Abstract
Context:
Over the past three decades, there has been a significant rise in the prevalence of noncommunicable diseases (NCDs) globally, accompanied by a relative decline in communicable diseases.
Aims:
With this background, the research was planned to determine the prevalence of acanthosis nigricans (AN) or skin tags (STs) in the study population and to examine the relationship between the presence of AN and ST with commonly used indicators such as waist-to-height ratio (W/Ht.), Indian Diabetes Risk Score (IDRS), and body mass index for predicting the risk of NCDs.
Settings and Design:
This cross-sectional study was done at a health facility in Lucknow (India).
Methodology:
Consecutive sampling was employed to select 152 apparently healthy adults as the participants. Data collection involved administering a questionnaire and conducting anthropometry using standardized methods. Visual inspection was conducted to identify AN or ST on the common sites.
Statistical Analysis Used:
Data entry was done in Microsoft Office Excel, followed by data analysis using SPSS. To test the association between variables “significance of difference of mean,” Chi-square test, logistic regression analysis, and estimation of Kohen’s kappa were used. A “P” value was considered statistically significant at <0.05 level. The sensitivity and specificity of AN and ST were also estimated in predicting the risk of NCDs.
Results:
The prevalence of AN was 19.08% (95% confidence interval [CI] = 12.76%–25.40%), while the prevalence of STs was 28.29% (95% CI = 21.05%–35.53%). AN showed a sensitivity of 22.4% and specificity of 96.3% with W/Ht. ratio as the standard, and a sensitivity of 26.44% and specificity of 90.77% with IDRS as the standard. ST exhibited a sensitivity of 32.0% and specificity of 88.89% with W/Ht. ratio as the standard, and a sensitivity of 37.93% and specificity of 84.62% with IDRS as the standard.
Conclusion:
AN and ST can be used as simple and time-saving tools in screening protocols for (NCDs). Further research is desirable to validate the findings.
Keywords: Acanthosis nigricans diagnosis, noncommunicable diseases screening, skin tags diagnosis
Résumé
Contexte:
Au cours des trois dernières décennies, il y a eu une augmentation significative de la prévalence des maladies non transmissibles (MNT) à l’échelle mondiale, accompagnée d’un déclin relatif des maladies transmissibles.
Objectifs:
Dans ce contexte, la recherche était prévue pour déterminer la prévalence de l’acanthose nigricans (AN) ou des acrochordons (ST) dans la population étudiée et pour examiner la relation entre la présence d’AN et de ST avec des indicateurs couramment utilisés tels que la taille. rapport taille (W/Ht.), score de risque de diabète indien (IDRS) et indice de masse corporelle pour prédire le risque de MNT.
Paramètres et conception:
cette étude transversale a été réalisée dans un établissement de santé à Lucknow (Inde).
Méthodologie:
Un échantillonnage consécutif a été utilisé pour sélectionner 152 adultes apparemment en bonne santé comme participants. La collecte de données impliquait l’administration d’un questionnaire et la réalisation d’anthropométries à l’aide de méthodes standardisées. Une inspection visuelle a été réalisée pour identifier AN ou ST sur les sites communs.
Analyse statistique utilisée:
La saisie des données a été effectuée dans Microsoft Office Excel, suivie d’une analyse des données à l’aide de SPSS. Pour tester l’association entre les variables « signification de la différence de moyenne », le test du chi carré, l’analyse de régression logistique et l’estimation du kappa de Kohen ont été utilisés. Une valeur « P » a été considérée comme statistiquement significative au niveau < 0,05. La sensibilité et la spécificité de l’AN et du ST ont également été estimées pour prédire le risque de MNT.
Résultats:
La prévalence de l’AN était de 19,08 % (intervalle de confiance à 95 % [IC] = 12,76 % à 25,40 %), tandis que la prévalence des ST était de 28,29 % (IC à 95 % = 21,05 % à 35,53 %). AN a montré une sensibilité de 22,4 % et une spécificité de 96,3 % avec W/Ht. ratio comme standard, et une sensibilité de 26,44 % et une spécificité de 90,77 % avec IDRS comme standard. ST présentait une sensibilité de 32,0 % et une spécificité de 88,89 % avec W/Ht. ratio comme standard, et une sensibilité de 37,93 % et une spécificité de 84,62 % avec IDRS comme standard.
