$. ,aist circumference is increasingly being accepted as the best anthropometric indicator of abdominal adiposity and metabolic ris6',<,.

REVIE" OF LITERATURE 1.C)**+,-./)0 )1 234,/5/2+6/- 7/.8 7-/4. .) 8+/98. *-./), 7-/4. :/*:;61+*+0:+, -02 <)23 6-44 /02+= /0 I*-0/-0 -2;,.4. Obesity is associated with many metabolic risks; study proved that waist to height ratio (W/Ht) and waist circumference (WC) could be used as simple and non invasive methods for detection of dyslipidemia as an important cardiovascular risk factor! in "ranian adult population and we suggest using these indices as simple and ine#pensive methods in clinical and epidemiological fields$ % 2. A S.;23 )1 C)**+,-./)0 <+.7++0 L/5/2 P*)1/,+ -02 "-/4. .) H/5 R-./)4 /0 P-./+0.4 7/.8 D/-<+.+4 M+,,/.;4. The association between lipid profile and body fat distribution had been much discussed during the past decades ()espres et al., 1"<5@)en6e et al., 1""3@ )ongsheng et al., 2000 and:ihl and Aurimae, 2001+. 4oth lipid profile and body fat have been shown to be the important predictors for metabolic disturbances including dyslipidaemia, hypertension, diabetes, cardiovascular diseases, hyperinsulinaemia etc.'

sample sub,ect of -*. sub,ects aged over *. years that the prevalence of diabetes was /$%01 as per the WHO criteria and was 2$-1 as per the &merican 'iabetological &ssociation Criteria!the prevalence after * hour post glucose load was %$0-1$ 3he mean glucose level increased with age and the 45"$
4. A S.;23 )1 C)**+,-./)0 <+.7++0 D+*/>+2 -02 B-4/:

. & study conducted in 'ombivili by ( ) "yer *+ in a

A0.8*)5)6+.*/: I02/:+4 /0 T35+ 2 D/-<+.+4 M+,,/.;4

waist circumference as measure of intraabdominal obesity had a poor correlation with 45" among the obese diabetic patients compared to a strong correlation among the non obese! while WC and WH) had a good correlation in both the obese and non obese diabetics! &dediran et al*% also found a strong correlation between 45" and WC! and WC and WH) in both diabetic patients with and without metabolic syndrome$ Wei et al investigated the predictive power of waist circumference! 45"! WH) and other anthropometric indices for type * diabetes in 5e#ican &mericans and found that although 45"! WH)! and waist were independent predictors for type * diabetes! waist circumference was the strongest and most consistent$6 ANNE$URE III &6. 'AIMS AND OBJECTIVES 3o study the occourence of body mass inde# (45") and waist hip ratio (WH)) in type "" diabetes mellitus sub,ects$ 3o know the lipid pattern ((erum cholesterol!triglicerides!H'7!and 7'7) in type "" diabetes mellitus sub,ects$ 3o correlate the body mass inde# and waist hip ration with lipid patterns in type "" diabetes mellitus sub,ects$ ANNE$URE IV &6.4'SOURCE OF DATA Bample si.e 100. :atients 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 )r.4.?.!mbed6ar 5edical 8ollege and -ospital ,ill be selected.

(6.5' MATERIAL AND METHOD OF COLLECTION OF DATA &nthropometric measurements to be done to calculate 4ody mass inde#(45") and waist hip ratio (WH)) $Waist to be measured at the midpoint between lower costal margin and superior illiac crest in the mid a#illary line Hip circumference measured at the level of greater trochanter of femur 84( and 994( to be determined by using glucose o#idase pero#idase test 7ipid profile to be done by en:ymatic method like ;ak<s method 45"=>*- for males and females to be taken to indicate generalised obesity WH)=>.$? for males and =>.$6 for females to be taken to indicate

&6.6' INCLUSION CRITERI: Type 2 )iabetes mellitus of at least 3months duration, able to give informed consent. &6.#' E$CLUSION CRITERIA Chronic alcoholics C)8 patients 9atients using 7ipid lowering agents

Hypothyroidism 8amily dyslipidaemias

INVESTIGATIONS RE?UIRED 1.C)65,+.+ <,))2 :);0. 2.FBS -02 PPBS .) <+ 2+.+*6/0+2 <3 ;4/09 9,;:)4+ )=/2-4+ 5+*)=/2-4+ .+4. .HBA1C 4.F-4./09 L/5/2 5*)1/,+ .) <+ 2)0+ <3 +0@36-./: 6+.8)2 ,/A+ B-AC4 6+.8)2 5.T83*)/2 5*)1/,+ 6.S+*;6 ;*+- -02 :*+-./0/0+ #.L/>+* 1;0:./)0 .+4. DOES THE STUDY RE?UIRE ANY INVESTIGATION S OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS AND ANIMALSD IF SO, PLEASE DESCRIBE BRIEFLY.

