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AimsGuidelines recommend hemoglobin A1c (HbA1c) as a diagnostic test for type 2 diabetes, but its accuracy may differ in certain ethnic groups.MethodsThe prevalence of type 2 diabetes by HbA1c, fasting glucose, and 2 h glucose was compared in 3016 participants from Chennai and Delhi, India from the CARRS-2 Study to 757 Indians in the U.S. from the MASALA Study. Type 2 diabetes was defined as fasting glucose ≥ 7.0 mmol/L, 2-h glucose ≥ 11.1 mmol/L, or HbA1c ≥ 6.5%. Isolated HbA1c diabetes was defined as HbA1c ≥ 6.5% with fasting glucose

Background: Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH) are prevalent in the community, especially among those with metabolic syndrome. Patients with fibrotic NASH are at increased risk of liver-related-events. Currently available non-invasive tests have not been utilized for screening for fibrotic NASH among the community. We aimed to develop a screening tool for fibrotic NASH among community members., Methods: We included two large cohorts aimed at assessing cardiovascular disease among community members. Fibrotic NASH was defined using the FibroScan-aspartate aminotransferase score of ≥0.67 that identifies ≥F2 fibrosis and a non-alcoholic fatty liver disease activity score ≥4 with a specificity of 90%. Metabolic parameters, biochemical tests and anthropometry were used to develop a multivariate model., Results: The derivation cohort (n = 1660) included a population with a median age 45 years, 42.5% males, metabolic syndrome in 66% and 2.7% (n = 45) with fibrotic NASH. Multivariate analysis identified the four significant variables (Age, body mass index , Diabetes and alanine aminotransferas levels) used to derive an ABDA score. The score had high diagnostic accuracy (the area under receiver-operating characteristic curve, 0.952) with adequate internal validity. An ABDA score ≥-3.52 identified fibrotic NASH in the derivation cohort with a sensitivity and specificity of 88.9% and 88.3%. The score was validated in a second cohort (n = 357) that included 21 patients (5.9%) with fibrotic NASH, where it demonstrated a high area under receiver-operating characteristic curve (0.948), sensitivity (81%) and specificity (89.3%)., Conclusions: ABDA score utilizes four easily available parameters to identify fibrotic NASH with high accuracy in the community., (© 2023 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Background: Non-alcoholic fatty liver disease (NAFLD) is a spectrum of disease ranging from simple steatosis, non-alcoholic steatohepatitis (NASH), through to advanced fibrosis and cirrhosis. We assessed the prevalence, spectrum, and determinants of NAFLD among adults in urban and rural North India., Methods: A representative sample of adults aged 30-60 years were recruited from urban Delhi and rural Ballabhgarh during 2017-2019. Participants underwent abdominal ultrasonography (USG) and vibration controlled transient elastography (VCTE) with FibroScan to assess fatty liver and fibrosis, respectively. We estimated the age- and sex-standardised prevalence of NAFLD and its spectrum. The factors associated with 'ultrasound-diagnosed NAFLD' were identified using multivariate logistic regression., Results: A total of 828 urban (mean ± SD age: 45.5 ± 8.0 years; women: 52.7%) and 832 rural (mean ± SD age: 45.1 ± 7.9 years; women: 62.4%) participants were recruited. The age- and sex-standardized prevalence of ultrasound-diagnosed NAFLD was 65.7% (95%CI: 60.3-71.2) in the urban and 61.1% (55.8-66.5) in the rural areas, respectively. The prevalence of NAFLD with elevated alanine transaminase (≥40IU/L) was 23.2% (19.8-26.6), and 22.5% (19.0-26.0) and any fibrosis by liver stiffness measurement on transient elastography (≥6.9 kPa) was 16.5% (13.8-19.8) and 5.2% (3.8-6.7) in urban and rural participants, respectively. In both urban and rural areas, diabetes, central obesity and insulin resistance were significantly associated with NAFLD., Conclusion: NAFLD prevalence was high among rural and urban North Indian adults, including fibrosis or raised hepatic enzymes. The strong association of metabolic determinants confirms its linkage with metabolic syndrome., Competing Interests: The authors have declared that no competing interests exist.

India is home to nearly 200 million undernourished people, yet little is known about the characteristics of those experiencing food insecurity, especially among urban households. The objectives of this study were: (1) to report the prevalence of food insecurity in two large, population-based representative samples in urban India, (2) to describe socio-economic correlates of food insecurity in this context, and (3) to compare the dietary intake of adults living in food insecure households to that of adults living in food secure households. Data are from 4334 households participating in an ongoing population-based cohort study of a representative sample of Delhi and Chennai, India. The most recent wave of data (2017-2018) were analysed. Food insecurity was measured using the 9-item Household Food Insecurity Access Scale (HFIAS) and dietary intake using a 33-item semi-quantitative food frequency questionnaire. The overall prevalence of food insecurity was 8.5% (95% confidence interval [CI], 6.8-10.2); 15.2% (95% CI 12.0-18.4) of the poorest households (lowest wealth index tertile) were food insecure compared to 1.7% (95% CI 1.0-2.3) of the wealthiest households (highest wealth index tertile). Participants experiencing food insecurity were significantly younger and more likely to be from Delhi compared to Chennai. After adjustment for socio-economic factors (city, age, sex, education, wealth index, fuel used for cooking, and source of drinking water), participants experiencing food insecurity had significantly higher meat, poultry, roots and tubers (potato), and sugar sweetened beverage intakes, and lower vegetables, fruit, dairy, and nut intakes. Food insecurity is highly prevalent among the poorest households in urban India and is associated with intake of a number of unhealthy dietary items., Competing Interests: Conflict of Interest The authors declared that they have no conflict of interest.

