The discovery of metformin as an anti-diabetic drug spans three centuries-beginning in the herb, Galega officinalis in the 17 ^th century and ending in its launch as "Glucophage" in the 20 ^th century. Extract from the leaves of G. officinalis was used to treat many ailments such as fever, plague and symptoms of diabetes. The herbal extract contains guanidine and galegine as major chemical components. These compounds, although had an anti-diabetic effect, were too toxic for clinical use. Discovery of antimalarial drug, paludrine which also had blood glucose lowering activity, at the Imperial Chemical Industries, UK prompted evaluation of paludrine analogues, as potential anti-diabetic agents. This speculation was also based on the structure of paludrine, which partly resembled galegine, a compound present in the extract of G. officinalis. This development coupled with Garcia's positive results using flumamine, a guanidine analogue, on 'flu' fever accelerated the evaluation of guanidine and galegine analogues for anti-diabetic activity. These efforts culminated in the discovery of metformin, introduced as 'Glucophage', by Jean Sterne, in 1957. In this article, we have highlighted the journey of metformin from a common countryside herb to its present day status of a 'Wonder Drug' sitting at the bedside of diabetic patients.

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Child and adolescent overweight and obesity have become an important global public health problem. Prevalence data for pediatric overweight and obesity in Nigeria are available. However, a review of such data is unavailable, and is, therefore, reported in this paper. A total of 37 full-length papers and 5 detailed abstracts which met the inclusion criteria were reviewed. The subjects in the reviewed papers were 2-20 years of age. Sixty nine percent and 14% of the studies were conducted in urban and rural areas, respectively. As much as 74% of the papers and 65% of the participants were from the South of Nigeria. Half of the papers used the World Health Organization reference standards for diagnosis. When apparent outliers were excluded, the prevalence of obesity in the "adolescents only" and "children and adolescents" subgroups were 0.0-2.8% and 0.0-5.8%, while for overweight in the respective groups they were 1.0-8.6% and 5.0-12.0%. The data from this study suggests that prevalence rates of obesity and overweight in Nigeria are not only lower than the figures reported from other parts of the world, but have also remained stable (albeit within wide margins) during the period.

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Aim: The aim was to examine the association between high maternal body mass index (BMI) and feto-maternal outcome in primigravida women. Settings and Design: Observational case-control study. Subjects and Methods: A case-control study was conducted on pregnant women admitted for delivery in the labor ward having height and weight recorded before pregnancy or up to 12 weeks of pregnancy fulfilling inclusion criteria. The control group of 200 women with BMI in the normal range (20-24.9 Kg/m ² ) was compared with study group of 200 women with BMI 25-29.9 Kg/m ² and more than 30 Kg/m ² . Outcome measures were maternal complications, obstetric complications and neonatal complications. Statistical Analysis Used: Data were entered and analyzed using IBM SPSS Statistics 21. The strength of association expressed as the odd ratio with 95% confidential interval values. Results: We found a linear relationship between increasing BMI and the risk of developing preeclampsia, gestational diabetes mellitus, failed induction of labor, cesarean section, both elective and emergency, postpartum hemorrhage, abnormal birth weight and neonatal intensive care unit admission. Conclusions: Obese pregnant women are at a higher risk of feto-maternal complications. Since it is a modifiable and preventable condition, preconception counselling, treatment of obesity before conception and awareness regarding associated health risks are highly desirable.

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Although rare, Porto mesenteric thrombosis is a well described complication after abdominal surgeries. In recent years the incidence of this condition has been on an increasing trend with the advent of laparoscopic surgery, particularly bariatric surgery. The pathogenesis of this condition can be explained by propensity of obese people for thrombotic events, intraoperative insult to portal tributaries and post operative dehydration. The clinical spectrum can vary from mild abdominal pain to severe bowel gangrene. Here in we are reporting a case of porto mesenteric thrombosis that occurred in an obese patient after laparoscopic sleeve gastrectomy.

