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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2024 | Month : May | Volume : 18 | Issue : 5 | Page : CC01 - CC05 Full Version

Assessment of Anthropometric Variables in Type 2 Diabetes Mellitus among 4,473 Subjects in 10 Wards of Urban Belagavi District, North Karnataka, India: A Community-based Cross-sectional Study

Published: May 1, 2024 | DOI: https://doi.org/10.7860/JCDR/2024/67379.19339

Madhav Prabhu, VA Kothiwale, KS Smitha, Harpreet Kour

1. Professor, Department of Medicine, JN Medical College, KLE Academy of Higher Education and Research, Nehru, Belagavi, Karnataka, India. 2. Professor, Department of Medicine, JN Medical College, KLE Academy of Higher Education and Research, Nehru, Belagavi, Karnataka, India. 3 Associate Professor, Department of Ophthalmology, JN Medical College, KLE Academy of Higher Education and Research, Nehru, Belagavi, Karnataka, India. 4. Associate Professor, Department of Physiology, JN Medical College, KLE Academy of Higher Education and Research, Nehru, Belagavi, Karnataka, India.

Correspondence Address :
Dr. Madhav Prabhu,
Professor, Department of Medicine, JN Medical College, KLE Academy of Higher Education and Research, Belagavi-590010, Karnataka, India.
E-mail: maddy2380@gmail.com

Abstract

Introduction: Type 2 Diabetes Mellitus (T2DM) is a global epidemic and a serious risk for the younger generation. A sedentary lifestyle, urbanisation, and poor dietary choices are cornerstones of diabetes. Early detection of risk factors and prevention of their progression can go a long way in delaying the onset of the disease and reducing the economic burden due to its secondary complications.

Aim: To assess anthropometric variables of T2DM among the population in Belagavi, North Karnataka, India.

Materials and Methods: A community-based cross-sectional study was conducted among a study population of 4,473 individuals in 10 wards of urban Belagavi district from September 2021 to September 2023 by house-to-house visits. The 10 wards were selected using a random allocation method by computer-generated random sequence. The study population was divided into three groups: the diabetic group, children of the diabetic group, and a healthy non diabetic group (Group-1, Group-2, and Group-3) with population sizes of 649, 855, and 2,969, respectively. Anthropometric parameters were recorded by trained nurses using measuring tapes, stadiometers, and weighing scales. Data were analysed using Statistical Package for Social Sciences (SPSS) 24.0 software. One-way Analysis of Variance (ANOVA) test was used to compare the data between the three groups. The Pearson’s correlation test was used to find the association between Body Mass Index (BMI) and Waist Hip Ratio (WHR). A p-value less than 0.05 was considered significant.

Results: There were no significant differences found in anthropometric parameters among the three groups (p>0.05). However, when comparing anthropometric parameters between different generations, a statistically significant difference was observed in Neck Circumference (NC) and WHR. Further, association between BMI and WHR among the three groups revealed that WHR is a better indicator of obesity compared to BMI, with a statistically significant p-value of 0.03. WHR detected 424 (90.4%), 463 (91.32%), and 1,220 (87%) obese cases in Group-1, Group-2, and Group-3, respectively, compared to BMI, which detected 371 (58.51%), 440 (52.25%), and 1,202 (41.91%) obese cases in Group-1, Group-2, and Group-3, respectively.

Conclusion: The NC and WHR are better indicators of anthropometric measurements. Anthropometry could be a non invasive, cost-effective predictive tool for the future risk of developing DM. The present study determined there is an impending need to conduct regular screening programs for early identification of anthropometrics other than BMI, WHR, and NC.

Keywords

Anthropometry, Hyperglycaemia, Sedentary lifestyle

Introduction
Diabetes mellitus is a group of metabolic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action, or both (1). It has been estimated that around 366 million people worldwide, or 8.3% in the age group of 20-79 years, had T2DM in 2011. This figure is expected to rise to 552 million (9.9%) by 2030 (2). Indians characteristically have increased insulin resistance, greater abdominal adiposity (higher waist circumference despite lower BMI), and a higher prevalence of impaired glucose tolerance, which contributes to a greater risk of developing the disease at a relatively younger age. Epidemiological transition, economic growth, physical inactivity, trendy dietary patterns, and environmental factors also add to this risk (3). An urbanised lifestyle, like changing food habits, sedentary working patterns, and stress, are the risk factors that make the population more vulnerable to diabetes mellitus (4).