Conclusion:
AN et ST peuvent être utilisés comme des outils simples et permettant de gagner du temps dans les protocoles de dépistage des (MNT). Des recherches plus approfondies sont souhaitables pour valider les résultats.
Mots-clés: diagnostic d’Acanthosis nigricans, dépistage des maladies non transmissibles, diagnostic des acrochordons
INTRODUCTION
Disease patterns around the globe have undergone rapid structural changes over the last three decades, with a sudden increase in the burden of common noncommunicable diseases (NCDs) like type-2 diabetes and cardiovascular diseases (CVDs) and a relatively decreasing trend of communicable diseases.[1] The global burden of disease study brings to light this phenomenon of epidemiological transition in India, with 62.7% of the total mortality in 2016 contributed by the NCDs.[2] Key elements contributing to the development of these NCDs have been identified and are studied together under the heading of metabolic syndrome (MS).[2] MS is a constellation of interconnected physiological, biochemical, clinical, and metabolic factors that directly increase the risk of CVDs, type-2 diabetes mellitus (DM), and all-cause mortality. It is constituted by abdominal obesity, insulin resistance, hypertension, and hyperlipidemia.[3] Various diagnostic criteria have been proposed for quantifying MS. However, the most widely used ones are from the International Diabetic Federation and the National Cholesterol Education Program Adult Treatment Panel III.[4,5] MS increases the risk of developing type-2 DM and CVDs over the next 5–10 years by five- and two-fold, respectively.[3] Furthermore, the patients with MS have an average four-fold increased risk of developing stroke and myocardial infarction and a two-fold risk of dying from a similar event compared with those without MS, regardless of previous history of cardiovascular events.[6]
Early identification of individuals who are apparently healthy but at higher risk of developing MS/NCDs opens up the possibility of early preventive interventions to prevent or delay the onset of diabetes and its subsequent devastating complications.
There is evidence that patients with acanthosis nigricans (AN) and skin tags (STs) bear a higher risk for developing the MS and type-2 diabetes with a significant correlation with high body mass index (BMI), high waist circumference, elevated blood pressure, dyslipidemia, hyperinsulinemia, hyperglycemia, impaired glucose intolerance, and insulin resistance.[7,8,9,10] To combat the burden of NCDs like type-2 diabetes/CVDs, early identification of at-risk persons is a worthy strategy. Strategies of National Program for Prevention and Control of NCDs also focus more on opportunistic screening of adults at all levels in the health-care delivery system from sub-center and above for early detection of diabetes, hypertension, and common cancers (population-based screening of common NCDs) utilizing the services of the frontline-workers and health-workers under the existing primary health-care system.[11] There is a need to search and explore for newer cost-effective, accessible, and effective screening tools for early detection of MS/NCDs, and the present study attempts to explore the utility of cutaneous markers like AN and ST as a screening tool to identify individuals at risk of NCDs.
