www.ijrhs.com Original Article ISSN (o):2321–7251

Anthropological status and prevalence of Type 2 Diabetes Mellitus in tribals and non-tribals of district of - Interim report Ramakrishna Chaturvedula1, Vishnu1, Dilip Rampure1, Vijay Bhaskar M2, Uday Bhanu.C3, Krishna CRPS3

1- Depart ment of General Medicine, Mamata Medical College, Khammam, A.P. 2- Department of Biochemistry, Mamata Medical

College, Khammam. 3- Research Consultants, Dhanavanthari Diabetic & Educational Society, Kothagudem, A.P. ()

Submission Date: 17-12-2013, Acceptance Date: 21-01-2014, Publication Date: 31-01-2014

How to cite this article: Vancouver/ICMJE Style

Chaturvedula R, Vishnu, Rampure D, MBV, CUB, CRPS K. Anthropological status and prevalence of Type 2 Diabetes Mellitus in tribals and non-tribals of of Andhra Pradesh - Interim report. Int J Res Health Sci [Internet]. 2014 Jan31;2(1):335-9. Available from http://www.ijrhs.com/issues.php?val=Volume2&iss=Issue1

Harvard style Chaturvedula , R., Vishnu., Rampure, D., M.B.V., C.U.B., C.R.P.S, K. (2014) Anthropological status and prevalence of Type 2 Diabetes Mellitus in tribals and non-tribals of khammam district of Andhra Pradesh - Interim report. Int J Res Health Sci. [Online]

2(1). p. 335-9 Available from: http://www.ijrhs.com/issues.php?val=Volume2&iss=Issue1

Corresponding Author:

Dr.Ramakrishna Chaturvedula, Department of General Medicine, Mamata Medical College & General Hospital, Khammam. Andhra

Pradesh . Email: [email protected]

Abstract: The cross sectional study was conducted among the tribes & non tribes of khammam district where in the tribal predominantly koyas, lambadis, konda reddys contribute 13% of total district population. The study is aimed to determine the anthropological status & prevalence of type2 diabetes (pre diabetic& diabetic status) in this population who reside in the remote corner of district they have their own life style specific customs and predominantly survive on forest food with high consumption of self brewed toddy as a comparable brew the non tribals residing in same area have been studied as separate group. Total number of 363 tribals and non tribals were included during peripheral health camps conducted in the tribal villages of namely Sitampeta and Edugurapally located in remote corners of khammam district. Lambadis (189,52.8%), koya tribals (140,38.5%) and non tribals( 34,9.13%) were subjected to all antropometric measurements (stature, weight, waist circumference, hip circumference, skin fold thickness by Harpenden calipers). Nutritional status BMI & individual groups categorized into under nourished (BMI <18.5%) normal nourished (18.5- 25.5) and over nourished (BMI>25%) as per WHO criteria random blood sugar was measured in all individuals by single prick glucometer (RBS>140mg was considered pre diabetic and more than 200 considered diabetic) systolic and diastolic blood pressures were recorded by standard sphygmomanometer. 40% tribals were under weight while 10% were over weight in both Koyas & Lambadas, 44% of nontribals were overweight with 11% being under weight. lambadi & koya tribal males showed high systolic BP as compared to females Males and females in both the tribes have similar nutritional status surprisingly lambada & koya females shows higher mean RBS levels compare to males. The systolic BP in tribal males was more than the females. The prevalence of diabetes among tribals is almost similar to the prevalence in the rural areas, while the prediabetic status is high and fast approaching semi urban status. The total number of diabetics in these

International Journal of Research in Health Sciences. Jan–Mar 2014 Volume-2, Issue-1 335 Ramakrishna Chaturvedula et al - Anthropological status and prevalence of Type 2 Diabetes Mellitus in tribals www.ijrhs.com

areas are 18 (4.95%) while 42 (11.57%) were in the prediabetic state. The Lambadas have more propensities to develop diabetes and a significant number of this tribe, found to be prediabetic state (11.11%) followed by the Koyas (10%) while the non-tribals have the maximum number in prediabetic state (20.5%). The Numbers detected to be diabetics are 15 (4.13%) in tribals and 8.8 % in non tribal groups. The lambada tribals have more tendency to develop DM and significant number of this tribe are in prediabetic state while koyas show 10% prediabetic incidence the greater incidence of prediabetic and diabetic status in non tribal population residing in same. Geographical area is probably due to sedentary life style economic prosperity as the majorities are traders, employees and contractors. The prediabetic prevalence is 20% in far with any urban city in India. The notable point is the prediabetic accounts for 4.34% while nearly detected diabetic’s accounts for 5.79% in under nourished group. While a significant 20.5% are seen in overweight group. While the non urban group are comparable to urban dwellers, the predominant prediabetic status in the tribals is the under nourished group is probably attributed to pancreatic beta cell dysfunction, while insulin resistance can explain the prediabetic and diabetic status in the overweight group. Analysis of more tribals and non tribals will clarify the situation and detailed individual evaluation is required for better understanding. This is an ongoing project and around 2000 tribals and non tribes will be scanned in next six months. This study was sponsored by Mamata Medical College, Khammam and Dhanvanthri Research & Educational Society, Kothagudem, Andhra Pradesh, India.