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Background: Metabolic syndrome (MetS) is a complex web of metabolic factors that are associated with a 2-fold risk of cardiovascular diseases and a 5-fold risk of diabetes. There are lacunae of Indian studies regarding its prevalence with special reference to metropolitan cities such as Mumbai, India. Aim: To determine the prevalence of MetS in apparently healthy adult male population from Mumbai city based on their anthropometric, biochemical, and clinical health markers. Materials and Methods: This study was a cross-sectional study comprising 313 apparently healthy adult males aged 18-65 years from upper-middle-income group from different locales of Mumbai. A standardized pretested questionnaire was used to collect data regarding demographic characteristics, anthropometric parameters, and biochemical and clinical health markers using standardized methods. The data were analyzed using SPSS statistical software. Any observed difference was considered statistically significant with P < 0.05. Results: The mean age of the subjects was 46 years. The prevalence of MetS was 40% with 82% of the population surveyed being overweight and obese and 70.3% of the population with waist circumference of ΃90 cm. It was observed that 36% of the subjects were prehypertensives and 23.4% had systolic and/or diastolic blood pressures ΃140/90 mmHg. Almost 40% of the subjects had dysglycemia with 34% of the subjects with high triglycerides, 26% with high total cholesterol, 64% with raised serum low-density lipoprotein cholesterol, and almost 66% with low serum high-density lipoprotein cholesterol levels. A significant positive correlation was observed between anthropometric and biochemical markers. Conclusion: In apparently healthy adult population of Mumbai, the prevalence of MetS was 40%. A significant positive correlation was observed between anthropometric, clinical, and biochemical markers. The study highlights the need for intervention to lower the risk markers predisposing the urban population to noncommunicable diseases.

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Accumulation of fat at ectopic sites rather than mere increase in body fat can explain almost all metabolic consequences of obesity. Certain characteristics of adipocytes like increased size and ectopic accumulation make them metabolically sick. Hence 'adiposopathy' seems to be more important than just 'adiposity'. Genetic and epigenetic factors, along with intra-uterine factors determine ectopic fat accumulation. These three factors result in low subcutaneous adipose tissue (SAT) volume leading to 'spillover' of excess fat to ectopic sites; determining 'metabolic economy', by creating a 'thrifty phenotype' with calorie excess later in life resulting in 'maladaptation' and excess weight gain. This is particularly important for South Asians who have been found to have low SAT volume and possess a 'thrifty phenotype'. Obesogenic diet and lack of physical activity contribute to ectopic fat deposition by creating a positive energy balance. Increased fructose and trans-fat consumption are important determinants of obesity and ectopic fat deposition. The good news is that ectopic fat is very responsive to treatment, disappearing at a faster rate with minimal weight loss, resulting in improvement in metabolic and organ functions. Physical activity causes negative energy balance and improves 'metabolic flexibility'. Targeting 'ectopic fat' should be the highlight of obesity management today and its primordial prevention should aim at targeting maternal nutrition.

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Background: Overweight and obesity are the most prevalent nutritional disorders in developed and developing countries due to rapid urbanization. Presently, the incidence of overweight, obesity and their related co-morbidities is increasing rapidly in India. Obesity itself is not an acutely lethal disease, but is a significant risk factor associated with a range of serious non-communicable diseases. Obesity is a major player responsible for increasing prevalence of diabetes mellitus, hypertension, cancer and lipid disorders. Aim: The present study was aimed to evaluate prevalence of obesity in housewives (HWs) and its relation with household activity in Ahmedabad city, India. Participants and Methods: The house-to-house survey or interview-based study was carried out among HWs (n=200) from different areas of Ahmedabad city to evaluate the prevalence of obesity. All study participants were categorized based on their socio-economical status and divided into three groups; Group I as upper middle class (UMC), Group II as middle class (MC) and Group III as lower middle class (LMC). Further, the participants were subcategorized to evaluate age-specific prevalence of overweight and obesity. Overweight and obesity were defined using body mass index criteria recommended by the World Health Organization. Participants were inquired for their daily household activity and physical activity. Results: Prevalence of overweight and obesity in HWs were found higher in MC group compared with UMC and LMC group. Moreover, age specific evaluation of prevalence of overweight and obesity was found to be higher in age group of 30-45 years followed by other age groups (<30 years and 46-60 years). Involvements of HWs in daily household activities were observed to be higher in LMC than in MC and UMC. Conclusion: The results of the present study revealed that the prevalence of overweight and obesity is higher in HWs belonging to MC families, which may be due low household and physical activities. The prevalence of obesity and overweight in HWs is directly proportional to reduced daily household activity and physical in activities.