METHODOLOGY
The objectives of the present study were to estimate the prevalence of AN and ST and also to explore the association between the presence of AN and ST with BMI, random blood sugar (RBS) levels, and other popular measures of assessing risk of NCDs like waist to height (W/Ht.) ratio, Indian Diabetes Risk Score (IDRS) in study population to see their utility as a risk predictor. The study was conducted in a tertiary health-care facility in Lucknow, Uttar Pradesh. It was a hospital-based cross-sectional study. The study was undertaken among the apparently healthy hospital staff, involving nurses, paramedics, and doctors, and apparently healthy patient attendants coming to the hospital, which constituted the sampling frame for the research study. Based on the prevalence of AN in adults as 16.1%,[7] at 95% confidence interval (CI) and 6% absolute error, the sample size of 151 was calculated. Participants willing to cooperate and participate in the study and who had given consent for visual inspection for AN/ST and RBS estimation by finger prick method were included in the study. Participants were selected from the sampling frame by using consecutive sampling. Known cases of diabetes, persons who had taken treatment for DM in the past, and people with other endocrine and systemic diseases known to produce AN were excluded from the study, persons with the intake of drugs such as nicotinic acid, oral contraceptives pills, and application of topical fusidic acid were also excluded, as intake of these drugs might also lead to the development of AN. After obtaining consent from the participants, data were collected with the help of a questionnaire, followed by inspection for the presence of AN and ST on body regions such as the nape of the neck and axilla by members of the research team. Anthropometric data were obtained using standard procedures and protocols to minimize observer bias. Photographs of AN/ST were also taken after obtaining the consent of the participants. In case of doubt regarding the diagnosis of AN/ST to the research team, the help of a dermatologist was sought to confirm the presence of AN/ST. Other than anthropometric measurements RBS levels were assessed using Accu-Check glucometer onsite. Data entry was done in Microsoft Office Excel version 2010, followed by data analysis using SPSS version 23, Armonk, NY: IBM Corp. To test the association between variables, the significance of the difference of mean, Chi-square test, logistic regression analysis, and estimation of Kohen’s kappa were used. A “P” value was considered statistically significant at <0.05 level. The sensitivity and specificity of AN and ST were also estimated in predicting the risk of NCDs.
Study variables/definitions
Acanthosis nigricans
AN is characterized by a symmetrical, hyper-pigmented, velvety thickening of the skin that is usually confined to the flexural areas of the body, particularly the nape of the neck and the axillae [Figure 1].[12,13]
Figure 1.
Acanthosis nigricans and skin tags
Skin tags
ST are benign polyp-like growths, usually found in the natural folds of the skin [Figure 1].[14,15]
Indian diabetic risk score)
The Indian diabetic risk score predicts the probability of diabetes based on four simple parameters - age, abdominal obesity, family history of diabetes, and physical activity. Maximum score possible is 100 and the minimum score is 0. Scores above 60 are considered high for developing type-2 diabetes.[16]
Waist circumference
The WHO STEPS protocol for measuring waist circumference instructs that the measurement be made at the approximate midpoint between the lower margin of the last palpable rib and the top of the iliac crest at a level parallel to the floor. For Asian population, waist circumference above 90 cm among males and above 8 cm in females increases the risk of NCDs.[17]
Random blood sugar
It is the measurement of blood glucose levels in a person regardless of the time of last meal taken by him.
Height and weight
Height and weight were measured using standard procedures and protocols mentioned in the WHO STEPS Surveillance protocol.[17]
Body mass index
For adults in the Asian Population, WHO defines overweight is a BMI ≥23.0 kg/m2 and obesity is a BMI value more or >25.0 kg/m2. BMI values of 23.0 kg/m2 increases the risk of NCDs.[18]
Waist-to-height ratio
W/Ht. ratio is a rapid and effective global indicator for the health risk of obesity. A boundary value of W/Ht. ratio = 0.5 indicates increased risk for men and women.[19]
Ethical approval
Ethical approval was taken from the institute ethical committee before starting the data of collection. Informed verbal consent was sought from each respondent. They were informed about the nature and the purpose of the survey and the procedure involved. It was explained to the subjects that the information they gave us would be kept confidential. All entry forms were kept in the custody of the principal investigator and completed questionnaires were viewed by approved study personnel only.
RESULTS
A total of 152 individuals were assessed for the presence of AN and ST, and all of them were included in the final data analysis. In the present study, the prevalence of ST comes out to be 28.29% (95% CI = 21.05–35.53) and the prevalence of AN comes out to be 19.08% (95% CI = 12.76–25.40). The mean age of the study population was 41.02 years (standard deviation = 14.67). Eighty-seven (57.2%) individuals were males and 65 (42.8%) were females. Ninety-eight (64.5%) individuals belonged to rural areas and the rest 54 (35.5%) were from urban areas. One hundred and forty (92.11%) of the population belonged to the Hindu religion, and the rest belonged to other religions. The majority 134 (88.16%) of the study population belongs to the above poverty line and majority 126 (82.89%) of them were literate. It was observed that mean BMI, waist circumference and W/Ht. ratio of the study population who had AN was significantly more than that of study participants who were not having AN. Similar type of findings were observed for ST also [Table 1].
