|  | Member's News | No.51 September 2007 |

Kinanthropometry, Physical Activity and Socio-Economic Cost of Diabetics in Kathmandu Diwakar Lal Amatya & Prof. Marina Goris |
Introduction The term diabetes mellitus describes metabolic disorder of multiple etiologies, characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs. There are mainly three types of diabetes: type 1, type 2, and gestational diabetes. The most common form of diabetes is type 2 diabetes. This form of diabetes is most often associated with old age, obesity, family history, previous history of gestational diabetes and physical inactivity. About 80 percent of people with type 2 diabetes are overweight. The disease often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations and nerve damage. Healthy eating, physical activity and blood glucose testing are the basic management tools for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels. The number of people diagnosed with diabetes has exploded in the past several decades. In 2000, it was estimated that 151 million persons worldwide had diabetes. At the current rate of increase, it has been projected that 221 million persons will be affected by 2010 and 324 million by 2025; most of these cases will be type 2 diabetes (1). It has been shown that regular physical activity increases insulin sensitivity and glucose tolerance. Moreover it has been recently shown that physical activity reduces the risk of type II diabetes. In an African American population in the United States it was observed that the prevalence of diabetes increases with the degree of inactivity and obesity. Obesity has been implicated as a risk factor for Type II diabetes and obesity is present in about 80% of type II diabetes patients. Body Mass Index is directly associated with increase risk of Type II diabetes in many ethnic groups (2). The prevalence of obesity has reached epidemic levels worldwide, and the related health risks of excess adiposity are well recognized by the medical community (3, 4). Specifically, waist circumference (WC) provides a simple and practical anthropometric measure for assessing central adiposity (5–9), and an increasing number of studies are reporting strong associations between WC, visceral adipose tissue, and obesity-related health risks (10- 18). Obesity and physical inactivity are well-established risk factors for the development of type 2 diabetes. It is estimated that for every 1-kg increase in weight, the prevalence of diabetes increases by 9%. Physical inactivity is associated with increased insulin resistance and poorer glycemic control independent of body weight. Physical activity is particularly important for the prevention and management of type 2 diabetes and its related morbidities. Epidemiological studies have shown that physical activity reduces the risk of type 2 diabetes by 30% in the general population (19). In one of the recent studies done in Nepal by Shrestha and his colleagues (20), have indicated that diabetes and hypertension are significant and related public health problems in those aged = 40 years in urban areas. As more than 80% of the total (approximately 23.02 million) population in Nepal resides in rural areas, the overall prevalence of diabetes and hypertension would not be high in the country as a whole, but there is an increasing trend of urbanisation along with population increase in the urban areas. According to the Nepal Diabetes association website out of all population, prevalence of diabetes in Urban and Rural areas is 14.6% and 2.5% respectively in the people more than 20 years and above in Nepal. Using either or both Fasting Plasma Glucose (FPG) and post-glucose 2-hour Plasma Glucose criteria, the prevalence of diabetes (diagnosed and undiagnosed) in population over 40 years in urban population in Nepal was 19.07% (21). The rapid increase in the prevalence of diabetes appears to have been greatly influenced be lifestyle changes associated with socio-economic development and urbanisation. The increase in diabetes and obesity in urban areas of Kathmandu may soon be a greater public health problem than infectious and/ or inflammatory diseases (22). The primary aim of this study was to investigate the anthropometric status of diabetic patients in Kathmandu, cardio-vascular fitness, the socio-economic impact in the society and the association between various variables for