The aim of the present study was to evaluate the impact of a high-protein meal replacement (HPMR) on weight and metabolic, lipid and inflammatory parameters in overweight/obese Asian Indians. In this 12-week open-label, parallel-arm randomised controlled trial, 122 overweight/obese men and women were administered either a HPMR or a control diet after 2 weeks of diet and exercise run-in. Body weight, waist circumference (WC), percentage body fat (%BF), fasting blood glucose, post-oral glucose tolerance test (post-OGTT) blood glucose, fasting and post-OGTT serum insulin, lipid profile, high-sensitivity C-reactive protein (hs-CRP), kidney function and hepatic aminotransferases were assessed before and after the intervention. Additional improvement in mean values for the following parameters in the HPMR group compared with the control group was observed: body weight, 4·9 % (95 % CI 3·8, 6·1; P<0·001); WC, 3·8 % (95 % CI 2·5, 5·1; P<0·001); %BF, 6·3 % (95 % CI 4·3, 8·2; P<0·001); systolic blood pressure, 2·8 % (95 % CI 0·4, 5·1; P=0·002); diastolic blood pressure, 3·5 % (95 % CI 0·7, 6·3; P= 0·01); post-OGTT blood glucose, 7·3 % (95 % CI 1·4, 13·1; P=0·02); total cholesterol, 2·5 % (95 % CI 1·6, 3·5; P<0·001); LDL-cholesterol, 7·3 % (95 % CI 1·7, 12·9; P<0·01); alanine aminotransferase, 22·0 % (95 % CI 2·1, 42; P=0·03) and aspartate aminotransferase, 15·2 % (95 % CI 0·9, 29·5; P=0·04). The absolute reduction in BMI was 0·9 units in the intervention arm compared with the control arm (–0·9 %, 95 % CI –1·4, –0·5; P<0·001) and in serum TAG was 11·9 mg/dl (–11·9 mg/dl, 95 % CI –21·1, –2·7; P<0·01). The reduction in fasting serum insulin in the intervention v. the control arm was 3·8 v. 0 % (P=0·002); post-OGTT serum insulin was 50·3 v. 77·3 mU/l (P=0·005); and hs-CRP, 16·7 % v. 0 % (P=0·002). These findings show that intervention with HPMR may lead to significant weight loss and improvement in obesity measures, metabolic, lipid and inflammatory parameters and hepatic transaminases in overweight/obese Asian Indians.

Increasing prevalence of childhood obesity calls for comprehensive and cost-effective educative measures in developing countries such as India. School-based educative programmes greatly influence children's behaviour towards healthy living. We aimed to evaluate the impact of a school-based health and nutritional education programme on knowledge and behaviour of urban Asian Indian school children. Benchmark assessment of parents and teachers was also done. We educated 40 196 children (aged 8–18 years), 25 000 parents and 1500 teachers about health, nutrition, physical activity, non-communicable diseases and healthy cooking practices in three cities of North India. A pre-tested questionnaire was used to assess randomly selected 3128 children, 2241 parents and 841 teachers before intervention and 2329 children after intervention. Low baseline knowledge and behaviour scores were reported in 75–94 % government and 48–78 % private school children, across all age groups. A small proportion of government school children gave correct answers about protein (14–17 %), carbohydrates (25–27 %) and saturated fats (18–32 %). Private school children, parents and teachers performed significantly better than government school subjects (P < 0·05). Following the intervention, scores improved in all children irrespective of the type of school (P < 0·001). A significantly higher improvement was observed in younger children (aged 8–11 years) as compared with those aged 12–18 years, in females compared with males and in government schools compared with private schools (P < 0·05 for all). Major gaps exist in health and nutrition-related knowledge and behaviour of urban Asian Indian children, parents and teachers. This successful and comprehensive educative intervention could be incorporated in future school-based health and nutritional education programmes.