Table 1.
Distribution pattern of acanthosis nigricans and skin tags
| Parameter (n=Total number of individuals) | ANs |
STs |
||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Present |
Absent |
P | Present |
Absent |
P | |||||
| n | Mean (SD) | n | Mean (SD) | n | Mean (SD) | n | Mean (SD) | |||
| Age (n=152) | 29 | 42.2 (15.2) | 123 | 40.7 (14.6) | 0.630 | 43 | 44.1 (13.7) | 109 | 39.8 (14.9) | 0.096 |
| BMI (n=152) | 29 | 28.06 (4.9) | 123 | 25.6 (5.2) | 0.019 | 43 | 27.9 (4.0) | 109 | 25.3 (5.5) | 0.001 |
| Waist (male) (n=87) | 20 | 98.8 (10.7) | 67 | 91.1 (10.6) | 0.007 | 28 | 97.6 (11.1) | 59 | 90.6 (10.4) | 0.006 |
| Waist (female) (n=65) | 9 | 95.1 (9.9) | 56 | 84.9 (10.2) | 0.016 | 15 | 92.1 (9.2) | 50 | 84.7 (10.5) | 0.013 |
| Waist/height ratio (n=152) | 29 | 0.61 (0.06) | 123 | 0.56 (0.07) | 0.001 | 43 | 0.60 (0.07) | 109 | 0.55 (0.07) | 0.001 |
| Systolic BP (n=152) | 29 | 128.1 (12.4) | 123 | 127.6 (18.0) | 0.847 | 43 | 130.9 (18.3) | 109 | 126.4 (16.4) | 0.164 |
| Diastolic BP (n=152) | 29 | 87.9 (12.5) | 123 | 86.0 (10.6) | 0.458 | 43 | 89.9 (11.8) | 109 | 85.0 (10.4) | 0.020 |
BP=Blood pressure, SD=Standard deviation, ANs=Acanthosis nigricans, STs=Skin tags
The association between various biophysical and personal characteristics and the presence or absence of AN and ST was also observed [Table 2]. On logistic regression analysis, the odds ratio measured the association between an assumed predictor variable (x), i.e., BMI, IDRS, waist circumference and the outcome variable (y), i.e., AN and ST was estimated. The higher odds for the presence of AN were seen in people with high waist line, overweight individuals, increased blood pressure, increased RBS levels and high Indian diabetic risk scores and this relation was significant for high BMI values and high IDRSs. A similar type of finding was observed for ST also [Table 3]. Sensitivity and specificity of AN and ST were also calculated after comparing them with W/Ht. ratio and IDRS as the current standards of predicting the risk of NCDs [Table 4].
Table 2.