the diabetic condition. Materials and Methods The data for this study had been collected from diabetic patients around Kathmandu Valley. Patients were informed by pamphlets, posters and personal phone calls. On 17th March, 2007 Free Diabetes Camp was organized for collecting all the necessary data for this study. The camp was organized in the National Stadium in Kathmandu. Ross Craft anthropometric equipments skinfold caliper, small sliding caliper and steel tape (Canada) were used for measurement of all the anthropometric measurements and Standard procedures were followed prescribed by International Society for the Advancement of Kinanthropometry (ISAK). A&D UC-300 Precision Health Scale (Japan) Strain Gauge set for Altitude and Latitude adjusted weighing machine was used for measuring body weight (Digital). Body weight was measured to the nearest 0.1 kg and height to the nearest 0.1 cm using calibrated scales and stadiometers. BMI was calculated as weight divided by height squared. All the anthropometric calculation had been done by using “Life Size Educational Computer Software” developed by Human Kinetic. Body fat percent had been calculated by fractionation method (23). For Cooper test international standard 400 meter track was used and total distance was measured to the nearest 100 m and then Max VO2 has been estimated by Phil Henson equation (24). Assistance of medical doctors was taken for taking interviews with the diabetic patients. Blood Sugar was analyzed in Hardic Life Style Clinic-Lalitpur. Blood Pressure has been measured by “Aneroid Sphygmomanometer-Japan". BMI was calculated as weight in kilograms divided by the square of height in meters. In the present study descriptive statistical tools such as mean and standard deviation were applied to analyze the data. For the comparison between men and women Students "t" test was applied. Correlation Matrix has been calculated to find out the relation between different variables. Results The primary study aim was to study the anthropometric status of diabetic patient in Kathmandu, cardio-vascular fitness, socio economic impact in society and the association between various variable for the diabetic condition. Altogether 92 diabetic subjects (59 men and 33 women) attended the camp and were all under medication (Table 1-3). They came with their own interest for check-up. Table 1 - Age, height and weight of diabetic men in Kathmandu Table 2 - Age, Height and weight of diabetic women in Kathmandu Table 3 - Average blood pressure, blood sugar, percent body fat and BMI of diabetic men in Kathmandu S.N. Age (Years) Blood Pressure Blood Sugar (mg %) % Body Fat BMI The mean blood pressure of the diabetic patients in Kathmandu has been observed between 127 to 136 mmHg for SBP and 85 to 88 DBP (Hypertension140/90 mmHg in adults). Since all of the subjects have diabetes and taking medicines regularly, their average fasting blood sugar has been observed between 103. 37 mg % (± 4.69) to 118.38 mg % (± 24.45) for different age groups. It is note worthy to observe that diabetic people over 60 years were seen with less percent body fat 23.8 % ± 7.67 and less BMI 24.4 (±1.22) than the other age category (Table 3). Table 4 - Average blood pressure, blood sugar, percent body fat and BMI of diabetic women in Kathmandu For the all women subjects, average blood pressure, fasting blood sugar level , percent body fat and BMI were observed with 129 ±9.68 (SBP) , 88.03 ± 6.61 (DBP) , 119.86 ± 20.28 (mg %), 31.2 (±5.18) and 27.4 (± 3.99) respectively (Table 4). Skinfold Pattern The skinfold pattern of diabetics of Kathmandu has been studied. The skinfolds studied in this study are; triceps, sub scapular, biceps, supraspinale, abdomen and medial calf. The fat folds were found to be of greater thickness at the trunk region and thinner at the limbs. Figure 1 - Average skinfold pattern of men and women diabetics in Kathmandu The minimum average skinfold value of men was noted at the medial calf (9 mm ±4.0) biceps (9.2 mm ± 4.1) and the maximum at abdomen 31.1 mm (±10.9) site (Figure 1). Similar characteristics have been observed in the women diabetics where earlier with higher values then the men. Apart from subscapular and abdomen skinfolds women were having greater skinfold thickness at triceps (20.5 mm ± 5.6), biceps (11.7 mm ±3.8), supraspinale ( 23.1 mm ± 7.5) and medial calf (16.4 mm ±5.8) than the men