Several genes like CAPN10, TCF7L2, PPARG, IRS-1 and IRS-2, KCNJ11, WFS-1, HNF1A, HNF1B, HNF4A, TCF7L2, etc., have been identified which have been associated with the various forms of diabetes (5). Most studies focus on the genetic inheritance of the disease, but there are very few studies that focus on the anthropometric changes that have taken place over time in subsequent generations of diabetics and the epidemiological causes for such changes if any (6),(7),(8). The lack of focus on epidemiological studies has resulted in poor preventive strategies when it comes to diabetes. Much emphasis has been placed on treating DM and associated complications, but little effort has been made towards the prevention of the same. Early detection of the risk factors and prevention of their progression can go a long way in delaying the onset of the disease and reducing the economic burden due to its secondary complications.

Considering this scenario, the literature survey revealed that there were no major studies conducted in Belagavi, India to address this problem. Hence, the present study was undertaken with the aim to assess the anthropometric factors related to T2DM among Belagavi, North Karnataka, India. The primary objectives of the study were to compare the anthropometric parameters between three groups (Group-1: Normal Control, Group-2: Healthy Children of Diabetics, and Group-3: Healthy Subjects) and to compare the anthropometric parameters of the diabetics between three generations (First, Second, and Third). The secondary objective of the study was to find an association between BMI and WHR among Group-1, 2, and 3, respectively.
Material and Methods
A community-based cross-sectional study was conducted among a study population of 4,473 individuals from 10 wards of urban Belagavi districts through house-to-house visits. The study period was from September 2021 to September 2023. The study was approved by the Institutional Ethical Committee via Reference: KLEU/Ethic/2012-13/D4565 dated 18/03/2013.

The 10 wards were selected using a random allocation method with a computer-generated random sequence placed in a sealed opaque envelope. The study protocol was explained to all participants, and written consent was obtained. Data collection started with a general discussion to build rapport with the subjects and establish confidence. Subjects who could not be contacted during the initial visit were contacted subsequently during weekends based on their convenience. The proforma included fields for name, age, gender, clinical history, family history, and recording of anthropometric measurements.

Sample size: According to the literature survey, assuming approximately a 13% prevalence of diabetes with a 95% Confidence Interval (CI) and a possible error of 10%, we initially screened a total of 5,150 people. However, only 4,473 individuals consented to participate in the study (9).

Grouping: The study population of 4,473 individuals was categorised into three groups as follows:

Group-1: (n=649) consisting of patients with diabetes mellitus diagnosed before screening.
Group-2: (n=855) Healthy children of diabetic patients.
Group-3: (n=2,969) Non diabetic individuals with no family history of diabetes.

Subgrouping: Group-1 was further subdivided into first-generation known diabetics, second-generation, and third-generation diabetics.

Inclusion criteria: All study subjects aged 18-60 years, patients with a history of diabetes mellitus, children of patients with diabetes mellitus, and healthy individuals from urban wards of Belagavi, Karnataka, who were willing to participate in the study were enrolled as study participants.

Exclusion criteria: Patients with chronic disorders or diseases like collagen vascular disorders or infections like tuberculosis, which may affect their anthropometric parameters due to underlying diseases, were excluded from the study.

Study Procedure

The data was collected by trained nursing staff to gather information and record all anthropometric measurements. All instruments were standardised for anthropometric measurements. Pilot testing was initially conducted on 100 medical students and then on 100 nursing staff to determine the reliability and validity of the proforma and measurements.

Study parameters:

1. Diagnosed cases of T2DM: Individuals with a history of diabetes or who were receiving diabetes drug treatment.
2. Family history of diabetes: Subjects with one or both parents/grandparents having diabetes were considered to have a positive family history.
3. Weight in kg: Body weight was measured (to the nearest 0.01 kg) with the subject standing still on the electronic weighing scale, feet about 15 cm apart, and weight equally distributed on each leg. Subjects were instructed to wear minimal outerwear (as culturally appropriate) and no footwear while their weight was being measured.
4. Height in cm: Height was measured using a non stretchable tape (to the nearest 0.1 cm) with the subject in an erect position against a vertical surface and the head positioned so that the top of the external auditory meatus was level with the inferior margin of the bony orbit (7).
5. Body Mass Index (BMI): BMI was calculated using the formula: weight (kg)/height (m2). Individuals were categorised as underweight with BMI <18.5, normal range with BMI 18.5-22.9, overweight with BMI >23-24.9, obese-1 with BMI 25-29.9, and obese-2 when BMI >30 kg/m2 (10).
The subjects with a BMI >23 kg/m2 and a WHR >1.0 in males and >0.8 in females were considered in the obese category.
The subjects with a BMI <23 kg/m2, and WHR <1.0 in males and <0.8 in females were categorised in the non obese category.
6. Waist circumference in cm: Waist circumference (to the nearest 0.1 cm) was measured using a tailor’s tape at a point midway between the tip of the iliac crest and the last costal margin in the back and at the umbilicus in the front. The International Diabetes Federation (IDF) standard cut-offs of ≥88 cm and ≥90 cm were used for women and men, respectively. This measurement is an indicator of abdominal obesity (11).
7. Hip circumference in cm: Hip circumference was measured at the widest portion of the hip (at the level of the greater trochanters) to the nearest 0.1 cm with a measuring tape, while the subject was standing with the arms by the side and feet together (11).
8. Neck Circumference in cm (NC): Neck circumference was obtained with the subject sitting with the head in a horizontal plane position. A measuring tape was applied around the neck below the laryngeal prominence and perpendicular to the long axis of the neck. The minimal circumference was measured and recorded to the nearest 0.1 cm (12).
9. Waist/Hip Ratio (WHR): The WHR was calculated as the ratio of waist circumference to hip circumference (11). A WHR of >0.9 for males and >0.8 for females was defined as truncal obesity.