To compare the glycaemic index (GI) of newly developed ‘atta mix’ roti with whole wheat flour roti. Eighteen healthy non-diabetic subjects consumed 50 g available carbohydrate portions of a reference food (glucose) and two test foods (whole wheat flour roti and atta mix roti) in random order after an overnight fast. The reference food was tested on three separate occasions, while the test foods were each tested once. Capillary blood samples were measured from finger-prick samples in fasted subjects ( − 5 and 0 min) and at 15, 30, 45, 60, 90 and 120 min from the start of each food. No significant difference was observed between roti prepared from whole wheat flour and atta mix in terms of appearance, texture, flavour, taste or acceptability. For each test food, the incremental area under the curve and GI values were determined. The GI of atta mix roti (27·3 (sem 2·2)) was considerably lower than the whole wheat flour roti (45·1 (sem 3·5), P < 0·001). Development of foods with lower dietary glycaemic load such as the atta mix roti could help in the prevention and control of diabetes in South Asian populations, which habitually consume very high glycaemic load diets.

The present study aimed at comparing the anthropometric profile of Asian Indian adolescents from Guadeloupe with that of their island counterparts. A total of 720 voluntary 11- to 17-year-old students participated: 180 Asian Indians and 540 age- and sex-matched students of other origin. Weight and height were measured to calculate the BMI. Waist and hip circumferences and bicipital, tricipital, subscapular and supra-iliac skinfold thicknesses were assessed. The percentage of body fat was estimated by bioelectrical impedance analysis. Obesity was defined from BMI according to the International Obesity Task Force recommendations. Asian Indians were smaller and lighter than their counterparts. They had a higher body fat percentage even after adjustment on BMI but the prevalence of obesity did not differ, with an overall prevalence of 5·69 (95 % CI 5·67, 5·71) %. No principal effects of ethnicity on waist and hip circumferences or the waist:hip ratio were evidenced. The sum of the four skinfold thicknesses was the strongest predictor of body fat percentage, and the adjustment of overall body fat on subcutaneous fat cancelled the effect of ethnicity on this dependent variable. The present study found that Asian Indian adolescents from Guadeloupe had the same tendency toward higher body fat and body fat-for-BMI as previously documented in Asian Indian adults. It raises the hypothesis of a higher cardiovascular risk in this ethnic group from adolescence and questions the validity of using common BMI references for screening obesity in multiethnic communities.

The aim of the study was to examine the association of dietary carbohydrates and glycaemic load with the risk of type 2 diabetes among an urban adult Asian Indian population. Adult subjects aged >20 years (n 1843) were randomly selected from the Chennai Urban Rural Epidemiology Study, in Chennai city in southern India. Dietary carbohydrates, glycaemic load and food groups were assessed using FFQ. Oral glucose tolerance tests were performed using 75 g glucose in all subjects. Diagnosis of diabetes was based on WHO Consulting Group criteria. OR for newly detected diabetes were calculated for carbohydrates, glycaemic load and specific food groups comparing subjects in the highest with those in the lowest quartiles, after adjustment for potential confounders such as age, sex, BMI, family history of diabetes, physical activity, current smoking, alcohol consumption and relevant dietary factors. We identified 156 (8·5 %) newly diagnosed cases of type 2 diabetes. Refined grain intake was positively associated with the risk of type 2 diabetes (OR 5·31 (95 % CI 2·98, 9·45); P < 0·001). In the multivariate model, after adjustment for potential confounders, total carbohydrate (OR 4·98 (95 % CI 2·69, 9·19), P < 0·001), glycaemic load (OR 4·25 (95 % CI 2·33, 7·77); P < 0·001) and glycaemic index (OR 2·51 (95 % CI 1·42, 4·43); P = 0·006) were associated with type 2 diabetes. Dietary fibre intake was inversely associated with diabetes (OR 0·31 (95 % CI 0·15, 0·62); P < 0·001). In urban south Indians, total dietary carbohydrate and glycaemic load are associated with increased, and dietary fibre with decreased, risk of type 2 diabetes.

