Papers by Krithiga Shridhar
SSM - Qualitative Research in Health
Table S1 (a): Component loadings for the 3 main dietary patterns (DPs) identified using principal... more Table S1 (a): Component loadings for the 3 main dietary patterns (DPs) identified using principal components analysis (PCA) of FFQ data from the Indian Migration Study*. Table S1(b): Socio-demographic and lifestyle characteristics of the Indian Migration study participants in the first (T1) and third (T3) tertiles of the three dietary patterns (N=7067). Table S2 (a): Multivariable-adjusted linear associations* (beta co-efficient, 95% confidence interval) of 'animal food' pattern with cardio-metabolic risk factors by four different regions of the Indian Migration Study. Table S2 (b): Multivariable-adjusted linear associations* (beta co-efficient, 95% confidence interval) of 'animal food' pattern with cardio-metabolic risk factors by different locations of the Indian Migration Study. Table S2 (c): Multivariable-adjusted linear associations* (beta co-efficient, 95% confidence interval) of 'animal food' pattern with cardio-metabolic risk factors by different stan...
Frontiers in Public Health
BackgroundStudies have highlighted a possible influence of gingival and periodontal disease (PD) ... more BackgroundStudies have highlighted a possible influence of gingival and periodontal disease (PD) on COVID-19 risk and severity. However, the evidence is based on hospital-based studies and community-level data are sparse.ObjectivesWe described the epidemiological pattern of SARS-CoV-2 infection in Delhi and evaluated the associations of gingival and PD with incident COVID-19 disease in a regionally representative urban Indian population.MethodsIn a prospective study nested within the Centre for Cardiometabolic Risk Reduction in South-Asia (CARRS) study, participants with clinical gingival and periodontal status available at baseline (2014–16) (n = 1,727) were approached between October 2021 to March 2022. Information on COVID-19 incidence, testing, management, severity was collected as per the WHO case criteria along with COVID-19 vaccination status. Absolute incidence of COVID-19 disease was computed by age, sex, and oral health. Differences in rates were tested using log-rank test...
Annals of oncology research and therapy, 2022
ISEE Conference Abstracts
ISEE Conference Abstracts
Cancer Epidemiology, Biomarkers & Prevention
Background:Evidence linking arsenic in drinking water to digestive tract cancers is limited. We e... more Background:Evidence linking arsenic in drinking water to digestive tract cancers is limited. We evaluated the association between arsenic levels in groundwater and gallbladder cancer risk in a case–control study (2019–2021) of long-term residents (≥10years) in two arsenic-impacted and high gallbladder cancer risk states of India—Assam and Bihar.Methods:We recruited men and women aged 30 to 69 years from hospitals (73.4% women), with newly diagnosed, biopsy-confirmed gallbladder cancer (N = 214) and unrelated controls frequency-matched for 5-year age, sex, and state (N = 166). Long-term residential history, lifestyle factors, family history, socio-demographics, and physical measurements were collected. Average-weighted arsenic concentration (AwAC) was extrapolated from district-level groundwater monitoring data (2017–2018) and residential history. We evaluated gallbladder cancer risk for tertiles of AwAC (μg/L) in multivariable logistic regression models adjusted for important confou...
CRC Press eBooks, Nov 25, 2022
Indian Journal of Medical Research
Protocol for conducting the scoping review of published contemporary literature aiming at compari... more Protocol for conducting the scoping review of published contemporary literature aiming at comparing the impact of COVID-19 pandemic on health service delivery and health systems across the continuum of care for cancer across developed regions and LMICs, with focus on India.
PLOS ONE, 2021
Background Certain oral bacterial pathogens may play a role in oral carcinogenesis. We assessed t... more Background Certain oral bacterial pathogens may play a role in oral carcinogenesis. We assessed the feasibility of conducting a population-based study in India to examine the distributions and levels of Porphyromonas gingivalis, Fusobacterium nucleatum and Prevotella intermedia in relation to oral leukoplakia (a potentially malignant disorder) and other participant characteristics. Methods This exploratory case-control study was nested within a large urban Indian cohort and the data included 22 men and women with oral leukoplakia (cases) and 69 leukoplakia-free controls. Each participant provided a salivary rinse sample, and a subset of 34 participants (9 cases; 25 controls) also provided a gingival swab sample from keratinized gingival surface for quantitative polymerase chain reaction (qPCR). Results Neither the distribution nor the levels of pathogens were associated with oral leukoplakia; however, individual pathogen levels were more strongly correlated with each other in cases ...