Background: In the context of rising obesity in South Asia, it is unclear whether the "South Asian phenotype"(described as high glucose, low high-density lipoprotein cholesterol, and high triglycerides at normal ranges of body weight) continues to be disproportionately exhibited by contemporary South Asians relative to other race/ethnic groups., Objectives: We assessed the distinctiveness of the South Asian cardiometabolic profile by comparing the prevalence of combined high glucose, high triglycerides, and low high-density lipoprotein cholesterol (combined dysglycemia and dyslipidemia) in resident South Asians with 4 race/ethnic groups in the United States (Asians, black persons, Hispanics, and white persons) overall and by body mass index (BMI) category., Methods: South Asian data were from the 2010 to 2011 Center for Cardiometabolic Risk Reduction in South Asia Study, representative of Chennai and New Delhi, India and Karachi, Pakistan. U.S. data were from the 2011 to 2012 National Health and Nutrition Examination Survey, representative of the U.S., Population: Combined dysglycemia and dyslipidemia was defined as fasting blood glucose ≥126 mg/dl and triglyceride/high-density lipoprotein cholesterol ratio >4. Logistic regression was used to estimate the relative odds and 95% confidence intervals of combined dysglycemia and dyslipidemia associated with each race/ethnic group (referent, U.S. white persons). Models were estimated among adults aged 20 to 79 years by sex and BMI category and accounted for age, education, and tobacco use. Data from 8,448 resident South Asians, 274 U.S. Asians, 404 U.S. black persons, 308 U.S. Hispanics, and 703 U.S. white persons without previously known diabetes were analyzed., Results: In the normal body weight range of BMI 18.5 to 24.9 kg/m(2), the prevalence of combined dysglycemia and dyslipidemia among men and women, respectively, was 33% and 11% in resident South Asians, 15% and 1% in U.S. Asians, 5% and 2% in U.S. black persons, 11% and 2% in U.S. Hispanics, and 8% and 2% in U.S. white persons. Compared with U.S. whites persons, South Asians were more likely to present with combined dysglycemia and dyslipidemia at all categories of BMI for men and at BMI 18.5 to 29.9 for women in adjusted models. The most pronounced difference between South Asians and U.S. white persons was observed at normal weight (adjusted odds ratio: 4.98; 95% confidence interval: 2.46 to 10.07 for men) (adjusted odds ratio: 9.09; 95% confidence interval: 2.48 to 33.29 for women)., Conclusions: Between 8% and 15% of U.S. men and 1% and 2% of U.S. women of diverse race/ethnic backgrounds exhibited dysglycemia and dyslipidemia at levels of body weight considered "healthy," consistent with the cardiometabolic profile described as the "South Asian Phenotype." Urban South Asians, however, were 5 to 9 times more likely to exhibit dysglycemia and dyslipidemia in the "healthy" BMI range compared with any other U.S. race/ethnic group., (Copyright © 2016 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.)

Use of matrix robust methods (MRM) to solve the problem of matrix-induced analytic errors appears to be a sound strategy. The development of MRM, however, is in an infancy stage. The principal barrier is the complexity of the matrix effect that involves interactions of the matrix, the analyte, and the technology base of the test method. Each of these three components has its own set of variables. The present article focuses on concepts and tactics to develop the MRM that appear promising on a path-forward basis. The author believes that the current environment favors probability of successful development of MRM. The quality awareness at all functional levels is high, technically feasible models for the design and development of MRM exist, and commercialization of such a method promises the developer a competitive advantage in the marketplace. The optimum strategy for MRM development appears to be evolutionary, ie, starting with a few critical methods and the samples representing the prevalent matrix types. Success in developing MRM also depends on close cooperation between the developers of the MRM, proficiency testing material, the proficiency testing providers, and the regulatory bodies. The research and development program may also include approaches that detect and/or correct the matrix-caused error(s) both in place of, or as an adjunct to, MRM. With respect to the development of genuine MRM, the author has given a typical development scenario comprising the design specifications, specific experimental approaches, evaluation, market introduction, and postintroduction monitoring of its robustness. The crux of the experimental approach is the response surface co-optimization of reaction conditions for the samples of prevalent matrix types such as the proficiency testing materials. The recommended approach is supported by examples of existing methods that exhibit robustness against certain types of matrices. The author believes that addition of MRM to the clinical chemistry methods repertoire is likely to improve the test result quality. It will also improve proficiency testing performance and patient care while boosting the morale of laboratory personnel.

A simple method is described for determining the relative cellulolytic activity of fungi. Opaque columns of an agar medium containing a partially crystalline cellulose preparation were inoculated with the fungi. Depth of the clear zone that developed beneath the growing cultures provided a visual measure of cellulolytic activity on a continuous, cumulative basis. Depth of clearing (DC) was determined for 25 species of fungi differing widely in cellulolytic activity, and compared by correlation analysis with results of three other methods for measuring cellulolytic activity. Relatively high coefficients of correlation (greater than 0.6) were obtained between DC and weight loss of cotton sliver, loss in tensile strength of cotton duck, and carboxymethyl cellulase activity in culture filtrates. In comparison with conventional assay procedures, the clearing method offered several advantages: (i) results were at least as well correlated with the capacity to utilize native cellulose as a substrate; (ii) the method measured activity of growing cultures rather than culture filtrates, thus involving less risk of losses due to product inhibition, binding, or denaturation of enzymes; (iii) repeated measurements were made on the same experimental set up, so that errors due to arbitrarily selected times of harvest were avoided conveniently; and (iv) the method required less working time and very simple equipment, making it convenient for large-scale screening tests.