A Cross-Sectional Study of Skeletal Muscle Strength, Work Done and Endurance Time in Underweight, Normal, Overweight and Obese Population
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A CROSS-SECTIONAL STUDY OF SKELETAL MUSCLE STRENGTH, WORK DONE AND ENDURANCE TIME IN UNDERWEIGHT, NORMAL, OVERWEIGHT AND OBESE POPULATION Dissertation submitted to THE TAMILNADU DR. M.G.R MEDICAL UNIVERSITY, CHENNAI – 600032 In partial fulfilment of the requirement for the degree of Doctor of Medicine in Physiology (Branch V) M.D. (PHYSIOLOGY) APRIL - 2020 DEPARTMENT OF PHYSIOLOGY COIMBATORE MEDICAL COLLEGE COIMBATORE – 14. UNIVERSITY REGISTRATION NO: 201715253 CERTIFICATE This dissertation entitled “A CROSS-SECTIONAL STUDY OF SKELETAL MUSCLE STRENGTH, WORK DONE AND ENDURANCE TIME IN UNDERWEIGHT, NORMAL, OVERWEIGHT AND OBESE POPULATION” is submitted to The Tamil Nadu Dr.M.G.R Medical University, Chennai, in partial fulfilment of regulations for the award of M.D. Degree in Physiology in the examinations to be held during May 2020. This dissertation is a record of fresh work done by the candidate Dr.SANDEEP.S, during the course of the study ( 2017 – 2020 ). This work was carried out by the candidate himself under my supervision. GUIDE: Dr.R.SHANMUGHAVADIVU. M.D., Professor and HOD, Department of Physiology, Coimbatore Medical College, Coimbatore – 14. PROFESSOR & HOD: Dr.R.SHANMUGHAVADIVU. M.D., Professor and HOD, Department of Physiology, Coimbatore Medical College, Coimbatore – 14. DEAN: Dr.B. ASOKAN M.S., M.Ch., Coimbatore Medical College & Hospital, Coimbatore – 14. DECLARATION I, Dr.SANDEEP.S solemnly declare that the dissertation entitled “A CROSS-SECTIONAL STUDY OF SKELETAL MUSCLE STRENGTH, WORK DONE AND ENDURANCE TIME IN UNDERWEIGHT, NORMAL, OVERWEIGHT AND OBESE POPULATION” was done by me at Coimbatore Medical College, during the period from June 2018 to June 2019 under the guidance and supervision of Dr.R.SHANMUGHAVADIVU M.D., Professor and Head of the Department, Department of Physiology, Coimbatore Medical College, Coimbatore. This dissertation is submitted to The Tamilnadu Dr. M.G.R. Medical University towards the partial fulfilment of the requirement for the award of M.D. Degree (Branch - V) in Physiology. I have not submitted this dissertation on any previous occasion to any University for the award of any degree. Place: Date: Dr.SANDEEP.S ACKNOWLEDGEMENT I express my sincere thanks to our respected Dean, Dr.B.ASOKAN M.S., MCh., Coimbatore Medical College, Coimbatore for permitting me to conduct the study. I thank Dr.C.LALITHA M.D., Vice Principal, Coimbatore Medical College, Coimbatore for her encouragement and suggestions in completing the study. I am extremely grateful to my beloved and respected Head of the Department of Physiology, Professor Dr. R.SHANMUGHAVADIVU, M.D., for her encouragement in helping me to take up this study. I express my heart - felt gratitude to her, for her moral support and encouragement throughout the conduct of the study and also during my post graduate course. I owe my sincere thanks to her. I will ever remain in gratitude to Dr.M.VIJAYALAKSHMI, M.D., Associate Professor, Department of Physiology for her valuable support and guidance for my study. My sincere thanks to beloved teachers Dr.S.Kavitha M.D., Dr.A.Abbas, M.D., Dr.A.Moorthy, M.D., Dr.E.S.Manikandan M.D., Dr.S.Kanchana Bobby M.D., Dr.P.Mohan.,M.D., Dr.S.Subhashini M.D., Mrs.D.RevathyM.sc., Dr.C.N.Angel Deepa, M.D., Dr.N.Latha M.D., Dr.K.Archanaa M.D., Assistant Professors, Department of Physiology for their valuable opinion and help to complete this study. I would like to thank all my tutors for their support in completing this study. My sincere thanks to our former Professor Dr.N.Neelambikai, M.D., former Associate Professors Dr.D.Selvam M.D.,D.C.H., Dr.B.Sujatha M.D.,D.A., Dr.R.Thenmozhi M.D.,D.C.P, former Assistant Professor Dr.S.Thenmozhi M.D., for their valuable opinion and help during the study. I immensely thank THE PRINCIPAL, Coimbatore Institute of Technology (CIT), Coimbatore for permitting me to conduct my study in their college premises. I would grossly fail in my duty, if I do not mention here of Students of Coimbatore Institute of Technology (CIT) who gave full cooperation while doing my study. My sincere thanks to all my fellow postgraduates for their involvement in helping me in this work. My family and friends have stood by me, during my times of need. Above all I thank the Lord Almighty for His kindness and benevolence. U R K U N D Urkund Analysis Result Analysed Document: Dr.SANDEEP.S THESIS.pdf (D57054979) Submitted: 10/15/2019 1:19:00 PM Submitted By: [email protected] Significance: 3 % Sources included in the report: https://www.arizona-horses.com/definitions/cheap-hydroxyzine-express/index.html https://www.pearson.com/content/dam/one-dot-com/one-dot-com/us/en/higher-ed/en/ products-services/course-products/marieb-10e-info/pdf/marieb-0321927028-chapter9.pdf https://quizlet.com/127551870/chapter-9-anatomy-flash-cards/ Instances where selected sources appear: 18 A CROSS-SECTIONAL