Association of acanthosis nigricans and skin tags with various biophysical and personal characteristics
| Biophysical characteristics | ANs |
STs |
||||
|---|---|---|---|---|---|---|
| Present | Absent | Test statistics, P | Present | Absent | Test statistics, P | |
| RBS value | ||||||
| <200 (0) | 26 | 111 | 0.063, 0.801* | 39 | 98 | 0.024, 0.876* |
| >200 (1) | 3 | 12 | 4 | 11 | ||
| BP | ||||||
| Normal (0) | 20 | 91 | 0.3, 0.583 | 28 | 83 | 1.905, 0.167 |
| High (1) | 9 | 32 | 15 | 26 | ||
| Daily physical activity (moderate intensity or equivalent) (min/day) | ||||||
| <30 (0) | 24 | 106 | 0.032, 0.858* | 37 | 93 | 0.013, 0.909 |
| >30 (1) | 5 | 17 | 6 | 16 | ||
| BMI | ||||||
| >23 (1) | 21 | 62 | 4.585, 0.032 | 33 | 50 | 11.857, 0.0005 |
| <23 (0) | 8 | 61 | 10 | 59 | ||
| Waist to height ratio | ||||||
| >0.5 (1) | 28 | 97 | 5.027, 0.024 | 40 | 85 | 4.776, 0.028 |
| <0.5 (0) | 1 | 26 | 3 | 24 | ||
| Waist line (male, n=87) (cm) | ||||||
| >90 (1) | 15 | 38 | 2.163, 0.141 | 21 | 32 | 3.438, 0.063 |
| <90 (0) | 5 | 29 | 7 | 27 | ||
| Waist line (female, n=65) (cm) | ||||||
| >80 (1) | 8 | 43 | 0.147, 0.701* | 15 | 36 | 3.824, 0.05* |
| <80 (0) | 1 | 13 | 0 | 14 | ||
| IDRS | ||||||
| >60 (1) | 23 | 64 | 7.134, 0.007 | 33 | 54 | 9.323, 0.002 |
| <60 (0) | 6 | 59 | 10 | 55 | ||
*Yates correction in Chi-square test. IRDS=Indian Diabetes Risk Score, RBS=Random blood sugar, BMI=Body mass index, BP=Blood pressure, ANs=Acanthosis nigricans, STs=Skin tags
Table 3.
Logistic regression analysis
| Characteristics | Categories | ATs presence |
STs presence |
|||
|---|---|---|---|---|---|---|
| Type | OR (95% CI) | P | OR (95% CI) | P | ||
| Waist circumference in females (cm) (reference=0) | >80 | UOR | 2.42 (0.39–47.01) | 0.424 | -* | - |
| ADJ | 0.58 (0.03–16.55) | 0.716 | -* | - | ||
| Waist circumference in males (cm) (reference=0) | >90 | UOR | 2.29 (0.79–7.70) | 0.147 | 2.53 (0.97–7.26) | 0.067 |
| ADJ | 1.31 (0.28–6.29) | 0.733 | 1.09 (0.28–4.20) | 0.899 | ||
| BMI (reference=0) | Over weight | UOR | 2.58 (1.10–6.62) | 0.036 | 3.89 (1.80–9.06) | 0.0008 |
| ADJ | 1.92 (0.77–5.11) | 0.170 | 3.06 (1.36–7.33) | 0.008 | ||
| BP (JNC 8) (reference=0) | Increased | UOR | 1.28 (0.51–3.03) | 0.584 | 1.71 (0.79–3.67) | 0.170 |
| ADJ | 1.02 (0.39–2.50) | 0.967 | 1.40 (0.61–3.15) | 0.419 | ||
| RBS (mg/dL) (reference=0) | >200 | UOR | 1.07 (0.23–3.66) | 0.924 | 0.91 (0.24–2.85) | 0.883 |
| ADJ | 0.72 (0.15–2.60) | 0.643 | 0.56 (0.14–1.90) | 0.376 | ||
| IDRS (reference=0) | High risk | UOR | 3.53 (1.42–10.11) | 0.0104 | 3.36 (1.55–7.81) | 0.003 |
| ADJ | 3.00 (1.13–9.00) | 0.035 | 2.53 (1.09–6.17) | 0.034 | ||
*Data insufficient. IRDS=Indian Diabetes Risk Score, RBS=Random blood sugar, BMI=Body mass index, BP=Blood pressure, OR=Odds ratio, CI=Confidence interval, ANs=Acanthosis nigricans, STs=Skin tags, UOR=Unadjusted odds ratio, ADJ=Adjusted Odds Ratio, JNC=Joint National Committee on Prevention, Detection, Evaluation and treatment of High Blood Pressure
Table 4.
