Malnutrition-related Diabetes Research Articles

Short-Term Exposure to Wildfire-Specific PM2.5 and Hospitalization for Diabetes Morbidity: A Study in Multiple Countries and Territories.

To evaluate associations of wildfire fine particulate matter (PM2.5) with diabetes across multiple countries and territories. We collected data on 3,612,135 diabetes hospitalizations from 1,008 locations in Australia, Brazil, Canada, Chile, New Zealand, Thailand, and Taiwan during 2000-2019. Daily wildfire-specific PM2.5 levels were estimated through chemical transport models and machine-learning calibration. Quasi-Poisson regression with distributed lag nonlinear models and random-effects meta-analysis were applied to estimate associations between wildfire-specific PM2.5 and diabetes hospitalization. Subgroup analyses were by age, sex, location income level, and country or territory. Diabetes hospitalizations attributable to wildfire-specific PM2.5 and nonwildfire PM2.5 were compared. Each 10 µg/m3 increase in wildfire-specific PM2.5 levels over the current day and previous 3 days was associated with relative risks (95% CI) of 1.017 (1.011-1.022), 1.023 (1.011-1.035), 1.023 (1.015-1.032), 0.962 (0.823-1.032), 1.033 (1.001-1.066), and 1.013 (1.004-1.022) for all-cause, type 1, type 2, malnutrition-related, other specified, and unspecified diabetes hospitalization, respectively. Stronger associations were observed for all-cause, type 1, and type 2 diabetes in Thailand, Australia, and Brazil; unspecified diabetes in New Zealand; and type 2 diabetes in high-income locations. Relative risks (95% CI) of 0.67% (0.16-1.18%) and 1.02% (0.20-1.81%) for all cause and type 2 diabetes hospitalizations were attributable to wildfire-specific PM2.5. Compared with nonwildfire PM2.5, wildfire-specific PM2.5 posed greater risks of all-cause, type 1, and type 2 diabetes and were responsible for 38.7% of PM2.5-related diabetes hospitalizations. We show the relatively underappreciated links between diabetes and wildfire air pollution, which can lead to a nonnegligible proportion of PM2.5-related diabetes hospitalizations. Precision prevention and mitigation should be developed for those in advantaged communities and in Thailand, Australia, and Brazil.

Diabetes Awareness & Its Challenges- A Hammering Issue

Diabetes is one of the most common non communicable diseases affecting many people of our country. India being a diabetic capital of world is facing a major epidemic of same. After Covid -19 pandemic its become more evident that person who were having deranged blood sugar level were more at risk of getting infections. So its very important to create awareness of same. According to National Family Health Survey -5 (NFHS-5) men & women with high or very high blood sugar level (>140mg/dl) who are taking medicines were 15.6 % & 13.5% respectively. Females 15 years & above whose blood sugar levels were high or very high were 6.1 & 6.3 % and men with same were 7.3 & 7.2 %(1). These findings were added first time in NFHS survey as more and more population are getting this silent but killer disease. The main risk factors for this disease are very well known like modifiable risk factors are obesity specially central obesity, gestational diabetes, sedentary life style, a highly saturated fat diet, reduced intake of dietary fibers, malnutrition related diabetes, excessive alcohol consumption etc (2).

An Atypical Form of Diabetes Among Individuals With Low BMI.

Diabetes among individuals with low BMI (<19 kg/m2) has been recognized for >60 years as a prevalent entity in low- and middle-income countries (LMICs) and was formally classified as "malnutrition-related diabetes mellitus" by the World Health Organization (WHO) in 1985. Since the WHO withdrew this category in 1999, our objective was to define the metabolic characteristics of these individuals to establish that this is a distinct form of diabetes. State-of-the-art metabolic studies were used to characterize Indian individuals with "low BMI diabetes" (LD) in whom all known forms of diabetes were excluded by immunogenetic analysis. They were compared with demographically matched groups: a group with type 1 diabetes (T1D), a group with type 2 diabetes (T2D), and a group without diabetes. Insulin secretion was assessed by C-peptide deconvolution. Hepatic and peripheral insulin sensitivity were analyzed with stepped hyperinsulinemic-euglycemic pancreatic clamp studies. Hepatic and myocellular lipid contents were assessed with 1H-nuclear magnetic resonance spectroscopy. The total insulin secretory response was lower in the LD group in comparison with the lean group without diabetes and the T2D group. Endogenous glucose production was significantly lower in the LD group than the T2D group (mean ± SEM 0.50 ± 0.1 vs. 0.84 ± 0.1 mg/kg · min, respectively; P < 0.05). Glucose uptake was significantly higher in the LD group in comparison with the T2D group (10.1 ± 0.7 vs. 4.2 ± 0.5 mg/kg · min; P < 0.001). Visceral adipose tissue and hepatocellular lipids were significantly lower in LD than in T2D. These studies are the first to demonstrate that LD individuals in LMICs have a unique metabolic profile, suggesting that this is a distinct entity that warrants further investigation.