Key words: Body Mass Index; Diabetes Mellitus; Systolic Blood pressure; Tribals

Introduction The main tribes in Khammam district A total number of 363 individuals with tribal comprising of over 13 % of total population are Lambadas constituting 189 (52.8%), tribal Koyas 140 predominantly Koyas, Konda reddies and Lambadas. (38.5 %) and the rest by Non tribal population 34 (9.13 Each one of these tribes lives in their own habituation %) were screened in two peripheral community based and follows their own specific customs, lifestyle and medical camps in the remote hamlets namely Sitampeta nutrition. The individual tribes are easily separated from and Edugurapally villages of Khammam district. This one another by characteristic anthropological study was carried with the prior approval from the differences. Lambadas (Sugalis) were nomadic by Institutional Ethics Committee, Mamata Medical nature, collect and sell forest produce, reside in hamlets College, Khammam. called Tandas, more advanced than other tribes with These individual tribals and non tribals were colourful attire and they are believed to be descendants assessed for their anthropological and nutritional status of Europeans and settled in rugged mountains of individually belonging to age group 18-60 years of both Afghanistan and migrated to deccan pleateu of Andhra sexes. Random blood sugar was also estimated for every Pradesh. Whereas, Koyas constitute 80% of tribal individual and RBS>140mg% was considered to indicate population and are fully dependent on forest products. a prediabetic state. Anthropological status was assessed Sorghum is staple crop along with rice, tobacco and by their stature, waist circumference & skin fold roots (‘Keski dumpa’ and ‘Karsi dumpa’) these roots are thickness and percentage of fat. Every individual cut and kept in running water for 3 days and boil to attending the camp were subjected to anthropometric make them edible and these roots form the main measurements: sustenance food. During toddy palm season, every Koya Stature, weight, waist circumference, hip family live mainly on palm juice which is consumed in circumference, and skin fold thickness BMI (Body mass community and called a ‘gujjadis’.Koyas are not yet index) , WHR (waist hip ratio), WSR (waist stature urbanized compared to adjacent towns. Both women and ratio) were computed by using Standardized measuring men consume brew from a special flower called “Ippa”. tapes, weighing and stature measurement scales and The Kondareddies live in thick forests and high Harpenden Calipers were used. Random blood sugar mountains [1,3]. was measured by single Prick Glucometer. Blood pressure both systolic and diastolic was measured by Materials and Methods standard Sphygmomanometer. A cross sectional study was conducted among Nutrition status was evaluated by using WHO adult Tribal and non tribal population of Khammam guide lines. District comprising of Lambadas, Koyas & Konda Under nutrition : BMI < 18.5 Reddys, residing in the same geographical area were Normal nutrition : 18.5 – 25.0 included. Over nutrition : BMI > 25

International Journal of Research in Health Sciences. Jan–Mar 2014 Volume-2, Issue-1 336 Ramakrishna Chaturvedula et al - Anthropological status and prevalence of Type 2 Diabetes Mellitus in tribals www.ijrhs.com

Results A total number of 180 Lambadas & 140 Koyas The above data from Koya tribals show both the genders were selected randomly based on the people attending a having similar anthropometrical characteristics. The tribal health camp along with 34 non tribals residing in males tend to higher systolic blood pressure and higher the area were included in this study and depicted gender average RBS levels as compared to females. wise. As the number of Kondareddies were very few they have been excluded in this study. The present study Table 3: Anthropological and physiological showed that, Lambadas and koya males and females characteristics of Koya tribals have similar anthropometric measurements. This may be

attributable to equal physical activity and similar nutrition intake (Table 1 and Figure 1).