counterparts. Somatotype of Diabetic Patients in Kathmandu Somatotype is the quantification of the present shape of the human body. It is expressed in a three number rating representing endomorphy (the relative adiposity of a physique), mesomorphy (the relative musculo-skeletal robustness of a physique) and ectomorphy (the relative linearity or slenderness of a physique) respectively and always in the same order. Table 5 - Somatotype of diabetic patients of Kathmandu n Endomorph Mesomorph Ectomorph Diabetes patients in Kathmandu are generally possessed with high rating in endomorph rating. Their average rating is 6.28 (± 1.50) and 7.01 (± 1.37) for men and women respectively (Table 5). In Mesomorph they were observed with moderate ratings with 4.94 (±1.48) and 3.95 (±1.17) for men and women respectively. In Ectomorph they were observed with very low ratings 1.30 (±1.07) and 0.56 (±0.71). In general Diabetics in Kathmandu can be categories as Mesomorphic endomorph, where endomorphy is dominant. Cooper Test Performances and Maximum Oxygen Capacity Fitness can be measured by the volume of oxygen one can consume while exercising at one’s maximum capacity. VO2 max is the maximum amount of oxygen in milliliters, one can use in one minute per kilogram of body weight. Table 6 - Cooper test and maximum oxygen capacity of diabetics in Kathmandu There is a trend of gradual decrease in the cooper test performance (distance covered in 12 minutes) from 1354 meters (± 110.8) for the age group 30 to 39.99 to over 60 years group (1172.3 m ± 83.02) in the men section and similar trend can be observed on the women’s groups also (Table 6). As the distance decreases it is natural that corresponding maximum oxygen capacity do shows a similar trend. Conclusion can be drawn that diabetics in Kathmandu have very low cardiovascular fitness according to latest cooper cardio respiratory fitness test norms (25). Diabetes Background, Medication, Women’s Attitude and Physical Activity Participants of the diabetes camp were briefly interviewed about their Diabetes background, medication, women’s attitude and physical activity. Altogether 19 questions were asked to them. According to men diabetic respondents 22 % of them were suffering this condition less then 5 years, 55.93 % were living between 5 to 10 years and 22 % men were living more than 10 year with this diabetic condition. Out of 33 women respondents, more than 54 % are living with diabetic condition more then 5 years and less than 10 years, 30.3 % respondents had expressed that they are living with more than 10 years and 15.15 percent of them were living less than 5 years. Along with diabetes condition, 44.07 % of the men and 36.36 % of the women had expressed with blood pressure problem, 13.56 % of the men and 21.21 % of the women have Osteoarthritis, 5% men have heart problem and 6.06 % women have COPD. Apart from diabetes 37.3 percent men and 33.33 percent women said they have no other Health problems. Only 32.2 % men and 39.4 % women had revealed that their parents are diabetic. Among diabetic patients who visited the camp, 50.6 % men and only 6.06 % women did smoke. Among these participants, 69.5 % men do drink alcohol but on the contrary 87.9 percent women does not. Medication Cost Majority of the diabetic patients do blood sugar test once in every two months (40.68 % of men and 45.45 % of women). Around 31 % of the men and the women test their blood each month and remaining rest does it every three months. Per blood sugar test, majority of the men (50.85 %) and the women (66.67%) respondents are paying more than 50 Rupees (1US$=65 Nepalese Rupees) and the rest of them are paying less than 50 Nepalese Rupees. The second step of the medication procedure is to visit the doctors to show their blood test report. 49.15 % the men and 51.52 % the women revealed that doctors are charging NRs 200 per visit. Other halves of the patients are paying more than NRs 200 per doctor visit. Since they are taking medicine regularly, 59.32 % of the men and 69.7 % of the women are spending NRs 500 per month for the medicine. The Rest of the patients do spend more than NRs1000.00 per month for medicine. Figure 2 - Monthly expenses for medication from their total income-men Most of the women who came to the camp are housewives. They do not have personal income and expenses are bared by their husbands. Among men, 96.6 % of them bear all these expenses by themselves and only 30.3 % of the women do bear these costs themselves. The cost for medication is big burden for the Nepalese people. According to the camp participants, 69.49 % of the men and 72.7 % of the women are spending 10 percent of their total income for the management of diabetic medications. 