An Atypical Form of Diabetes Among Low Body Mass Index Individuals in India

Background: Diabetes among low BMI individuals has been recognized for over 60 years as an entity that is prevalent in low- and middle-income countries (LMICs), and formally classified as Malnutrition-Related Diabetes Mellitus by the World Health Organization (WHO) in 1985. However, the WHO withdrew this category in 1999, citing a lack of supportive evidence. Definitive metabolic characterization of these individuals is therefore essential to establish that this is a distinct form of diabetes. Methods: State-of-the-art, dynamic metabolic studies were used to characterize a group of underweight (BMI 18.3±0.2 kg/m2) Southern Indian individuals with diabetes (“Low BMI Diabetes”; LD) in whom all currently known forms of diabetes were excluded by careful immunogenetic analysis. They were compared with four demographically-matched groups: type 1 diabetes (T1D), type 2 diabetes (T2D), and two groups of non-diabetic subjects who were BMI-matched to LD and T2D. To overcome ‘glucose toxicity‘, all subjects with diabetes underwent correction of hyperglycemia. Insulin secretion was assessed by C-peptide deconvolution, following a mixed-meal tolerance test. Hepatic and peripheral insulin sensitivity were analyzed using tracer-based stepped hyperinsulinemic-euglycemic pancreatic clamp studies. Body composition was measured by Dual Energy Absorptiometry (DEXA) and hepatic and myocellular lipid contents were assessed by 1 H-nuclear-magnetic-resonance-spectroscopy. Findings: Metabolic profiles of LD subjects were distinct from T1D and T2D. Insulin secretion was substantially lower in LD than in T2D, yet higher than in T1D. Although insulin sensitivity varied among LD subjects, they were more insulin sensitive than T2D subjects. Their peripheral insulin sensitivity did not differ from T1D subjects. Endogenous glucose production, a marker of hepatic insulin resistance, was similar in LD compared to T1D subjects, yet lower than in T2D. LD subjects also showed heterogeneity of visceral adipose tissue (VAT) and hepatocellular fat, with VAT averaging higher than T1D subjects, while both were significantly lower than T2D subjects. Additionally, compared to lean-nondiabetic subjects, LD subjects had lower insulin secretion, similar peripheral and hepatic insulin sensitivity, and higher VAT and hepatocellular fat. Interpretation: These studies are the first to demonstrate that low BMI individuals with diabetes in LMICs have a unique metabolic profile. Following correction of glucose toxicity, these individuals are characterized by markedly impaired insulin secretion, variable peripheral insulin sensitivity, and heterogeneity in visceral and hepatocellular triglyceride levels. These findings demonstrate that diabetes among low BMI individuals in LMICs is a distinct entity that warrants further investigation. Funding Information: This study was supported by the Global Diabetes Institute of the Albert Einstein College of Medicine. Declaration of Interests: None declared. Ethics Approval Statement: These comprehensive metabolic studies were performed at the Department of Endocrinology, Christian Medical College (CMC) Vellore, India, in collaboration with the Global Diabetes Institute, Albert Einstein College of Medicine, New York, USA. Approval was obtained from the Institutional Review Boards of both institutions. The objectives of the study were explained to all participants and informed consent was obtained. The study protocol was conducted in accordance to the declaration of Helsinki.