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The prevalence of obesity and vitamin D deficiency has increased in the last decade, becoming pandemics. In obesity, macrophage accumulation occurs in the adipose tissue. This is associated with a low-grade chronic inflammation and leads to the release of inflammatory cytokines. Vitamin D was found to have anti-adipogenic activity and may exert immunoregulatory effects as well as reduce the adipose tissue inflammation. Recent studies suggest that vitamin D and vitamin D receptor (VDR) play an important role in adipose tissue whereas the expression of genes of the 25-hydroxyvitamin D 1α-hydroxylase (CYP27B1) and VDR were demonstrated in human adipocytes. Growing evidence suggests vitamin D also plays a role in the type of preadipocytes, and the proneness to the inflammatory process.

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Objective: The aim was to study herb-drug interaction of two ayurvedic formulations - DMFN01 (Nisha-Amalaki) powder and DMFN02 (Mamejava) ghanavati with metformin at a single dose in healthy volunteers. Materials and Methods: This was an open-labelled, single dose, crossover, and randomized volunteer study. Healthy volunteers were studied in two groups (6/group). Volunteers were randomized to oral metformin (500 mg single dose) alone or with concurrent DMFN01 (10 g), or DMFN02 (750 mg). Venous blood samples were collected at different time points from 0 to 24 h. Plasma metformin concentrations were measured by high performance liquid chromatography coupled with an ultraviolet detector. Results: Simultaneous administration of DMFN01 with metformin showed a reduction in the mean area under the curve (AUC [0-24 h]) of metformin by 51% (P < 0.002) when compared with metformin alone. However, co-administration of DMFN02 did not show any significant difference in the mean AUC of metformin (P = 0.645). One volunteer had a reduction of 41% in AUC of metformin with DMFN 02. Conclusions: These data raise relevant questions on therapeutic control of hyperglycemia when DMFN01 choorna is given concurrently with metformin. Based on known absorption pattern of metformin an interval of 2 h between the oral doses of metformin and ayurvedic formulations would be advisable to avoid interactions. In reverse pharmacological studies, at an early stage, such interaction studies are desirable.

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Introduction and Objectives: Almost two-thirds of all deaths worldwide are due to noncommunicable diseases (NCDs), which are primarily associated with tobacco-use, alcohol consumption, physical inactivity, unhealthy diet, obesity and raised blood pressure and are largely preventable. Despite the increasing burden of NCDs and their risk factors in India, information on the prevalence of preventable risk factors is restricted to some areas. This study was done to assess the prevalence and distribution of various risk factors for NCD in population of an urban area of Puducherry, in South India. Methodology: This population-based survey was conducted using the "World Health Organization step-wise approach to surveillance of NCDs" (steps) methodology. All the eligible subjects in systematic randomly selected households were interviewed. Standardized protocols were used to assess major behavioral risk factors (tobacco-use, alcohol consumption, unhealthy diet and physical inactivity) and physiological risk factors (overweight, abdominal obesity and raised blood pressure) for NCDs. Means and proportions were calculated for measured variables, and Chi square test was applied to find the associations. Results: Among 569 study subjects interviewed, almost half (48%) were aged <40 years and 52% (n = 295) were men. The prevalence of various risk factors was; tobacco-use (13.4%), alcohol consumption (14.2%), physical inactivity (51.5%), unhealthy diet (86.5%), overweight (36.0%), obesity (21.3%), abdominal obesity (63.3), hypertension (25.3%) and prehypertension (47.8%). Tobacco-use and alcohol consumption was significantly more prevalent among males (p < 0.05). Almost half of the study subjects had two or more risk factors. Conclusion: Present community-based study reveals the high burden of NCDs risk factors in urban population of Puducherry and the burden was particularly higher among males. This also reiterates the need to address these issues comprehensively as a part of NCDs prevention and control strategy. Further, multi-sectoral efforts like ban on sale or raising the tax on alcohol and tobacco products, health education and communication activities, enabling environment for people to engage in physical activities and other measures to lower the burden of NCDs risk factors in community have to be encouraged.