22 % of the men and 21.2 % of the women spent 5 % of their income for the medication. The rest of the diabetic patients spend 15 % or more for the medication form their total income. In the Nepalese society there is a custom of too much feeding with food rich in calories and fat after delivery of a child. Apart from this these women were not allowed to work physically inside or outside their home. So, women were asked to give their opinion on excess feeding after delivery. 51.1 % of the women had opinioned that excess feeding to women after delivery is good for their health. The Rest of the others said vice-versa. On the other side, 57.6% of the women had opinioned that doing exercise or household works are not good for the women after the delivery of a child. There is no doubt that exercise is very important in managing diabetes. Combining diet, exercise and medicine will help control one’s body weight and blood glucose level. Diabetic patients in the camp were asked for the details of their exercise habits. More than 50 percent respondents (55.03 % men and 51.52 %women) do have exercise habit. The others do not do any kind of exercises. Among the person with exercise habit, 51.5 % of the men and 70.6 % of the women do exercise for 60 minutes and 30 minutes respectively per day. Men diabetic patients do walking (78.8%), running (15.15%) and badminton (6 %) as the main choices during activities. On the other side all the women who did exercise (51.5 %) did only walking. Figure 3 - Do the doctors explain properly for exercise? As mentioned before, after blood test the diabetic patients do go to visit medical doctors for the medicine prescription and some other advices concerning food and exercises. Around 45 % out of all the respondents said doctors do not explain properly for exercises programs. Around two third of the diabetic patients expressed that they did not have disruptive sleep at night. 47.46 % of the men and one third of the women do sleep 7 hours and 6 hours respectively at night. 5 % of the men and 9.1% of the women have only 4 hours of sleep at night. Table 7 - Comparisons between men and women on different variables Students “t” Test has been applied for the comparison between men and women diabetics on different anthropometrical and other variables. There has been no significant difference between men and women on age, blood pressure, sugar level, sub-scapular, supraspinale, abdomen skinfolds, hip circumference and the sum of six skinfolds. Women are nearly 10 cm shorter in height then the men counterparts and the difference is significant. On endomorphy and triceps skinfold women diabetic have higher values then the males. It is natural that females do possess more % of fat in their body than their male counterparts. Women diabetics have 31.2 % body fat in compare to men with 26.55 % and the difference is highly significant. Others variables like mesomorphy, ectomotphy, waist circumference, Cooper test and max Vo2, the women have significantly lower values than the men. In BMI, biceps and medial calf skinfolds women have significantly greater average values than the male counterparts. Correlation Matrix of Different Variables Various correlations have been calculated among different anthropometrical and other variables. Table 8 - Correlation matrixes of Kathmandu diabetics on different variables - Men It has been observed that body weight had shown a fair correlation with % body fat (0.74), supraspinale skinfold (0.72), abdomen skinfold (0.73), and higher association on BMI (0.82), Waist (0.81) and Hip circumference (0.85) a men diabetics in Kathmandu. In the same way percent body fat had shown strong correlation with endomorphy (0.97), supraspinale (0.81). Body Mass Index (0.71) and abdomen skinfold (0.70) have fair association with % body fat. Endomorphy had shown higher association with supraspinale skinfold (0.88) and fair association with abdomen skinfold (0.72). Mesomorphy also had fair association with BMI (0.76). Table 9 - Correlation matrixes of Kathmandu diabetics on different