A role of dietary nutrients in relation to insulin resistance has been suggested but conclusive evidence in human beings is lacking. Asian Indians and South Asians are prone to develop insulin resistance and the metabolic syndrome. In the present paper, data pertaining to nutrient intake, insulin resistance and cardiovascular risk factors in Asian Indians and South Asians have been reviewed. In these populations, several dietary imbalances have been reported: low intake of MUFA, n-3 PUFA and fibre, and high intake of fats, saturated fats, carbohydrates and trans-fatty acids (mostly related to the widespread use of Vanaspati, a hydrogenated oil). Some data suggest that these nutrient imbalances are associated with insulin resistance, dyslipidaemia and subclinical inflammation in South Asians. Specifically, in children and young individuals, a high intake of n-6 PUFA is correlated with fasting hyperinsulinaemia, and in adults, high-carbohydrate meal consumption was reported to cause hyperinsulinaemia, postprandial hyperglycaemia and hypertriacylglycerolaemia. Dietary supplementation with n-3 PUFA leads to an improved lipid profile but not insulin sensitivity. Inadequate maternal nutrition in pregnancy, low birth weight and childhood ‘catch-up’ obesity may be important for the development of the metabolic syndrome and diabetes. Even in rural populations, who usually consume traditional frugal diets, there is an increasing prevalence of cardiovascular risk factors and the metabolic syndrome due to changes in diets and lifestyle. Nationwide community intervention programmes aimed at creating awareness about the consequences of unhealthy food choices and replacing them by healthy food choices are urgently needed in urban and rural populations in India, other countries in South Asia and in migrant South Asians.

Hypovitaminosis D is common in Asian Indians. Physicians often prescribe 1500 μg (60 000 IU) cholecalciferol per week for 8 weeks for vitamin D deficiency in India. Its efficacy to increase serum 25-hydroxy vitamin D (25(OH)D) over short (2 months) and long (1 year) term is not known. We supplemented a group of twenty-eight apparently healthy Asian Indians detected to have low serum 25(OH)D (mean 13·5 (sd 3·0) nmol/l) on screening during January–March 2005. Serum parathyroid hormone (PTH) level was supranormal in 30 % of them. Oral supplementation included 1500 μg cholecalciferol per week and 1g elemental Ca daily for 8 weeks. Serum 25(OH)D, total Ca, inorganic P and intact (i) PTH were reassessed in twenty-three subjects (twelve females and eleven males) who had follow up at both 8 weeks and 1 year. At 8 weeks the mean 25(OH)D levels increased to 82·4 (sd 20·7) nmol/l and serum PTH normalized in all. Twenty-two of the twenty-three subjects had 25(OH)D levels>49·9 nmol/l. At 1 year, though the mean 25(OH)D level of 24·7 (sd 10·9) nmol/l was significantly higher than the baseline, all subjects were 25(OH)D deficient. Five subjects with supranormal iPTH at baseline showed recurrence of biochemical hyperparathyroidism. Thus, with 8 weeks of cholecalciferol supplementation in Asian Indians with chronic hypovitaminosis D, mean serum 25(OH)D levels would be normalized and serum PTH value would be reduced to half. However, such quick supplementation would not maintain their 25(OH)D levels in the sufficient range for 1 year. For sustained improvement in 25(OH)D levels vitamin D supplementation has to be ongoing after the initial cholecalciferol loading.