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A global epidemiological transition in the prevalence of noncommunicable diseases is taking place due to the emergence of behavioral and metabolic risk factors. A renewed interest in the role of serum uric acid as a risk factor has been generated and a crossover from rheumatology to composite of cardiovascular disorders is taking place. Hyperuricemia (HU) is defined as serum urate level > 6.8 mg/dl that is, the limit of urate solubility at physiological temperature and pH. The prevalence of HU and its complications have increased globally in the past decades. It is an indicator of a widespread transition in lifestyle. The positive association between serum uric acid and hypertension, coronary artery disease, stroke, heart failure, renal failure, and preeclampsia has been recognized. Evidence suggests that elevated serum uric acid is strongly associated with and predictive of insulin resistance and metabolic syndrome. The role of HU in the pathogenesis of cardiovascular and renal diseases involves effects on the endothelial function, oxidative metabolism, and platelet aggregation. Among the constellation of established atherosclerotic cardiovascular risk factors HU has an additive or synergistic impact on the outcomes. As an independent risk factor for cardiovascular and related diseases, the role of HU has been extensively debated for many years. Besides being a biomarker and risk factor, HU is also emerging a target for the prevention of atherosclerotic cardiovascular diseases. In most of the patients, with asymptomatic HU, treatment is not advocated to reduce cardiovascular risk. Currently, no guidelines and recommendations have been updated in the pharmacological management of asymptomatic HU. It will be particularly important to design large, long-term studies that would determine the effects of urate-lowering therapy on cardiovascular disease.

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The prevalence of obesity and related co morbid conditions are on an exponential growth globally as well as in developing countries like India encompassing children to elderly population with disregard to socioeconomic status. This review is an attempt to evaluate the published work on obesity and bariatric/metabolic surgery in Indian obese patients to identify gaps in evidences. Based on the current literature research, it can be concluded that there is a need for updated information on the prevalence of obesity in Indian sub-continent. The latest National Family Health Survey is of 2007/2008 and WHO data is of 2010. The increasing prevalence of obesity and metabolic syndrome and perception of disease emphasizes that there is a need for effective communication and education to mothers to bring awareness and reduce the burden in India. Effective outcome with respect to weight loss was observed with Roux-en-Y Gastric Bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), like adjustable gastric banding and also mini-gastric bypass. This weight loss was stable over long follow-up for majority of patients with a reduction of body mass index ranging from 10 to 14 kg/m ² 3 years after bariatric surgery (BS). With respect to treating type 2 diabetes mellitus (T2DM) RYGB and LSG are the two most published metabolic procedure in Indians for surgical treatment of T2DM. No mortality has been recorded so far in published literatures for any types of procedures. BS offers economic benefit to patients in the long run however further studies are warranted.

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Background: Noninsulin dependent diabetes mellitus (NIDDM) is a menacing life-style disorder; in Ayurveda, it is equated to Madhumeha. The concept of Prakriti (Ayurvedic constitution) can be applied for manifestations and prognosis of diseases like diabetes. Aim: The aim was to study the biochemical and anthropometric profiles of different Sharirika Prakriti (bodily constitution) in NIDDM patients. Material and Methods: Prakriti of 100 patients of NIDDM was assessed as per a tested Prakriti assessment proforma. Vata, Pitta and Kapha-dominant Prakritis were analyzed according to the characteristics found in patients. Biochemical and anthropometric variables were measured and interpreted as per the individual Prakriti. Biochemical variables of patients were compared in different Prakriti groups in the parameter of mean ± standard deviation. Results: Kapha-dominant Prakriti patients were found to have higher level of fasting blood sugar, postprandial blood sugar, serum cholesterol, serum triglycerides, high density lipoprotein, serum urea and serum creatinine than in other Prakriti. Alkaline phosphatase, SGPT and SGOT levels were higher in the Pitta-dominant Prakriti but the values were in the normal range. Patients with Vata dominant Prakriti had higher level of serum protein, serum albumin and serum globulin, but the values were in the normal limits. All these variables were compared with the dominant Dosha Prakriti and discussed vis-à-vis Ayurvedic features accordingly. Conclusion: Dosha dominant Prakriti has an influence on the biochemical and anthropometric parameters of NIDDM patients, which need to be explored in a sample.