1743-P: Metabolic Characteristics of Diabetes among Low-BMI Individuals in India

Diabetes among low BMI individuals has been recognized globally for over 60 years, and classified by WHO as malnutrition-related diabetes mellitus in 1985. Despite its prevalence in low and middle income countries, this condition has never been comprehensively studied. State of the art metabolic studies were performed in 20 South Indian men with Low BMI Diabetes (LD; BMI 18.3 ± 0.9 kg/m2), after excluding monogenic and immune diabetes, and visible pancreatic pathology. Other groups were studied: T1D, T2D, and nondiabetic subjects (BMI-matched to LD and T2D). Insulin secretion was assessed by C-peptide deconvolution following a mixed-meal tolerance test. Peripheral and hepatic insulin sensitivity were analyzed using tracer-based (6,6-deuterated glucose), stepped hyperinsulinemic-euglycemic pancreatic clamps following correction of glucose toxicity. LD subjects were distinct from both T1D and T2D. Insulin secretion was significantly lower in LD than in T2D subjects, yet higher than in T1D. LD subjects were more insulin sensitive than T2D; glucose uptake and endogenous glucose production did not differ from lean nondiabetic or T1D subjects. These comprehensive studies are the first to demonstrate that LD individuals are characterized by markedly impaired insulin secretion yet preserved insulin sensitivity. Thus, diabetes in low BMI individuals is a distinct entity that warrants further investigation. Disclosure E. Lontchi Yimagou: None. R. Das Gupta: None. S. Anoop: None. S. Kehlenbrink: None. J. Moy: None. A. Manavalan: None. P.M. Mathias: None. A. Goyal: None. M. Carey: None. D.T. Stein: None. N. Thomas: None. M. Hawkins: None. Funding National Institutes of Health (R01DK069861)

Malnutrition Related Diabetes Mellitus in Indian Population

Malnutrition related diabetes mellitus (MRDM) is rare type of diabetes associated with long term malnutrition and is not uncommon in India. Diabetes mellitus is the most common endocrine disorder of multifactorial aetiology and has been linked to both chronic under nutrition and obesity. Malnutrition is often related to deficient micro and macro nutrients, unhealthy behaviours and low socioeconomic status. Various clinical studies have underlined the relationship between malnutrition and diabetes mellitus. In the present review, we mainly explored malnutrition related diabetes mellitus in Indian population. Maternal under nutrition during pregnancy causes a decrease in the fetal intrauterine development rate known as intrauterine growth retardation (IUGR). Malnutrition majorly causes persistent insulin deficiency, glucose intolerance and insulin resistance and there by increases the risk of diabetes in Indian population. In this study we have also discussed the pathogenesis of MRDM and their management like self- dietary management and evidence based individualized nutritional therapy.

Conceptual study of malnutrition related diabetes mellitus

The Diabetes mellitus (DM) is a metabolic disease characterized by absolute or relative insulin deficiency. Type 1 diabetes is commonly known as juvenile diabetes, because it typically strikes during childhood and sometimes adolescents, and young age group. Now in the whole world nearly about 24% of population is suffering from diseases. The first widely accepted classification of diabetes mellitus was published by WHO in 1980 named them as IDDM (type-1) and NIDDM (type-2) and Malnutrition related diabetes mellitus (MRDM) was introduced in 1985. In India Malnutrition has high prevalence rate Malnutrition during intrauterine and early childhood period may impair growth and development. This review provides an overview of Juvenile Diabetes in children with MRDM. The juvenile diabetes and MRDM is a palliative disease. It cannot be completely cured, but can be controlled by medication, food, Ayurvedic Chikitsa and Lifestyle Changes.

Fibrocalculus Pancreatic Diabetes in a Young Female: A Rare Form of Secondary Diabetes

Fibrocalculus pancreatic diabetes (FCPD) is a rare form of diabetes. FCPD is one of the two forms of malnutrition related diabetes mellitus (MRDM), the other one being protein deficient diabetes mellitus (PDDM). Fibrocalculus pancreatic diabetes was introduced for this form of diabetes by the World Health Organization study group report on diabetes. Several case reports of FCPD have been described in literature from tropical, poverty striken African and Asian countries for over 50 years. In India most cases are reported from Southern and Eastern India specifically from Kerala, Chennai and Odisha. From Jharkhand it is not reported.