variables -Women Similarly, women diabetics had shown strong and fair associations among different variables. It has been observed that body weight had shown a high correlation with BMI (0.83), waist circumference (0.79), and a fair association with hip circumference (0.70). Percent Body Fat had shown strong association with endomorphy (0.97), supraspinale skinfold (0.88) and fair association with BMI (0.71), abdomen skinfold (0.81). Endomorphy had shown higher association with supraspinale (0.88) and abdomen skinfold (0.77). Mesomorphy also had fair association with BMI (0.76). Discussion The present surveys study is an effort to describe the prevalence of anthropometric status, socio-economical and fitness related factors of diabetics in Kathmandu. The included population may consider as representative of middle class urban population in Kathmandu valley. So the obtained results may not be readily applied to the rest of the Nepalese population, for instance countryside populations, or populations from other regions of the country. In the present investigation, the most striking characteristics of age groups 30 - 39.99 and 40 - 49.99 men are having more blood pressure, sugar % body fat and BMI is found to be higher that older age groups. The main reason behind this might be using car and motor bikes of this age group. Taking into the consideration to BMI and % body fat, the studied population had a higher prevalence of being overweight and obese. The prevalence of hypertension in those with type 2 diabetes rises from 40% among those aged 45 years to 60% in those aged 75 years. Hypertension in diabetes further increases the already increased risk of cardiovascular disease, retinopathy, and microalbuminuria (26). The use of skinfold and anthropometric techniques on diabetics have been largely directed towards estimating the amount of subcutaneous fat in the body. Diabetics in Kathmandu are having enormous fat in their body. Women diabetics are having more skinfolds thickness than the men counterparts. Usually most of the women stay home doing house hold works whereas men goes outdoor. Definitely because of this reason men are physically more active than women in Kathmandu. Because of these reason high rating in endomorphy is natural. In San Diego, California somatotyped 47 Type II diabetic women aged 30 to 72 (> 140 mg/dl) by the Heath-Carter anthropometric method. The mean somatotype was 9.5 – 6 – 1, with 91.5 % dominating in endomorphy and 85 % meso-endomorphs (27). Endomorphs are large framed, heavy-set individuals with relatively low metabolic rates who find it extremely difficult to lose adipose tissue. They require fewer calories to maintain lean tissue and have a need for more rest days since the breakdown and rebuilding of muscle tissue does not occur as readily as for the other two types of somatotypes (28). Along with diabetes condition, prevalence of blood pressure and osteoarthritis are seen in Kathmandu. Marginal percentage diabetics have heart problem and COPD. Genetic relation is prevailed with 32.2 and 39.4 percent for men women respectively. 50.6 % men and only 6.06 % women diabetics do have smoking habit. Among these participants, 69.5 % men do drink alcohol but on the contrary 87.9 % women does not. Medication for the management of diabetes is becoming big burden for poor people in Kathmandu. Nearly 70 percent of Kathmanduites Diabetics are spending more than 10 percent of their total income for the management diabetes. Kathmanduites are paying money for every step from blood test to purchase of prescribed medicine. Very few can get reimbursement from their office or insurance companies. Social welfare or health insurance is in infant stage in Nepal. Medical treatment is a big business in Nepal and the government is helpless for the welfare of people. 