Table 1: Distribution of various groups of individual based on tribe wise and gender wise Group Total Male Females

Lambadas 189 (52.8%) 70 (37.03%) 119 (62.07%)

Koyas 140 (38.5 %) 63 (45%) 77 (55 %)

Non tribals 34 (9.3 %) 15(44.11%) 19 (55.88%)

Total 363 152 (40.86%) 230 (59.13%) Table 4: Anthropological and physiological characteristics of Lambada tribals Results from present the study on BMI clearly From the present study, the data among the Lambada showed that Lambada & Koya females are more tribals show a similar pattern as seen in Koyas. undernourished when compared with respective males, while overall prevalence of undernourishment is 40% in both tribes. The nutritional statuses as determined on the basis of BMI showed that almost 35 – 40 % of the tribal’s were underweight while less than 10% were overweight. The nontribal population had the highest proportion of overweight patients (44.11) with 11 % being undernourished (Table 2 and Figure 2).

Table 2: BMI based Nutritional status between tribes & non tribes Type Under Normal Overweight

nourished Table 5: Anthropological and physiological characteristics of Non tribals Lambadas 36.50 55 8.50

Koyas 39.4 52 8.60

Non tribals 11.66 44.23 44.11

International Journal of Research in Health Sciences. Jan–Mar 2014 Volume-2, Issue-1 337 Ramakrishna Chaturvedula et al - Anthropological status and prevalence of Type 2 Diabetes Mellitus in tribals www.ijrhs.com while the non tribal’s have the maximum number in pre The data among the Non tribes show a similar pattern diabetic state (20.5%). The Numbers detected to be but weigh more with greater BMI and much higher RBS diabetics are 15 (4.13%) in tribal’s and 8.8 % in non levels while surprisingly the blood pressure levels are tribal groups. The total Number of diabetics detected in lower as compared to tribal’s. these areas are 18 (4.95% while 42 (11.57%) were in the prediabetic state. Table 6 (a): Comparative physical & physiological analysis in Male Tribes & Non tribes Table 8 : Prevalence of Diabetes / Prediabetes based on BMI Caste BMI GM WS FA WH Systolic Diastoli RBS BMI < BMI BMI > Total (Kg/M T R T R BP (mm c (mg/d 18.5 25 2) (m % hg) BP(mm l) (18.5 – m) hg) 25.0) Lamba 20.9 4.13 0.34 88.0 1.04 142.2 87.5 140.2 Groups Lambadas da M M F M F M F Koya 21.11 4.30 0.32 87.1 0.87 162.5 82.5 152.7 F Non- 24.34 4.59 0.36 87.6 0.89 130.3 84.66 151.7 PD 1 2 0 0 7 11 8 11 tribes DM 2 2 0 0 3 2 5 4

Table 6 (b): Comparative physical & physiological Koyas analysis in female Tribes & Nontribes PD 3 2 0 0 4 5 7 7 Caste BMI GM WS FAT WH Systoli Diastoli RBS

(Kg/M T R % R c BP c (mg/ DM 2 1 0 0 2 1 4 2 2) (m (mm BP(mm dl) m) hg) hg) Non tribals Lambad 19.84 3.89 0.34 84.54 0.82 122.5 84.5 69.17 PD 1 0 0 0 2 3 3 3 a DM 0 0 0 0 1 1 1 1 Koya 18.98 4.04 0.34 83.23 0.83 117.5 70 72.30 nontribe 21.48 4.32 0.38 80.0 0.84 124.2 77.6 160.7 s The notable point in the above table is that prediabetics account for 4.34 % while newly detected diabetics accont for 5.79 % in the Lambadas in undernourished group while significant number are Summary data of the tribals demonstrate the same 23/180 in the over nourished group. Similar pattern is observations as detailed above. observed in the koya tribals. While the non urban group Table 7: Total number of Diabetics and Pre-diabetics in show predominant overweight pre & established Tribals & Non tribals diabetics (Table 8). Pre- Diabetic diabetics Discussion Group Total No (RBS > (RBS > 140 200mg%) The prevalence of diabetes among the tribal’s is mg%) almost similar to prevalence in rural area while the Lambada 189 21 (11.11 %) 09 (4.76 %) prediabetics significantly high and fast approaching the Koyas 140 14 (10 %) 06 (4.2 %) semi urban areas. Due to the routine lifestyle and increased physical activity and lower BMI, prediabetic Non tribals 34 07 (20.5 %) 03 (8.8 %) & diabetic status were expected to be lower as these populations are considered to be the least possible to The above table (Table 7) shows that the have metabolic syndrome. This may be attributable to Lambadas have more propensity to develop diabetes and changing lifestyles of the tribal population with possibly a significant Number of this tribe are found to be insulin resistance coming into picture in overweight prediabetic state (11.11%) followed by the Koyas (10%) tribal’s [4-6]. The non tribal’s in the area are

International Journal of Research in Health Sciences. Jan–Mar 2014 Volume-2, Issue-1 338 Ramakrishna Chaturvedula et al - Anthropological status and prevalence of Type 2 Diabetes Mellitus in tribals www.ijrhs.com

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