Sensitivity and specificity of acanthosis nigrican/skin tag in predicting risk-taking waist/height ratio and Indian Diabetes Risk Score as the gold standard test
| AN | ANs |
|||||
|---|---|---|---|---|---|---|
| Waist/height ratio |
IDRS |
|||||
| ≥0.5 | <0.5 | ≥60 | <60 | |||
| Present | 28 | 1 | 23 | 6 | ||
| Absent | 97 | 26 | 64 | 59 | ||
| Sensitivity (%) | 22.4 | 26.44 | ||||
| Specificity (%) | 96.3 | 90.77 | ||||
| PPV (%) | 96.55 | 79.31 | ||||
| NPV (%) | 21.14 | 47.97 | ||||
| LR+ | 6.05 | 2.86 | ||||
| LR− | 0.81 | 0.81 | ||||
| Accuracy (%) | 35.53 | 53.95 | ||||
| MCC | 0.18 | 0.22 | ||||
|
| ||||||
| ST |
STs
|
|||||
|
Waist/height ratio
|
IDRS
|
|||||
| ≥0.5 | <0.5 | ≥60 | <60 | |||
|
| ||||||
| Present | 40 | 3 | 33 | 10 | ||
| Absent | 85 | 24 | 54 | 55 | ||
| Sensitivity (%) | 32.0 | 37.93 | ||||
| Specificity (%) | 88.89 | 84.62 | ||||
| PPV (%) | 93.02 | 76.74 | ||||
| NPV (%) | 22.02 | 50.46 | ||||
| LR+ | 2.88 | 2.47 | ||||
| LR− | 0.76 | 0.73 | ||||
| Accuracy (%) | 42.11 | 57.89 | ||||
| MCC | 0.18 | 0.25 | ||||
Worst value: −1, best value: +1. MCC=Matthew’s correlation coefficient, NPV=Negative predictive value, PPV=Positive predictive value, IRDS=Indian Diabetes Risk Score, ANs=Acanthosis nigricans, STs=Skin tags, LR== Likelihood Ratio
We also looked for the degree of agreement between the presence of AN or ST and risk prediction by IDRS, BMI, and W/Ht. ratio using Cohen’s kappa values. Cohen suggested the kappa results be interpreted as follows: values ≤ 0 as indicating no agreement and, 0.01–0.20 as none to slight, 0.21–0.40 as fair, 0.41–0.60 as moderate, 0.61–0.80 as substantial, and 0.81–1.00 as almost perfect agreement.[20] The degree of agreement for the presence of AN and high-risk prediction by IDRS, BMI, and W/Ht. ratio were 0.155 (95% CI: 0.01–0.30), 0.128 (95% CI: −0.02–0.28), and 0.078 (95% CI: −0.03–0.19), respectively, and for ST it was 0.207 (95% CI: 0.06–0.36), 0.241 (95% CI: 0.09–0.39), and 0.0954 (95% CI: −0.03–0.22), respectively. Thus, we found fair agreement between presence of ST and risk prediction by IDRSs and BMI values in the present study. There was none to the slight agreement between the presence of ST and risk prediction by waist circumference values. There was none to slight agreement noticed for risk prediction by AN and IDRS, BMI, and W/Ht. ratio.
,(Worst value: -1; best value: +1)
DISCUSSION
In our research study, we tried to look for the significance of AN and ST in predicting the risk of NCDs in the study population. We used different ways to judge the association of these cutaneous skin markers with the risk of NCDs. In the present study, there was no significant association of AN and ST with sociodemographic variables such as gender, education status, occupation, religion, and family type. In the present study, it was observed that the mean BMI of the study population who had AN was significantly more than the mean BMI of that study population who was not having AN. In a study done by Kong et al.,[21] it was observed that AN is an independent risk factor associated with hyperinsulinemia, with the development of DM. In the same study, it was also shown that AN was more frequent in patients with high BMI. Another study done by Grandhe et al.[22] found that there was association of increasing severity of AN with increasing BMI, waist circumference, hip circumference, and waist–hip ratio. In their study, a significant correlation was seen only with DM and BMI. Scott and Hall[23] suggested that AN in obese children is a marker of metabolic dysfunction since these patients presented an increased risk of developing type-2 diabetes. These results are in accordance with the present study. Similarly, the mean values of waist circumference in male and female having AN was significantly more in comparison to the mean waist circumference of those study populations who were not having AN. Likewise, mean W/Ht. ratio was higher in the study population having AN, than those people without AN and this association was statistically significant too. Similar kind of results were seen in other studies as well.