Diabetes in rural individuals of different nutritional status and the alarming situation demands focus more on its under-nutrition association

Objective: To study the relationship of nutritional-status with diabetes. Design: The socioeconomics/anthropometrics, blood-glucose/systemic-hypertension are evaluated in consecutively-selected diabetic-patients. Setting: Semi-urban/rural India. Subjects: Hyperglycaemic patients (total 90/male 37). Results: Blood-glucose (PP-mean ± SE) in individuals is overweight – 38.89% (226.94 ± 9.59), normal-weight − 50% (217.58 ± 1.34), underweight − 11.11% (305.50 ± 21.35) indicating most hyperglycaemia in undernourished-group (F = 6.357, p < 0.003). This group occupies higher glucose-groups in ≤140, 141–270, and ≥270 mg/dL. The blood-glucose negatively correlates with waist(r = −0.282; p < 0.01) and hip (r = −0.254; p < 0.05) circumference indicating the under-nutrition association with glucose-homeostasis (F = 7.6–8.2, p < 0.001). The higher glucose is noticed in more number of individuals in lower (<40 years) age-group (χ2 = 12.86; p < 0.002/ρ = −0.355; p < 0.001). The prevalence of hypertension is 28% (underweight = 20%, overweight = 27%, normal = 30%). The group of 141–270 mg/dL glucose has 45% and rest groups together have 23% hypertensive individuals relating directly, hypertension and diabetic-onset. Conclusions: Diabetes, explored in <40 years group and even more in female should be extensively studied accounting WHO categorization (1985/TRS/727) of malnutrition related diabetes (MRDM). Further, different interactive risk-factors should be properly addressed and the global-malnutrition/gender-based inequities be eradicated.

Epidemiology, complications and management of diabetes in Ethiopia: A systematic review

Non-communicable diseases are becoming major problems of public health importance in most developing countries as a result of the effects of globalization and epidemiologic transition; however, there is little evidence regarding diabetes and other non-communicable diseases in these countries. The aim of this study was to conduct a systematic review of the literature on the magnitude of diabetes, the relationship between malnutrition and diabetes, diabetic complications, and the management of diabetes in Ethiopia. Relevant studies and other evidence were identified by searches in the Embase from 1970 to December 2011 and by reviewing the reference lists from retrieved articles. Relevant articles from non-indexed local journals were also included. Data were extracted and summarized using the major themes of the systematic review. Although the prevalence of diabetes in Ethiopia is estimated to be 2% nationally, evidence suggests that it prevalence could be >5% in those older than 40 years of age in some settings. Studies in the 1980s and 1990s have reported conflicting evidence regarding malnutrition-related diabetes; however, more recent studies are reconfirming a strong association between malnutrition and diabetes. There is remarkable prevalence of both acute and chronic complications in diabetic cases in Ethiopia. In addition to this, more than one-third, but only less than half, of diabetic patients in Ethiopia receive standard diabetes care. The results of this study indicate that, in response to the emergence of diabetes and other non-communicable diseases, effective and efficient prevention and control strategies should be designed and implemented in Ethiopia.

Malnutrition-Related Fulminant Type 1 Diabetes in a Patient with Sturge-Weber Syndrome

Fulminant type 1 diabetes is a subtype of idiopathic type 1 diabetes and is characterized by a short duration of symptom onset and an absence of anti-islet autoantibodies. It has not been common since first reported in Japan, and only two childhood cases are reported in Korea. Malnutrition-related diabetes is associated with malnutrition and characterized by low body weight and hyperglycemia without ketoacidosis. Here we report a case of malnutrition-related fulminant diabetes in a 15-year-old girl with Sturge-Weber syndrome.

Le diabète sucré en Afrique : un enjeu de santé publique

W.H.O. predicts that there will be some 438 million diabetic patients in 2030, most of them living in developing countries. The IFD estimates that the prevalence of diabetes will rise by 98% in Africa during the next 20 years, with dramatic implications for public health and national budgets of the poorest countries. Type 2 diabetes is the most common form in Africa; type 1 is rarer than in western countries and tends to occur later. Two other forms seem specific to black Africans: ketosis-prone atypical diabetes, and tropical malnutrition-related diabetes. An increasing prevalence of obesity, diabetes and impaired glucose tolerance is observed in all parts of Africa. Several factors contribute to this situation, including aging, dietary transitions and lack of physical activity, all of which are related to rapid urbanization. In Africa, diabetes is associated with a high mortality rate, especially among insulin-dependent patients. Poor metabolic control can lead to severe ketosis and hypoglycemic accidents that carry a poor prognosis. Microvascular complications include retinopathy and nephropathy, and most patients cannot afford hemodialysis. Foot ulcers are frequent, due to trauma and neuropathies. Macrovascular complications are also increasing, with a high prevalence of hypertension. The poor prognosis of diabetes in Africa is related to late diagnosis, poor education, inadequate access to insulin, antidiabetic drugs and glycemia self-monitoring devices, absence of controlled diets, and difficult access to medical care in rural areas. Patient empowerment, knowledge and self-care must be improved. African governments must develop national prevention programs. Special attention must be paid to the prevention of obesity and diabetes. The urban environment, infrastructure, education, exercise and safe nutrition must be part of an overall policy designed to reduce the burden of chronic non transmissible diseases.