Statitical Analysis

The data were analysed using International Business Machines (IBM) Corp. Released in 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp. A one-way ANOVA test was used to compare the data among the three groups. An independent t-test was used to compare anthropometric parameters between the groups. A p-value less than 0.05 was considered significant. The association between BMI and WHR among the three groups of the study population was assessed using the Chi-square test.
Results
The three groups were analysed for anthropometric comparison by ANOVA Test. No significant difference was found in the anthropometric parameters among the three groups (p>0.05) (Table/Fig 1).

The results of the comparison of anthropometric parameters between the 1st, 2nd, and 3rd generations of diabetics in the study population were analysed by ANOVA test and showed a significant difference in WHR (p=0.06) and NC (p=0.032) (Table/Fig 2). The weight also increased across three generations but was statistically insignificant (p=0.703). This indicates that as the generation progresses, individuals are becoming metabolically obese compared to their previous generations.

The comparison of anthropometric parameters between two generations showed an increased weight, waist, hip, and WHR from the 1st to the 2nd and 3rd generations. Waist hip circumference was significantly increased from the 1st to the 3rd generation (p=0.029) and from the 2nd to the 3rd generation (p=0.018). Similarly, there was a significant increase in NC from the 1st to the 3rd generation (p=0.023), and also from the 2nd to the 3rd generation (p=0.009). WHR was significantly increased from the 2nd to the 3rd generation (p=0.023). It was also observed that the BMI remained more or less the same, whereas WHR, weight, waist, and NC showed an increase across the generations (Table/Fig 3).

Obesity, as defined by BMI, was compared with that defined by WHR among DM patients of Group-1, and both were found to be significantly different (p=0.03). Among the DM population, as per WHR classification, 424 (90.4%) were found to be obese, however, BMI could detect only 371 (58.51%) (Obese I+Obese II). For Group-2, As per WHR, 463 (91.32%) were obese compared to 440 (52.25%) by BMI Classification. Similar observations were made in Group-3, where 1220 (87.64%) were diagnosed as obese according to WHR classification, compared to 1202 (41.91%) using BMI classification (Table/Fig 4). This shows that WHR is a better indicator of obesity compared to BMI.
Discussion
The present study identified increased NC and WHR to be associated with T2DM. The risk of T2DM is determined by the interplay of genetic and metabolic factors. Being overweight and obese, along with physical inactivity, is estimated to cause a large proportion of the global diabetes burden (12). A meta-analysis on predicting the incidence of diabetes has reported that higher waist circumference and higher BMI are associated with an increased risk of T2DM, although the relationship may vary in different populations (13),(14). In the present study, it has been observed that BMI alone is not a robust marker for T2DM, and other anthropometric factors, especially WHR, may prove to be stronger predictors of the disease. Generations of diabetics have distinctive characteristics that can prove to be good indicators of an individual’s predisposition to develop T2DM, apart from family history. As generations progress, the anthropometric measurements appear to be more diabetogenic, thus explaining the importance of the study.

According to a study by Alzeidan R et al., NC stands out as an independent predictor of obesity, metabolic syndromes, and diabetes mellitus. The present study also has similar findings, indicating that across generations, BMI may not be a good marker of obesity (15).

Generation-wise analysis of NC in Group-1 showed a statistically significant difference between the generations. It was found to increase from the 1st to the 3rd generation (p=0.023) and from the 2nd to the 3rd generation (p=0.009). This is supported by a study by Cho NH et al., who studied NC in an Asian population and found that NC in DM patients was significantly larger compared to non diabetics (16). In the present study, NC was highest in the 3rd generation, which can be attributed to changes in lifestyle from generation to generation. Various studies have reported that as diabetics progress through generations, there is an increase in the incidence of diabetes, and there is often fall short of surrogates for the detection of this possible marker for propensity to develop diabetes. Increased fat deposition around the neck could be a potential marker for insulin resistance and an increase in the chance to develop diabetes (17),(18).