The study examines the relationship between fruit and vegetable intake (g/d) and CVD risk factors in urban south Indians. The study population comprised of 983 individuals aged ≥ 20 years selected from the Chennai Urban Rural Epidemiological Study (CURES), a population-based cross-sectional study on a representative population of Chennai in southern India. Fruit and vegetable intake (g/d) was measured using a validated semi-quantitative FFQ. Linear regression analysis revealed that after adjusting for potential confounders such as age, sex, smoking, alcohol, BMI and total energy intake, the highest quartile of fruit and vegetable intake (g/d) showed a significant inverse association with systolic blood pressure (β = − 2·6 (95 % CI − 5·92, − 1·02) mmHg; P = 0·027), BMI (β = − 2·3 (95 % CI − 2·96, − 1·57) kg/m2; P < 0·0001), waist circumference (β = − 2·6 (95 % CI − 3·69, − 1·46) cm; P < 0·0001), total cholesterol (β = − 50 (95 % CI − 113·9, − 13·6) mg/l; P = 0·017) and LDL-cholesterol concentration (β = − 55 (95 % CI − 110·8, − 11·1) mg/l; P = 0·039) when compared with the lowest quartile. A higher intake of fruit and vegetables explained 48 % of the protective effect against CVD risk factors. Increased intake of fruits and vegetables could play a protective role against CVD in Asian Indians who have high rates of premature coronary artery disease.

The aim of this study was to ascertain whether international glycaemic index (GI) values, predominantly developed using peoples living in Europe, North America or Australia, are applicable to Asian Indians resident in their own country. Thirty-four Caucasian subjects were recruited in Oxford, UK and thirteen Asian Indian subjects in Chennai, India. Two types of sweet biscuits and three breakfast cereals were tested for glycaemic response in each group. Subjects were served equivalent available carbohydrate amounts (50 g) of test foods and a reference food (glucose), on separate occasions. Capillary blood glucose was measured from finger-prick samples in fasted subjects ( − 5 and 0 min) and at 15, 30, 45, 60, 90 and 120 min after starting to eat. For each test food, the incremental area under the curve (IAUC) and GI values were determined. Although the glycaemic response to the reference food was higher in Asian Indian subjects compared with UK Caucasian subjects (IAUC 219 mmol/min per litre v. 157 mmol/min per litre, respectively; P < 0·01), there was no significant difference in GI values of the five test foods between the two groups. This is the first study known to the authors to examine the role of ethnicity on GI when the subjects are resident in their own countries. The findings from this study have important implications for the use of the GI concept worldwide and support the application of international values to different ethnic groups. The higher glycaemic response to all foods in Asian Indians may represent another mechanism for increased diabetes susceptibility among Asian Indians.

Asian Indians are at high risk for the development of atherosclerosis and related complications, possibly initiated by higher body fat (BF). The present study attempted to establish appropriate cut-off levels of the BMI for defining overweight, considering percentage BF in healthy Asian Indians in northern India as the standard. A total of 123 healthy volunteers (eighty-six males aged 18–75 years and thirty-seven females aged 20–69 years) participated in the study. Clinical examination and anthropometric measurements were performed, and percentage BF was calculated. BMI for males was 21·4 (SD 3·7) KG/M2 AND FOR FEMALES WAS 23·3 (sd 5·5) kg/m2. Percentage BF was 21·3 (sd 7·6) in males and 35·4 (sd 5·0) in females. A comparison of BF data among Caucasians, Blacks, Polynesians and Asian ethnic groups (e.g. immigrant Chinese) revealed conspicuous differences. Receiver operating characteristic (ROC) curve analysis showed a low sensitivity and negative predictive value of the conventional cut-off value of the BMI (25 kg/m2) in identifying subjects with overweight as compared to the cut-off value based on percentage BF (males >25, females >30). This observation is particularly obvious in females, resulting in substantial misclassification. Based on the ROC curve, a lower cut-off value of the BMI (21·5 kg/m2 for males and 19·0 kg/m2 for females) displayed the optimal sensitivity and specificity, and less misclassification in identification of subjects with high percentage BF. Furthermore, a novel obesity variable, BF:BMI, was tested and should prove useful for interethnic comparison of body composition. In the northern Indian population, the conventional cut-off level of the BMI underestimates overweight and obesity when percentage BF is used as the standard to define overweight. These preliminary findings, if confirmed in a larger number of subjects and with the use of instruments having a higher accuracy of BF assessment, would be crucial for planning and the prevention and treatment of various obesity-related metabolic diseases in the Asian Indian population.