51.1 % of the women had opinioned that excess feeding to women after delivery is good for their health. It’s very difficult to change their social custom and people’s mentality. Lots of Nepalese people still believe social rituals and forced to follow within society. Bhattarai and Singh in their study of 200 of urban Kathmandu have found body weight of 61.3 kg ± 4.9, 67.2 kg ± 6.3 and 63.4 ± 6.4 before the first pregnancy and 6 months and 1 year after delivery respectively. Similarly, the mean and ± SD of body mass index were 21.3 ± 1.8, 27.9 ± 2.5 and 26.7 ± 2.8 respectively for the same sample (29). More than 50 percent respondents do have exercise habits. Around 45 percent out of all the respondents say doctors do not explain properly for exercises. Doctors involved in treatment of diabetics need to acquire more knowledge for physical exercise and convince their clients more effectively. A greater reduction in cardiovascular disease risk would be anticipated by increasing either the duration or intensity of physical activity. Data from most weight loss studies suggest that 60–75 min of moderate intensity activity (e.g. walking) or 35 min of vigorous activity (e.g. jogging) daily is needed to maintain long-term weight loss (30). They have shown very low cardiovascular fitness with 25.9 ml/kg/min (± 1.76) for men and 24.01 ml/kg/min (± 1.76) for women. The reason behind this condition is that the women diabetics have more body fat % than the men. Londeree in his study on long distance runners had concluded that each one-percentage increase in percentage in fat, the Vo2 max decrease slightly more than one percentage (31). Christou et al. (32) observed that waist circumference, BMI, and total body fat were better predictors of insulin sensitivity, assessed with an intravenous glucose tolerance test, than VO2max in 135 men aged 20–79. Body fat distribution is also an important risk factor for obesity-related diseases. Excess abdominal fat (also known as central or upper-body fat) is associated with an increased risk of cardiometabolic disease. However, precise measurement of abdominal fat content requires the use of expensive radiological imaging techniques. Therefore, waist circumference (WC) is often used as a surrogate marker of abdominal fat mass, because WC correlates with abdominal fat mass (subcutaneous and intra-abdominal) and is associated with cardiometabolic disease risk (6). Men and women who have waist circumferences greater than 40 inches (102 cm) and 35 inches (88 cm), respectively, are considered to be at increased risk for cardiometabolic disease (33). There have been various stronger correlations among different variable of diabetics of Kathmanduites. Percent body fat had shown strong correlation with endomorphy, supraspinale. Body Mass Index and abdomen skinfold have fair association with % body fat in men. Body weight of women diabetics had shown high correlation with BMI, waist circumference. Percent body fat had shown strong association with endomorphy, supraspinale skinfold and fair association with BMI, abdomen skinfold. Endomorphy had shown higher association with supraspinale and abdomen skinfold. Conclusions Women diabetics have 31.2 percent body fat in compare to men (26.55%) and the difference is highly significant. On the basis of BMI and % body fat, the studied diabetics of Kathmandu population had a higher prevalence of overweight and obese. Women have greater skinfold thickness at triceps (20.5 mm ± 5.6), biceps (11.7 mm ±3.8), supraspinale (23.1 mm ± 7.5) and medial calf (16.4 mm ±5.8) in compare to men counterparts. Diabetics in Kathmandu are generally possessed with high rating in endomorph rating with average rating of 6.28 (± 1.50) and 7.01 (± 1.37) for men and women respectively. In mesomorph they were observed with moderate ratings with 4.94 (±1.48) and 3.95 (±1.17) for the men and the women respectively. Gradual decrease in cooper test performance has been observed from 1354 meters (± 110.8) for the age group 30 to 39.99 to over 60 years group (1172.3 m ± 83.02) in both men and women sections resulting very low cardiovascular fitness according to latest cooper cardio respiratory fitness test norms. Prevalence of high blood pressure and osteoarthritis are seen diabetics in Kathmandu. Genetic relation is prevailed with 32.2 and 39.4 % for men and women respectively. 