STUDY OF SKELETAL MUSCLE STRENGTH, WORK DONE AND ENDURANCE TIME IN UNDERWEIGHT, NORMAL, OVERWEIGHT AND OBESE POPULATION CONTENTS CONTENTS S.NO CONTENTS PAGE NO 1 INTRODUCTION 01 2 AIMS AND OBJECTIVES 05 3 REVIEW OF LITERATURE 06 4 MATERIALS & METHODS 54 5 RESULTS 61 6 DISCUSSION 79 7 SUMMARY 86 8 CONCLUSION 87 9 BIBLIOGRAPHY 10 ANNEXURES ABBREVATIONS WHO World Health Organisation BMI Body Mass Index NCD Non Communicable Diseases MVC Maximum Voluntary Contraction ET Endurance Time WD Work Done MW Molecular Weight SR Sarcoplasmic Reticulum ECF Extra Cellular Fluid STS Sarcotubular System DHP Dihydropyridine receptor CICR calcium-induced calcium release SERCA Sarcoplasmic Endoplasmic Reticulum Calcium ATPase Ca2+ Calcium Mg+ Magnesium ATP Adenosine Tri Phosphate ADP Adenosine Di Phosphate nm Nanometre Ach Acetyl Choline CF Critical Frequency CO2 Carbon-di-Oxide RMP Resting Membrane Potential CK Creatine Kinase CP Creatine Phosphate INTRODUCTION INTRODUCTION Malnutrition refers to excesses, deficiencies or imbalance in a person's intake of energy and/or nutrients. The term Malnutrition addresses 3 broad conditions like undernutrition, micronutrient related malnutrition and overweight, obesity & diet related non-communicable diseases. The under nutrition includes wasting (low weight for height), stunting (low height for age), underweight (low weight for age) and deficiencies in vitamins and minerals. Under nutrition makes the children much more vulnerable to disease and death. Wasting is low weight for the height and it indicates recent and severe weight loss. Stunting is low height for the age and it indicates chronic or recurrent under nutrition.(1) Overweight and obesity is when a person is too heavy for his or her height. Abnormal or excessive fat accumulation can impair health. Overweight and obesity result from an imbalance between energy consumed (too much) and energy expended (too little). Globally, people are consuming foods and drinks that are more energy-dense (high in sugars and fats), and engaging in less physical activity. Every country in the world is affected by one or more forms of malnutrition. Combating malnutrition in all its forms is one of the greatest global health challenges. Women, infants, children and adolescents are at particular risk of malnutrition. Malnutrition increases health care costs, reduces productivity and slows economic growth, which can perpetuate a cycle of poverty and ill health. 1 Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person's weight in kilograms divided by the square of his height in meters (kg/m2). As per WHO classification, BMI of<18.5 is Underweight,>25 is Overweight and >30 is Obese. But as per Asia pacific guidelines, BMI of <18.5 is underweight, 23-24.9 is overweight and >25 is obese. In 2016, 13% of world adult population were obese. Overweight and obesity are linked to more deaths worldwide than underweight. In 2014, approximately 462 million adults worldwide were underweight, while 1.9 billion were either overweight or obese.(1) Energy imbalance between calories used and calories consumed becomes the fundamental cause of obesity and overweight. Non- communicable diseases (NCD) like diabetes, dyslipidemia stroke, heart disease, osteoarthritis increases, as the BMI increases. As the pandemic of overweight around the globe continues to rise, many countries face a double burden of over nutrition and undernutrition.(2) Adopted by the World Health Assembly in 2004, the "WHO Global Strategy on Diet, Physical Activity and Health" describes the actions needed to support healthy diets and regular physical activity. The Strategy calls upon all stakeholders to take action at global, regional and local levels to improve diets and physical activity patterns at the population level. These two conditions are associated with distinct types of public health problems. A significant increasing trend in the prevalence of overweight and obesity 2 among children and adolescents has been documented over the last few decades in the developed as well as in developing countries.(3) The most significant long-term consequences of childhood and adolescent overweight and obesity are their persistence into adulthood with all of the attendant health risks. Poor nutritional status during adolescent period is an important determinant of health status.(4) Undernutrition and stunting limits work capacity and endurance in both boys and girls. Early malnutrition would affect physical work capacity through a height, body mass and more specifically, muscle mass. Height in particular has most often been shown to be associated with work output, productivity or income.(5) Nutritional outcomes have important implications for health and development: thinness (poor nutrition) results in limiting school achievement and work productivity and gives rise to poor reproductive health outcomes; and obesity not only has an impact during adolescence but also across the life-course as a risk factor for Non- communicable diseases.(6) Muscle cell is an excitable tissue like neuron.