Insulin-requiring diabetes in Ethiopia: associations with poverty, early undernutrition and anthropometric disproportion

Most insulin-requiring diabetes patients in Ethiopia have an atypical form of the disease, which resembles previous descriptions of malnutrition-related diabetes. As so little is known about its aetiology, we have carried out a case-control study to evaluate its social and nutritional determinants. Men and women with insulin-requiring diabetes (n=107), aged 18-40 years, were recruited in two centres, Gondar and Jimma, 750 km northwest and 330 km southwest of the capital, Addis Ababa, respectively. Controls of similar age and sex (n=110) were recruited from patients attending other hospital clinics. Diabetes was strongly associated with subsistence farming, odds ratio=3.5 (95% confidence interval: 1.5-7.8) and illiteracy/low levels of education, odds ratio=4.0 (2.0-8.0). Diabetes was also linked with a history of childhood malnutrition, odds ratio=5.5 (1.0-29.0) the mother's death during childhood, odds ratio=3.9 (1.0-14.8), and markers of poverty including poorer access to sanitation (P=0.004), clean water (P=0.009), greater overcrowding (P=0.04), increased distance from the clinic (P=0.01) and having fewer possessions (P=0.01). Compared with controls, people with diabetes had low mid upper arm circumference, body mass index (BMI) and fat/lean body mass (P<0.01). In addition, men with the disease tended to be shorter, were lighter (P=0.001), with reduced sitting height (P=0.015) and reduced biacromial (P=0.003) and bitrochanteric (P=0.008) diameters. Insulin-requiring diabetes in Ethiopia is strongly linked with poor education and markers of poverty. Men with the disease have associated disproportionate skeletal growth. These findings point towards a nutritional aetiology for this condition although the nature of the nutritional deficiency and its timing during growth and development remains obscure.

Insulin-requiring diabetes in rural Ethiopia: should we reopen the case for malnutrition-related diabetes?

We evaluated the incidence of insulin-requiring diabetes in a rural area of sub-Saharan Africa. Health surveillance data from a chronic disease programme in two zones of Ethiopia, Gondar and Jimma, were studied. The two zones have a population of more than 5,000,000 people. In Gondar Zone (1995-2008) and Jimma Zone (2002-2008) 2,280 patients presented with diabetes, of whom 1,029 (45%) required insulin for glycaemic control at diagnosis. The annual incidence of insulin-requiring diabetes was 2.1 (95% CI 2.0-2.2) per 100,000 and was twice as high in men (2.9 per 100,000) as in women (1.4 per 100,000). In both sexes incidence rates peaked at the age of 25 to 29 years. Incidence rates in the urban areas of Gondar and Jimma were five times higher than in the surrounding rural areas. Patients with insulin-requiring diabetes from rural and urban areas had a very low BMI and most were subsistence farmers or unemployed. The typical patient with diabetes in rural Ethiopia is an impoverished, young adult male with severe symptoms requiring insulin for glycaemic control. The low incidence rates in rural compared with urban areas suggest that many cases of this disease remain undiagnosed. The disease phenotype encountered in this area of Africa is very different from the classical type 1 diabetes seen in the West and most closely resembles previous descriptions of malnutrition-related diabetes, a category not recognised in the current WHO Diabetes Classification. We believe that the case for this condition should be reopened.

A sub-Saharan African perspective of diabetes

Diabetes mellitus is an important and increasing cause of morbidity and mortality in sub-Saharan Africa. Accurate epidemiological studies are often logistically and financially difficult, but processes of rural-urban migration and epidemiological transition are certainly increasing the prevalence of type 2 diabetes. Type 1 disease is relatively rare, although this may be related to high mortality. This diabetic subgroup appears to present at a later age (by about a decade) than in Western countries. Variant forms of diabetes are also described in the continent; notably 'atypical, ketosis-prone' diabetes, and malnutrition-related diabetes mellitus. These types sometimes make the distinction between type 1 and type 2 diabetes difficult. Interestingly, this is also a current experience in the developed world. As more detailed and reliable complication studies emerge, it is increasingly apparent that African diabetes is associated with a high complication burden, which is both difficult to treat and prevent. More optimistically, a number of intervention studies and twinning projects are showing real benefits in varying locations. Future improvements depend on practical and sustainable support, coupled with local acceptance of diabetes as a major threat to the future health and quality of life of sub-Saharan Africans.