Waist size was found to increase significantly from the 1st to the 3rd generation (p=0.029). Waist (p=0.018), NC, and WHR (p=0.023) were observed to be significantly higher in the 3rd generation compared to the 2nd generation. These observations prove that the altered lifestyle in the newer generation increases the propensity towards lifestyle-related diseases, a common risk factor among younger generations, and may lead to an early incidence of DM in individuals. It is possible that over generations, we have evolved into a more atherogenic and insulin-resistant phenotype (19),(20).

Previous studies have reported that dietary practices are linked to unhealthy body weight and/or a higher risk of type-2 diabetes, including a high intake of saturated fatty acids, high total fat intake, and inadequate consumption of dietary fibre (21),(22). High intake of sugar-sweetened beverages, which contain considerable amounts of free sugars, increases the likelihood of being overweight or obese, particularly among children. Recent evidence further suggests an association between high consumption of sugar-sweetened beverages and an increased risk of T2DM (23),(24).

It was observed that instead of BMI, WHR was a more accurate indicator of obesity, as there was a statistically significant difference (p<0.05) among the number of obese DM patients (Group-1) based on BMI and WHR. This may be attributed to the fact that the occurrence of diabetes is more associated with abdominal obesity rather than overall obesity status (23). The findings in the present study also substantiate the fact that the risk of diabetes is higher among those with a high waist circumference. Studies have reported that despite having a normal BMI, an adult Indian has more chance of having abdominal obesity (25),(26). Thus, if Western parameters for obesity are used from an Indian perspective, it is likely to miss out on a significant chunk of the population at risk of developing diabetes.

In other studies, it has been seen that insulin resistance in non obese Asians is due to the high percentage of visceral fat (25),(26). Populations in South-east Asia develop diabetes at a lower level of BMI than populations of European origin (27). These findings have been further supported by several other studies from India and other countries (28),(29),(30),(31),(32),(33),(34). However, there have been other studies where no association between BMI and diabetes mellitus could be established (35),(36). It is also known that many Asians have pear-shaped bodies (with more weight around the hips). If we consider only BMI, we might miss pear-shaped individuals in the detection of obesity.

In the present study, WHR in male obese study subjects was significantly (p<0.05) distributed among all the groups, namely DM subjects, healthy children of DM diagnosed, and healthy subjects, as compared to the female study population. These findings were consistent with studies conducted by various other researchers (34),(35),(36),(37).

The present study also reported that WHR, rather than BMI, is a better indicator of DM. It was observed that there was a significant difference between BMI and WHR among healthy children of diabetic patients (Group-2) and subjects in the healthy group (Group-3). Children of diabetic parents have a higher risk of developing diabetes if anthropometrics are considered.

Based on the current evidence, the present study can propose that factors like NC and WHR can be better predictors of obesity than BMI alone. Since T2DM is directly linked with obesity, these anthropometric factors can serve as good non invasive and cost-effective indicators of a person’s tendency to develop diabetes. Using only BMI in the anthropometric determination of obesity may underestimate the extent of the burden of obesity in society. This hypothesis also supports the Y-Y paradox, which proves that although two people have the same BMI, they may differ in body fat percentage, which can be reflected in NC or WHR (38). Mohan V et al., showed a higher prevalence of diabetes mellitus among subjects with both diabetic parents (55%) compared to those with one diabetic parent (22%) (35). This aspect can be considered when studying T2DM prevalence across communities due to its significant association with T2DM. Cohort studies with a larger sample size would, however, be necessary to determine the optimal range for the various anthropometric measurements specific to the Indian population.

Limitation(s)

The sample taken from one town may not be representative of the entire picture; multicentric trials are needed.
Conclusion
In conclusion, NC and WHR are better indicators of anthropometric measurements. Anthropometry could be a non invasive, cost-effective predictive tool for the future risk of DM development. There is an impending need to conduct regular screening programs for the early identification of anthropometric causes of diabetes mellitus, and intensive health education programs focusing on these risk factors are recommended to be carried out among different populations to control T2DM. WHR should be routinely measured in clinical practice, as the method is robust, non invasive, and can also help for better patient management. Accordingly, the inclusion of WHR and NC measurement in routine practice, especially in high population/DM patient settings, will help in the early management of patients, and the technique is also helpful in low economic settings. Anthropometry could be a cost-effective substitute available in high-population and limited resource-setting countries like India.
Acknowledgement
Authors would like to acknowledge all the participants who gave consent for the study.
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DOI and Others
DOI: 10.7860/JCDR/2024/67379.19339

Date of Submission: Sep 05, 2023
Date of Peer Review: Nov 01, 2023
Date of Acceptance: Feb 10, 2024
Date of Publishing: May 01, 2024

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
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