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Type 1 diabetes mellitus (T1DM) is a common pediatric endocrine condition and Mauriac syndrome (MS) is described as one of the manifestation of poorly controlled diabetes. It manifests as hepatomegaly, growth delay, elevated liver enzymes, and serum lipids and glycogen accumulation in hepatocytes. We report a 7-year-old child of MS with poorly controlled T1DM. With appropriate management, the patient showed improvement symptomatically and in liver size. The fasting blood sugar and triglycerides showed a reduction.

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Metabolic control is the first step in managing microvascular complications of diabetes including diabetic retinopathy. Important parameters proved to be of the key role in managing diabetic retinopathy and preventing sight-threatening complications thereof include blood sugar levels, serum lipid profile, hemoglobin levels and renal function tests. The severity of hyperglycemia and hypertension are main modifiable factors which may prevent the development of diabetic retinopathy. Thus, all the diabetics have to be compliant in having a good metabolic control which not only prevents or slows down risk of visual loss, but also is associated with a better cardiovascular activity ultimately contributing to a better quality-of-life in these subjects.

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Introduction: Prevalence of overweight and obesity has been reported in developing countries, especially in urban populations. Prevalence of obesity increased from rural (12.8%) than in urban (14.6%) area and overweight in increased from rural (25.8%) than urban (26.3%) area in the age 14-16 years Surat, Gujarat. Objective: To ascertain the prevalence of overweight/obesity among adolescents in urban and rural area of Salem District, Tamil Nadu. Methods: The study was carried out at the Salem block in Salem District. Cross-sectional data were collected from November 2012 to March 2013. Anthropometric measurements were recorded among 1898 school going adolescents, and body mass index (BMI) was calculated. Multistage stratified random sampling design was employed. School going adolescents in the age group of 11-15 years who were studying 6 ^th -10 ^th standard were included. Area of residence was collected from the school register with the help of class teachers. Results: The overall prevalence rate of overweight/obese among adolescents was found to be 12.11%. The highest prevalence was observed at the age of 14 years (15.76%). The prevalence rate of overweight/obese was higher in rural (13.16%) than urban (11.33%) area. Consequently, the prevalence rate of overweight/obesity was higher in rural girls (15.88%) and urban girls (13.74%) compared with boys (12.18%) in rural and (10.45%) urban areas. The highest rate of prevalence was observed at the age of 15 years (14.42%) in urban and 12 years (8.30%) in a rural area. Conclusion: An increasing prevalence of overweight/obesity was seen in rural adolescents especially in girls. Hence, it is an urgent need for immediate and targeted preventive measures.

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Introduction: The objective was to assess the prevalence of hyperuricemia among newly diagnosed hypertensive patients in a tertiary care hospital in the Northern hilly state of Himachal Pradesh, India. Materials and Methods: In all 118 newly diagnosed patients with hypertension above the age of 20 years were included. Uric acid (UA) was measured using enzymatic uricase method. Hyperuricemia was defined as serum urate level > 6.8 mg/dl. National Cholesterol Education Program-Adult Treatment Panel III criteria modified for Asian subjects, was used for defining metabolic syndrome (MS). Student's t-test for mean of continuous variables and Chi-square test for proportions were used for statistical significance. Results: The mean UA level among all the hypertensive subjects was 4.7 ± 1.0 mg/dl. The mean UA of patients with MS was 5.2 ± 1.3 mg/dl while in those without MS was 4.2 ± 0.7 mg/dl. The difference in mean UA in the two groups was statistically significant (P = 0.001). The prevalence of hyperuricemia was 5%, and all the patients were postmenopausal females among the MS group. Conclusion: In this study, cross-sectional associations between hypertension, MS and hyperuricemia were observed.