[23,24,25,26] In the present study, it was observed that among the persons having AN and ST, the majority of them had high W/Ht. ratios. In the present study, a significant association was found between the presence of AN and high IDRSs. Among individuals with AN, 79.3% had IDRSs > 60, and this difference was statistically significant. Similarly, a significant association was observed between the presence of STs and high IDRSs using Pearson’s Chi-square test. The degree of agreement between the presence of AN or ST and risk prediction based on IDRS, BMI, and waist-to-height ratio varied when analyzed using Cohen’s kappa values. The agreement ranged from none to slight/fair, depending on the specific variable being considered. However, the study revealed a high specificity of these cutaneous skin markers in predicting the risk of NCDs. This high specificity indicates a high positive predictive value for AN and ST in predicting the risk of NCDs in apparently healthy individuals. Although the sensitivity of these skin markers is low, they can still be used as a screening tool to identify a considerable proportion of high-risk individuals without the need for invasive tests or time-consuming risk calculation methods. The study findings highlight the significant association between AN and ST with high IDRSs, indicating their potential as markers for predicting NCDs risk. While the agreement between these skin markers and other risk predictors varied, their high specificity suggests their usefulness in identifying individuals at risk of developing NCDs in a simple and noninvasive manner. In nutshell, we set out to investigate the agreement between conventional methods of predicting the risk of NCDs and the presence or absence of AN and ST. Through various testing approaches, we observed a diverse range of outcomes. While some instances revealed significant associations between these factors, in other cases, there was little to no discernible agreement. While the study’s findings may not uniformly demonstrate a consistent relationship between the traditional predictors and AN or ST, the overall body of evidence strongly indicates their potential significance in assessing and addressing the risk of NCDs. Incorporating these additional variables into existing predictive models may provide a more comprehensive understanding of the risks involved. Further research and refinement of these methods are warranted to elucidate the extent to which AN and ST can enhance the accuracy and effectiveness of NCDs risk prediction.
CONCLUSION
In this research study, the presence of AN and ST was more commonly observed in individuals who were considered high risk based on current methods of predicting risk such as high scores of BMI/W/Ht. ratio/IDRS/waist circumference. The study suggests that AN and ST should not be ignored by health-care providers as they can serve as important indicators of internal metabolic diseases. The presence of these cutaneous skin markers can be used as a screening tool in public health to prevent future morbidities such as diabetes and NCDs. Although AN and ST are often disregarded by patients due to their asymptomatic nature, the study emphasizes their importance and recommends that they should not be overlooked during clinical examinations.
These skin conditions can act as markers for the need to measure laboratory data that may indicate insulin resistance and predict the risk of developing NCDs, like type-2 DM. When combined with other risk predictors like high BMI and increased W/Ht. ratio, the accuracy of predicting these conditions will be enhanced, leading to more effective preventive efforts. The early detection of precursor signs for NCDs like type-2 DM can enable the implementation of preventive, curative, or health promotion intervention strategies before the onset of the disease and its complications. While commonly used methods for predicting the risk of NCDs can be time-consuming, visual inspection of AN and ST can be utilized as a simple and time-saving screening tool, particularly in resource-limited settings and community-level screenings. The study suggests that this approach would be effective in controlling NCDs in the Indian population. However, we acknowledge that further research is needed to assess the utility of AN and ST in predicting the risk of NCDs. The present study was hospital-based and had a small sample size, highlighting the need for larger studies to validate these findings.
Limitations of the study
Increasing the sample size would have provided a more precise estimate of the relationship between AN/ST and other NCDs risk prediction scores. Since the study was conducted in a hospital setting, there is a possibility of bias in the findings. To enhance the validity of the results, it would have been beneficial to select the study population from the community. It would have been advantageous to use probability sampling methods to select the study population from the sampling frame, ensuring a more representative sample.
Financial support and sponsorship
The research study was done under ICMR-Short Term Studentship Project-2019.
Conflicts of interest
There are no conflicts of interest.
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