50.6 of the men and only 6.06 of the women diabetics do smoking habit. Among these participants, 69.5 % of men do drink alcohol but on the contrary 87.9 % of the women do not. 57.6 % of the women had opinioned that doing exercise or household works are not good for the women after delivery a child. More than 50 percent respondents (55.03 of the men % and 51.52 % of the women) do have exercise habit. Approximately 45 % out of all the respondents say doctors do not explain properly for exercises. Doctors involved in treatment of diabetics need to acquire more knowledge for physical exercise and convince their clients more effectively. On variables like mesomorphy, ectomotphy, waist circumference, cooper test and max Vo2, women have less average values than the men and the differences are highly significant. Around two third of the diabetic patients expressed that they do not have disruptive sleep at night. Body weight had shown higher correlation with BMI, waist and hip circumference for men diabetics in Kathmandu. On the other side percent body fat had shown strong correlation with endomorphy, supraspinale. BMI and abdomen skinfold have fair association with % body fat. Body weight of the women diabetics had shown high correlation with BMI, waist circumference, and fair association with hip circumference. Percent body fat had shown strong association with endomorphy and supraspinale skinfold. Recommendations Since research literature on Nepalese diabetics is scarce, more research is needed on diabetes. Weight loss is recommended for all overweight and obese diabetics in Kathmandu through physical activity. Physical activity is an important component of a comprehensive weight management program. Regular, moderate intensity physical activity enhances long-term weight maintenance. Regular activity also improves insulin sensitivity, glycemic control, and selected risk factors for cardiovascular disease (i.e., hypertension and dyslipidemia), and increased aerobic fitness decreases the risk of coronary heart disease. The primary approach for achieving weight loss is lifestyle change and an increase in physical activity. Although medical doctors are advising to do physical activity more effective counseling efforts are necessary. More public education about the risk factors of diabetes and links with cardiovascular disease is needed in Nepal. Acknowledgement The investigator extends thanks to all the subjects for their kind cooperation and selfless support during the course of research. From Nepal, the investigator is grateful to National Sports Council and Nepal Athletics Association for their kind cooperation for providing office and stadium track for the conducting Diabetics camp. The investigator would remain thankful to Bimala Joshi (Amatya), Prakash Lal Shrestha, Chhitij Arun Shrestha, Prabin Tuladhar, Rajendra Tuladhar, Bhairab Shahi, Bulal Maharjan, Dhani R. Chaudhari, Dhurba Khanal, Shanta Bahadur Shrestha, Pradeep Maharjan, Prakash Maharjan, Bishnu Hari Dahal, Kopil Kumar Thapa, Dr. Pawan Shrestha and Dr. Om Singh for their help and cooperation while colleting data during the camp. References M. Christa, D. Angela, T. Barbara, H. Margit and L. Hannelore: Body fat distribution and risk of type II diabetes in the general population: are there differences between men and women? Am J Clin Nutr 84:483-9, 2006 A. Deghate, Schattner, P. and D. Earl: An Update on Etiology and Epidemiology of diabetes Mellitus.Ann. N.Y. Acad. Sci.1084/1-29 New York Academy of Sciences, 2006 Stamler J: Epidemic obesity in the United States. Arch Intern Med. 153:1040–4, 1993 Seidell JC. Obesity in Europe: scaling an epidemic. (2006) Int J Obes Relat Metab Disord; 19:S1– 4, 1995 Prentice AM and Jebb SA. Beyond body mass index. Obes Rev. 2001; 2:141–7 Goh VH, Tain CF, Tong TY, et al. Are BMI and other anthropometric measures appropriate as indices for obesity? A study in an Asian population. J Lipid Res. 45:1892– 8. 2004 Neovius MG, Linne YM, Barkeling BS, Rossner SO. Sensitivity and specificity of classification systems for fatness in adolescents. Am J Clin Nutr. 80:597– 603, 2004 Lean ME, Han TS, and Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ 1995; 311:158–61. Han TS, McNeill G, Seidell JC and Lean ME. Predicting intra abdominal fatness from anthropometric measures: the influence of stature. Int J Obes Relat Metab Disord. 