Journal of Global Health Reports, 2020
Background We report the feasibility of using telephones for active surveillance of cancer surviv... more Background We report the feasibility of using telephones for active surveillance of cancer survival and also present absolute survival rate and its predictors for lung cancer (LC) and gallbladder cancer (GBC) in north India. To date, such information from resource intensive settings is limited. Methods Study participants were 530 men and women (259 LC and 271 GBC), registered at ‘Post Graduate Institute of Medical Education and Research’, Chandigarh. Eligible patients were diagnosed with LC or GBC between ages 30 and 69 years during a five-year period from January 1 2010 through December 31 2014, and had a valid telephone number. Information on socio-demographic factors, disease characteristics and treatment status was abstracted from medical records. Participants (or their family/relatives) were followed-up with telephone interviews (March 1 2016 to July 31 2016) to ascertain vital status. Absolute 1-, 3- and 5-year survival rates were calculated using Kaplan-Meier method; weighted...
Nutrition Reviews, 2020
Evidence to date suggests that high sodium intake affects health adversely, yet the role of a pop... more Evidence to date suggests that high sodium intake affects health adversely, yet the role of a population-level strategy to reduce sodium intake is often contested. This review focuses on current available evidence on regional sodium intake levels, health implications of sodium intake, and population-level strategies implemented worldwide. The limitations in evidence, the difficulties in implementing population-wide strategies to reduce sodium intake, and the need for such strategies are critically reviewed. Evidence clearly shows that sodium has an adverse effect on blood pressure, cardiovascular disease, and mortality. However, whether reduced sodium intake benefits all individuals or only hypertensive individuals is still unclear. Methodological issues and publication bias in current evidence are other matters of concern in sodium-related research. While it is essential to continue working toward the World Health Organization’s target of 30% reduction in sodium intake, due conside...
Proceedings of the Indian National Science Academy, 2018
Cardiovascular diseases (CVD) arethe leading cause of disability and mortality in India with ever... more Cardiovascular diseases (CVD) arethe leading cause of disability and mortality in India with ever increasing trends. The ubiquitous prevalence of CVD risk factors, despite some heterogeneity across different social strata, urban-rural locations and geographical regions, has been proven in several studies. Diet and nutrition have played a definitive role in this phenomenon. As India grapples with a dual burden of under-and over-nutrition, social factors at multiple levels such as individual's education and income, local food environment, migration and urbanization of populations, national agricultural produce and policies as well as global trade policies have complex relationships with diet as well as CVD. A deeper understanding of these factors is vital in designing public health interventions that are more targeted and relevant for the Indian population. Policy changes and community interventions based on societal needs may be necessary if we are to achieve the sustainable development goal targets by 2030, benefitting the larger population.
Current Developments in Nutrition, 2018
Background: Evidence suggests a role for elevated serum calcium in dysregulated glucose metabolis... more Background: Evidence suggests a role for elevated serum calcium in dysregulated glucose metabolism, linked through low-level chronic inflammation. Objectives: We investigated the association of elevated serum calcium concentrations (corrected for albumin) with markers of dysregulated glucose metabolism and type II diabetes and tested if these associations were accounted for by chronic inflammation in a rural Indian population. Methods: A cross-sectional analysis of participants aged 40-84 y from the Andhra Pradesh Children and Parents Study (APCaPS; n = 2699, 52.2% women) was conducted. Comprehensive information on household, sociodemographic, and lifestyle factors; medical and family history; physical measurements; blood measurements including fasting plasma glucose (FPG), fasting insulin (FI), serum calcium, albumin, phosphorous, vitamin D (in a subset), and creatinine were analyzed. Additionally, in a random sample of healthy participants (n = 1000), inflammatory biomarkers (interleukins 6 and 18, soluble intercellular adhesion molecule 1, adiponectin, and high-sensitivity C-reactive protein) were measured and an inflammatory score (IScore) calculated. Results: After adjustments for sociodemographics, lifestyle factors, and anthropometry the highest calcium quartile (Q4 compared with Q1) was associated with FI (β = 1.4 µU/ml; 95% CI: 1.2, 1.5 µU/ml; P-trend < 0.001), the homeostasis model assessment for insulin resistance (HOMA-IR) (β = 1.4; 95% CI: 1.2, 1.5; P-trend < 0.001), and was modestly associated with FPG (β = 2.1 mg/dL; 95% CI: −0.9, 5.2 mg/dL; P-trend = 0.058) and prevalent type II diabetes (OR = 1.6; 95% CI: 1.0, 2.6; P-trend= 0.020). In the healthy subgroup, the association of the highest calcium quartile was similar for FI and HOMA-IR. Additional adjustment with IScore did not alter the associations. Further, in a subset, all these associations were independent of endogenous regulators of calcium metabolism (serum vitamin D, phosphorus, and creatinine). Independently, after accounting for potential confounders, the highest IScore quartile (Q4 compared with Q1) was positively associated with FPG, FI, HOMA-IR, and prevalent prediabetes, and also with serum calcium concentrations in men. Conclusions: Elevated serum calcium was positively associated with markers of dysregulated glucose metabolism and prevalent type II diabetes in a rural Indian population. Chronic inflammation did not mediate this association but was independently associated with markers of dysregulated glucose metabolism. Inflammation might be responsible for elevated serum calcium concentrations in men.