Dietary Counseling Versus Dietary Supplements for Malnutrition in Chronic Pancreatitis: A Randomized Controlled Trial

Up to 50% of patients with chronic pancreatitis (CP) are malnourished. There are limited data on the role of dietary intervention in improving the nutritional status of such patients. The aim was to compare the efficacy of medium chain triglyceride (MCT)-enriched commercial dietary supplements with dietary counseling for homemade food in the management of malnutrition in patients with CP. In a randomized controlled trial, consecutive undernourished patients with CP (body mass index [BMI] <18.5 kg/m(2)) at a tertiary care hospital were randomized to receive either dietary counseling for regular homemade food or commercial MCT-enriched dietary supplements for a period of 3 months to compensate for the dietary calorie deficit. All patients received standard management for CP including pancreatic enzyme supplements. Primary outcome measure was improvement in BMI. Sixty malnourished patients with CP were randomized to counseling group (n = 29; mean age, 32 +/- 10 years; male, 83%) and supplementation group (n = 31; mean age, 28 +/- 10 years; male, 84%). BMI increased in both the counseling group and supplementation group (17.2 +/- 1.7 vs 18.1 +/- 1.8 kg/m(2), P = .001; 16.7 +/- 1.6 vs 18.2 +/- 1.6 kg/m(2), P = .001). There were similar improvements in triceps skinfold thickness, dietary intake, fecal fat, and pain score during a period of 3 months in both groups. There was, however, no significant difference between the counseling and supplementation groups with regard to any of the outcome measures. Dietary counseling for a balanced homemade diet is as good as commercial food supplements in improving malnutrition in patients with CP.

No association of SUMO4 M55V with autoimmune diabetes in Asian‐Indian patients

Autoimmune diabetes [type 1 diabetes mellitus (T1DM), latent autoimmune diabetes in adults (LADA) and part of malnutrition-related diabetes] has been shown to have genetic predisposition. Studies in IDDM 5 have lead to the discovery of a novel polymorphism 163 A-->G, of SUMO4 (small ubiquitin-related modifier) gene, associated with risk to T1DM in Asians, but not in Caucasians. We studied patients with T1DM (n = 134), patients with LADA (n = 101), patients with malnutrition-modulated diabetes mellitus (n = 66) and patients with fibrocalculous pancreatic diabetes (n = 43) and healthy controls subjects (n = 114) from Cuttack, India. Polymerase chain reaction-sequence-specific primer (PCR-SSP) was used to amplify the 163 A-->G sequences. Restriction fragment length polymorphism (RFLP) was performed using restriction enzyme Taq I (PCR-RFLP). Differences in the allelic frequencies of the A and the G alleles were tested statistically using Fisher's exact test or chi-squared test wherever appropriate. P-values were considered significant when equal to or less than 0.05. No significant association was detected between SUMO4 M55V and T1DM susceptibility in Asian-Indians. Comparison of the A and G alleles with HLA DR3-DR4 did not result in any significant P-values. No significant association was found between SUMO4 M55V and LADA or malnutrition-related diabetes mellitus (MRDM). Our results show that Asian-Indians with T1DM are different from other Asian populations. Asian-Indians show more similarity to Caucasians with respect to the association of SUMO4 M55V variant in T1DM. Association studies on Asian-Indian patients with LADA and MRDM showed no significant difference in the presence of the A and the G alleles when compared to healthy controls.

Immunogenetic studies on malnutrition-modulated diabetes mellitus.