21:587– 93, 1997 Despre´s JP, Prud’homme D, Pouliot MC, et al. Estimation of deep abdominal adipose-tissue accumulation from simple anthropometric measurements in men. Am J Clin Nutr.54:471–7, 1991 Hill JO, Sidney S, Lewis CE, et al. Racial differences in amounts of visceral adipose tissue in young adults: the CARDIA (Coronary Artery Risk Development in Young Adults) study. Am J Clin Nutr. 69:381–7, 1999 Sidney S, Lewis CE, Hill JO, et al. Association of total and central adiposity measures with fasting insulin in a biracial population of young adults with normal glucose tolerance: the CARDIA study. Obes Res. 7:265–72, 1999 Mokdad AH, Ford ES, Bowman BA, Nelson DE, Engelgau MM, Vinicor F, Marks JS: Diabetes trends in the U.S.: 1990– 1998. Diabetes Care 23:1278–1283, 2000 U.S. Department of Health and Human Services: Surgeon General’s report on physical activity and health, 1996. Available from http://www. cdc.gov/nccdphp/sgr/sgr.htm. Accessed 15 January , 2005 U.S. Department of Health and Human Services: The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. Rockville, MD, Public Health Service, Office of the Surgeon General, 2001 American Diabetes Association, National Institute of Diabetes, Digestive and Kidney Diseases: The prevention or delay of type 2 diabetes (Position Statement). Diabetes Care 26 (Suppl. 1):S62–S69, 2003 Franz MJ, Bantle JP, Beebe CA, Brunzell JD, Chiasson JL, Garg A, Holzmeister LA, Hoogwerf B, Mayer-Davis E, Mooradian AD, Purnell JQ, Wheeler M: Evidence based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications (Review). Diabetes Care 25: 148–198, 2002 Klein S, Sheard NF, Pi-Sunyer X, Daly A, Wylie-Rosett J, Kulkarni K, Clark NG, the American Diabetes Association, the North American Association for the Study of Obesity, the American Society for Clinical Nutrition: Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies: a statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Diabetes Care 27: 2067–2073, 2004 Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C: Physical activity/exercise and type 2 diabetes. Diabetes Care 27: 2518–2539, 2004 Morrato EH, Hill JO, Wyatth R, Vahram G, Sullivan P W. Are Health Care Professionals Advising Patients With Diabetes or At Risk for Developing Diabetes to Exercise More? Diabetes Care 29:543–548, 2006 Shrestha UL and Singh DL, Bhattarai.: The prevalence of hypertension and diabetes defined by fasting and 2-h plasma glucose criteria in Urban Nepal Diabetic UK. Diabetic Medicine 23, 1130-1135, 2003 Nepalese Diabetes Association Website - 2007 Sasaki H, Kawasaki T, Ogaki, Kobayashi S, Itoh K, Yoshimizu, Sharma S and Acharya GP: The Prevalence of diabetes mellitus and impaired fasting glucose/glycaemia (IFG) in suburban and rural Nepal – the community-based cross-sectional study during the democratic movements in Nepal. Diabetes Research and Clinical Practice 67, 167-174, 2005 Norton, K and Olds T: Anthropometrica A textbook of body measurement for sports and health courses. Sydney, Australia: University of New South Wales Press, 1996 Henson P: The Physiology of Training. Track and Field Quarterly Review, Volumn 83 # 3, 31-35, Fall 1986 Cooper Institute, Dallas USA: Fitness Assessment Update, Cardio respiratory Fitness Test Norms - 2007 Stewart J, Brown K, Kendrick D and Dyas J: Understanding of blood pressure by people with type 2 diabetes: a primary care focus group study. Br J Gen Pract. April 1; 55(513): 298–304, 2005 Carter, JEL and Heath BH: Cambridge Studies in Biological Anthropometry, Somatotype-Development and Application, Cambridge University Press Cambridge 301, 1990 Rosscraft website: Anthropometry: A General Introduction www.Rosscraft.ca 2007. Amatya, DL: Obese Emphases Physical Fitness Program. Science and Future-Monthly Magazine, April-May, Vol-1No. 8, 2005 Bhattarai MD, Singh DL: Excessive weight gain after pregnancy in urban areas: one important area to prevent diabetes. Nepal Med Coll J. 7(2):87-9, Dec, 2005 Londeree, B.R: The use of Laboratory Test Results with Long Distance Runners. Sports Medicine. 3, 201 – 213, 1986 Christou DD, Gentile CL, DeSouza CA, Seals DR, Gates PE: Fatness is a better predictor of cardiovascular disease risk factor profile than aerobic fitness in healthy men. Circulation 111:1904–1914, 2005 Klein S, Allisond B, Heymsfields B, Kelleyd E, Leibel R L, Nonas C, Kahnr: Waist Circumference and Cardiometabolic Risk. A Consensus Statement from Shaping America’s Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Diabetes Care, Volume 30, Number 6, June 200 Contact Diwakar Lal Amatya President-National Association for Sports Science Health and Fitness 16/1, Nakabahil, Lalitpur, Nepal Emails: dlamatya@ntc.net.np, amatyadiwakar@yahoo.com Prof. Marina Goris Department of Kinesiology Dept. Biomedische Kinesiologie Heverlee, Belgium Email: marina.goris@faber.kuleuven.be http://www.icsspe.org/portal/index.php?w=1&z=5 Kinanthropometry, Physical Activity and Socio-Economic Cost of Diabetics in Kathmandu Diwakar Lal Amatya & Prof. Marina Goris