Advances in Nutrition, 2018
Epidemiologic cohort studies enrolling a large percentage of vegetarians have been highly informa... more Epidemiologic cohort studies enrolling a large percentage of vegetarians have been highly informative regarding the nutritional adequacy and possible health effects of vegetarian diets. The 2 largest such cohorts are the European Prospective Investigation into Cancer and Nutrition–Oxford (EPIC-Oxford) and the Adventist Health Study–2 (AHS-2). These cohorts are described and their findings discussed, including a discussion of where findings appear to diverge. Although such studies from North America and the United Kingdom have been important, the large majority of the world's vegetarians live in other regions, particularly in Asia. Findings from recent cohort studies of vegetarians in East and South Asia are reviewed, particularly the Tzu Chi Health Study and Indian Migration Study. Important considerations for the study of the health of vegetarians in Asia are discussed. Vegetarian diets vary substantially, as may associated health outcomes. Cohort studies remain an important to...
International journal of environmental research and public health, Sep 6, 2018
Evidence from India, a country with unique and distinct food intake patterns often characterized ... more Evidence from India, a country with unique and distinct food intake patterns often characterized by lifelong adherence, may offer important insight into the role of diet in breast cancer etiology. We evaluated the association between Indian dietary patterns and breast cancer risk in a multi-centre case-control study conducted in the North Indian states of Punjab and Haryana. Eligible cases were women 30⁻69 years of age, with newly diagnosed, biopsy-confirmed breast cancer recruited from hospitals or population-based cancer registries. Controls (hospital- or population-based) were frequency matched to the cases on age and region (Punjab or Haryana). Information about diet, lifestyle, reproductive and socio-demographic factors was collected using a structured interviewer-administered questionnaire. All participants were characterized as non-vegetarians, lacto-vegetarians (those who consumed no animal products except dairy) or lacto-ovo-vegetarians (persons whose diet also included egg...
Nutrition journal, Jan 8, 2018
Dietary patterns (DPs) in India are heterogenous. To date, data on association of indigenous DPs ... more Dietary patterns (DPs) in India are heterogenous. To date, data on association of indigenous DPs in India with risk factors of nutrition-related noncommunicable diseases (cardiovascular disease and diabetes), leading causes of premature death and disability, are limited. We aimed to evaluate the associations of empirically-derived DPs with blood lipids, fasting glucose and blood pressure levels in an adult Indian population recruited across four geographical regions of India. We used cross-sectional data from the Indian Migration Study (2005-2007). Study participants included urban migrants, their rural siblings and urban residents and their urban siblings from Lucknow, Nagpur, Hyderabad and Bangalore (n = 7067, mean age 40.8 yrs). Information on diet (validated interviewer-administered, 184-item semi-quantitative food frequency questionnaire), tobacco consumption, alcohol intake, physical activity, medical history, as well as anthropometric measurements were collected. Fasting-bloo...
Asian Pacific Journal of Cancer Prevention, 2015
Background: In India, cancer accounts for 7.3% of DALY's, 14.3% of mortality with an age-standard... more Background: In India, cancer accounts for 7.3% of DALY's, 14.3% of mortality with an age-standardized incident rate of 92.4/100,000 in men and 97.4/100,000 in women and yet there are no nationwide screening programs. Materials and Methods: We calculated age-standardized and age-truncated (30-69 years) detection rates for men and women who attended the Indian Cancer Society detection centre, New Delhi from 2011-12. All participants were registered with socio-demographic, medical, family and risk factors history questionnaires, administered clinical examinations to screen for breast, oral, gynecological and other cancers through a comprehensive physical examination and complete blood count. Patients with an abnormal clinical exam or blood result were referred to collaborating institutes for further investigations and follow-up. Results: A total of n=3503 were screened during 2011-12 (47.8% men, 51.6% women and 0.6% children <15 years) with a mean age of 47.8 yrs (±15.1 yrs); 80.5% were aged 30-69 years and 77.1% had at least a secondary education. Tobacco use was reported by 15.8%, alcohol consumption by 11.9% and family history of cancer by 9.9% of participants. Follow-up of suspicious cases yielded 45 incident cancers (51.1% in men, 48.9% in women), consisting of 55.5% head and neck (72.0% oral), 28.9% breast, 6.7% gynecological and 8.9% other cancer sites. The age-standardized detection rate for all cancer sites was 340.8/100,000 men and 329.8/100,000 women. Conclusions: Cancer screening centres are an effective means of attracting high-risk persons in low-resource settings. Opportunistic screening is one feasible pathway to address the rising cancer burden in urban India through early detection.
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Papers by Krithiga Shridhar