Genetic studies of malnutrition-related diabetes are few. We have analyzed the HLA class II gene polymorphism in malnutrition-modulated diabetes mellitus (MMDM), which was previously referred to as protein-deficient diabetes mellitus (PDDM) in the 1985 WHO classification. Insulin-dependent diabetes mellitus (IDDM) is a polygenic disorder with an autoimmune basis for disease development. In addition to HLA, a second susceptibility locus for IDDM has been identified to lie in the major histocompatibility class III region. Both IDDM and MMDM in eastern Indians are associated with DR3-DQ2 but not DR4-DQ8. The presence of autoantibodies to IDDM autoantigens in clinical MMDM either identifies the slow-onset form of IDDM or suggests autoimmunity different from that in IDDM. Our study demonstrates that the presence of GAD65 antibody and DR3-DQ2 positivity in MMDM patients identifies the underlying autoimmune mechanism in the etiology in eastern India. In autoantibody-negative MMDM patients an association with DR7-DQ2 is identified. The date obtained also indicate the possibility that MMDM can coexist with IDDM in these patients and that malnutrition could be one of the reasons for the slower onset in IDDM-prone individuals. The association of DR7-DQ2 suggests that there is a different immunogenetic background to MMDM than to IDDM. MICA is located in the MHC class I region and is expressed by monocytes, keratinocytes, and endothelial cells. Sequence determination of MICA gene identifies trinucleotide repeat (GCT) microsatellite polymorphism in exon 5. Five alleles with 4, 5, 6, and 9 repetitions of GCT or 5 repetitions of GCT with 1 additional nucleotide insertion (GGCT) are identified. The alleles are A4, A5, A5.1, A6, and A9. We studied the association of MICA alleles with IDDM (n = 52) and MMDM (n = 41) patients and healthy controls (n = 73) from Cuttack, eastern India. MICA was typed by PCR amplification, and fragment sizes were determined in an ABI prism DNA sequencer. Allele 9 of MICA is positively and allele 4 negatively associated with MMDM patients compared to controls. Allele 5 is positively associated with IDDM (OR 2.64, P < 0.05) when compared to controls. Our findings suggest that MMDM is immunogenetically different from IDDM in eastern India and that MIC-A is important in the pathogenesis of MMDM patients from Cuttack in eastern India.

Effect of Wainan Rogo on body weight and plasma glucose in Wistar rats.

Wainan Rogo (WR) is a deep-fat fried dough made from grated fresh cassava. It was found in a cross sectional case-control study to have a risk factor 3.2 times higher in diabetic than non diabetic indigenes of Borno State of Nigeria. This study examines the chemical composition, and effects of WR on body weight and blood glucose in Wistar rats. The study found a higher fat and lower protein composition of the WR diet, and found a higher plasma glucose in the WR fed rats and a more significant weight loss in this group than in the control (CF) fed rats. The findings of this study seem to support the high risk for diabetes associated with WR in the cross sectional study. The chemical composition of WR and its effect on body weight and blood glucose are further discussed, with a call for further studies of the food as a marker in the search for the pathophysiology of Malnutrition-Related Diabetes Mellitus (MRDM).

Association of HLA class II alleles with different subgroups of diabetes mellitus in Eastern India identify different associations with IDDM and malnutrition-related diabetes.

Genetic studies of Malnutrition related diabetes are few. We have analyzed HLA class II gene polymorphism in different types of diabetes mellitus patients from Cuttack in Eastern India. Patients with insulin-dependent diabetes mellitus (IDDM), non-insulin-dependent diabetes mellitus (NIDDM) and malnutrition-related diabetes mellitus (MRDM), which is subdivided into protein-deficient diabetes mellitus (PDDM) and fibrocalculous pancreatic diabetes (FCPD), were studied and their associations with autoantibody markers. IDDM and PDDM were associated with DR3 and DQ2 but not DR4 and DQ8. FCPD was positively associated with DQ9 (A*0201-B*0303). The association of DQ9 with FCPD suggests differences in the genetic background for susceptibility between IDDM and MRDM in the Cuttack population. There is no association seen between HLA-DR-DQ and NIDDM patients from Eastern India. Clinical classification of diabetes into IDDM, NIDDM and MRDM does not identify the underlying pathological mechanisms. Presence of autoantibodies to IDDM autoantigens in clinical MRDM and NIDDM identifies the slow-onset form of IDDM. Due to the absence of autoantibody assays for diagnosis of IDDM in India, slow onset IDDM is not diagnosed and the patients are classified as NIDDM or MRDM. Our study demonstrates that the presence of GAD65 antibody and DR3-DQ2 positivity in MRDM and NIDDM patients in Eastern India would suggest the presence of slow-onset IDDM. Our data would indicate alternatively that MRDM can coexist with IDDM in these patients and malnutrition could be one of the reasons for the slower onset in IDDM-prone individuals.