Y+4,/. *+E;/*+4 .8+ 1),,)7/09 /0>+4./9-./)0 .) <+ 2)0+ 1.C)65,+.+ <,))2 :);0. 2.FBS -02 PPBS .) <+ 2+.+*6/0+2 <3 ;4/09 9,;:)4+ )=/2-4+ 5+*)=/2-4+ .+4. .HBA1C 4.F-4./09 L/5/2 5*)1/,+ .) <+ 2)0+ <3 +0@36-./: 6+.8)2 ,/A+ B-AC4 6+.8)2 5.T83*)/2 5*)1/,+ 6.S+*;6 ;*+- -02 :*+-./0/0+ #.L/>+* 1;0:./)0 .+4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF THE ABOVE.

&6.%' REFERENCES 1.-ui.inga 55,?othman ?2.!ddressing the diabetes pandemicC!comprehensive approach.$ndian A 5ed ?es 2003@12&C&<1%& 2.,ild s,?oglic D,Dreen !,Bicree ?,6ing h.Dlobal prevalence of diabetesCestimates for the year 2000 and pro ections for 2030.)iabetes care200&@2'C10&'%53. 3. 5ohan 1 Bandeep B )eepa ? Bhah 4 1argese 8 9pidemiology of Type 2 )iabetes $ndian scenario $ndian A med ?9B 200'@125C21'%30 & ?amachandran ! Aali 51 5ohan 1 Bnehalatha 8 1ishwanathan 5 .-igh prevalence of )iabetes $n urban population in south $ndia 45A1"<<@2"'@5<'%"0. 5.:an E? 2i D, -u Fh ,ang A/ Fang ,y !n G/ et al.9ffect of diet and e/ercise in preventing 7$))5in population with impaired glucose toleranceCthe da ;ing $DT and diabetes study.)iabetic care 1""'@20C53'%&&. 6.C)**+,-./)0 )1 234,/5/2+6/- 7/.8 7-/4. .) 8+/98. *-./), 7-/4. :/*:;61+*+0:+, -02 <)23 6-44 /02+= /0 I*-0/-0

-2;,.4, &li Chehrei 5'0! (aeid (adrnia 5'*! &mmar Hassan:adeh @eshteli 5(+! 5ohammad&li 'aneshmand and Aalal )e:aei 5'/ Asia Pac J Clin Nutr 2007;16 (2):248-253

5'/

'. . A S.;23 )1 C)**+,-./)0 <+.7++0 L/5/2 P*)1/,+ -02 "-/4. .) H/5 R-./)4 /0 P-./+0.4 7/.8 D/-<+.+4 M+,,/.;4, H-*2+> S/098 S-028;1, S83-6-, K),+32 -02 K-*-0F/. S/098 S-028 <. A S.;23 )1 C)**+,-./)0 <+.7++0 D+*/>+2 -02 B-4/:

A0.8*)5)6+.*/: I02/:+4 /0 T35+ 2 D/-<+.+4 M+,,/.;4, Buropean

Aournal of (cientific )esearch "((C 0/-. *0%D Eol$+% Co$+ (*..?)!
pp /+2 /// F BuroAournals 9ublishing! "nc$ *..?

". -oward 41, et al. $ntegrated study of low density lipoprotein metabolism and 12)2 metabolism in non%insulin dependent diabetes mellitus. 5etabolism 1""< @ 33 C <'0%<''. 10.8haturvedi 7, Aohn -. *uller and 5ar a%?itta Tas6inen. )iffering associations of lipid and lipoprotein disturbances with the macrovascular and microvascular complications of type 1 diabetes. )iabetes care 2001 @ 2& (12+ C20'1%20'3.'. 5a..one T. 8urrent 11..B.? $yer , ?evati ? $yer, B.1 Hpashi, 5.7 4aithule. I)iabetes mellitus in )ombivili 0 !n Hrban :opulation BtudyJ A!:$ 2001 @ &" C '13% '13 12. !rora, 5.C A Stud !" C!rr#lati!n $#t%##n &i'id Pr!"il# and $!d (at in Pati#nts )it* + '#rt#nsi!n, -ia.#t#s /#llitus and 0ari!us +#art -is#as# in A1ritsar2 -iss#rtati!n !" /ast#rs in S'!rts :hysiotherapy (Hnpublished+, Duru 7ana6 )e Hniversity, !mritsar (2003+ 13.Aanssen, $., -eymsfield, B.4., !llison, ).4., Kotler, ).:. and ?oss, ?.C 4ody mass inde/ and weist circumference independently contribute to the prediction of non abdominal, abdominal subcutaneous, and visceral fat. A12 J Clin2 Nutr2, 75: 683-688 (2002)2

ANNE$URE VI REMARKS OF THE GUIDE $ will be the guide for )r.5an unath :atil, :D Deneral 5edicine and the thesis wor6 will be done under my supervision.

Bignature of the guide