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Background: Blends of rice bran oil (RBO) offer promise as functional foods to lower cholesterol. In Japan, a blend of 70% RBO and 30% safflower oil (KO) was shown to lower cholesterol in young healthy volunteers. However, this effect has not been demonstrated in hyperlipidemic individuals in the Indian population. Objective: We evaluated the effect of the blend on blood lipids in hyperlipidemic individuals for 12 weeks after 2 weeks stabilization period. Design: The study was a double blind, randomized, and controlled study. Thirty-five free-living individuals of either gender, aged 18-70 years completed this study. Assessment of subjects was carried out at baseline and weeks 0, 4, 8, and 12. Results: All 35 subjects completed the study. There was a significant reduction in serum cholesterol (21%, P < 0.001) at the end of 12 weeks in the experimental group. In the control group, there was a significant reduction till week 8 (17%, P < 0.001), followed by an increase at week 12. A similar trend was seen with serum low density lipoprotein (LDL). At week 12, LDL in the experimental group was significantly lower (P < 0.05) than LDL in the control group. Conclusions: Consumption of a diet enriched in the blended oil and meeting the recommended dietary guidelines resulted in an improved lipid profile. The blend can play an important role in the diet of people at risk of coronary heart disease.

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The escalating twin pandemics of obesity and type 2 diabetes mellitus (T2DM) present a major global public health burden. Bariatric surgery is an effective treatment for obese patients with T2DM, as it not only causes weight loss, but also improves metabolic risk factors including glycemia, hypertension and dyslipidemia. Although several studies have shown impressive remission rates of T2DM following bariatric surgery, these studies have used different definitions of remission. In an attempt to solve the problem of inconsistent definitions, the American Diabetes Association and International Diabetes Federation, two large diabetes organizations, have developed standardized criteria for T2DM remission. These criteria are comprised of clinical parameters including glucose, lipid and blood pressure control and medication usage. Studies using these criteria have reported lower rates of remission than those previously reported using nonstandardized definitions. This review describes the existing literature on remission of T2DM following bariatric surgery, and emphasizes the importance of using the standardized definitions established in order to improve remission rates and thus reduce the incidence of the macrovascular and microvascular complications of T2DM.

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Obesity and osteoarthritis are globally reaching epidemic proportions. Their concomitant association is well-known. The cumulative impact of these conditions on morbidity and the quality-of-life is sizeable, particularly for the aged. Obesity leading to osteoarthritis of the weight-bearing joints is well-appreciated. Inversely, however it is less emphasised that osteoarthritis of big joints of the lower limbs contributes to obesity because of the resultant physical inactivity. The increased adiposity is known to secrete proinflammatory cytokines that adds to the biomechanical cause of osteoarthritis. Besides mechanical and inflammatory mechanisms, genetic factors also play a causative role in both obesity and osteoarthritis as separate and concomitant disorders. The genetic and epigenetic mechanisms are gradually being unravelled for the comorbidity of obesity and osteoarthritis. Thus, the molecular pathophysiology of the concomitant existence of obesity and osteoarthritis is highly intriguing. Identifying the appropriate choice and sequence of therapeutic targets for reversal of this complex pathogenesis is a challenging task. Ayurvedic understanding of this comorbidity and experiential therapeutic base can offer a strategy for the prevention and management of the disorders. "Sthaulya" and "Sandhigatavata" are the respective clinical syndromes, described in Ayurveda for obesity and osteoarthritis. The imbalance in the respective "Dhatvagni" (metabolic paths) of "Meda-Dhatu" (adipose tissue) and "Asthi-Dhatu" (bone tissue) is the putative central pathogenetic mechanism involved for the comorbidity. The present article analyses some of the insights and experience from Ayurveda so as to provoke a meaningful debate on the opportunities for integrative care for obesity related osteoarthritis through reverse pharmacology path.

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