


































Food Science and Nutrition Studies 

ISSN 2573-1661 (Print) ISSN 2573-167X (Online) 

Vol. 1, No. 2, 2017 

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122 
 

Glycemic and Lipid Metabolic Markers in Type 2 Diabetes 

Mellitus Patients after Consuming Red Pigmented Parboiled 

Rice as a Staple—A Clinical Trial 

Upul Cosomn1, Priyadarshika Hettiarachchi2, Kamani Wanigasuriya3 & Rasika Perera4* 

1 Department of Allied Health Sciences, Faculty of Medical Sciences, University of Sri 

Jayewardenepura, Gangodawila, Sri Lanka 

2 Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, 

Gangodawila, Sri Lanka 

3 Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, 

Gangodawila, Sri Lanka 

4 Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayewardenepura, 

Gangodawila, Sri Lanka 

* Rasika Perera, E-mail: rasika@sjp.ac.lk 

 

Received: November 13, 2017 Accepted: November 22, 2017 Online Published: November 27, 2017 

doi:10.22158/fsns.v1n2p122        URL: http://dx.doi.org/10.22158/fsns.v1n2p122 

 

Abstract 

Red pigmented rice has been proven to have unique properties beneficial to health. These might be 

further enriched if parboiled. This study investigated the effects of consumption of RPPR on glycemic 

response, lipid profile and BMI in diabetics.  

For this prospective study patients with diabetes mellitus (aged 40-75 yrs) in a prison (n = 69) were 

recruited. Their usual diet in prison was red pigmented rice. They were served 180 g of RPPR for 16 

weeks during intervention period. 

Fasting Plasma Glucose (FPG) and BMI was assessed at 0, 4, 8, 12 weeks and glycated haemoglobin 

and lipid profile at 0 and 16 weeks. Values at 0 weeks were compared with those at 4, 8, 12, 16 weeks 

after consuming RPPR using ANOVA repeated measures. HBA1c and lipid profile at 16 weeks were 

compared with the 0 week value. During consumption of RPPR, FPG was significantly reduced at 8 (p 

= 0.006), 12 (p = 0.002), and 16 weeks (p = 0.005), with a significant reduction of the BMI at 8 (p = 

0.028) and 16 weeks (p = 0.003). At the end of 16 weeks of consuming RPPR, LDL, Total Cholesterol 

(TC) and TC/HDL ratio were significantly reduced compared to 0 weeks (p = 0.001, p = 0.013, p = 

0.032, respectively. These results suggest that RPPR consumption reduces FPG, LDL, TC,TC/HDL 

ratio and BMI. 



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Keywords 

glycemic control, lipids, Type 2 Diabetes Mellitus, red pigmented parboiled rice 

 

1. Introduction 

Due to increasing obesity rate and westernization of life styles, the prevalence and the incidence of 

Type 2 Diabetes Mellitus (T2DM) in developing countries are increasing dramatically (Jayawardena et 

al., 2012). Rice (Oriza Sativa) is the staple diet consumed by more than half the world population. 

Although studies have indicated that white rice consumption is associated with increased risk of T2DM, 

there are only few interventional studies carried out to identify a healthy rice variety (Hu et al., 2012). 

Colored rice (black, purple, red, brown) due to its edible pigments deposited in the nutrient containing 

pericarp of the rice grain is a special entity studied worldwide. Colored rice contains a variety of 

pigments and bioactive substances. This include numerous anti-oxidant molecules such as phenolic 

acids, flavonoids, anthocyanins, proanthocy-anidins, tocopherols, tocotrienols and Y-oryzanol, etc. (Nam 

et al., 2003). As evidenced by epidemiological studies, there might be an association between low 

incidence of certain chronic diseases amongst rice consumers,which might be due to anti-oxidant 

compounds in rice (Goufo & Trindade, 2014). 

Among the antioxidants, anthocyanin, which is the pigment found in red or purple pericarp of rice, is 

considered a natural colorants of foods. It is reported that there are unique properties of anthocyanin 

pigment such as antioxidant activity (Nam et al., 2006), anti-inflammatory (Wang et al., 2007), 

anticancer (Hyun & Chung, 2004) and hypoglycemic (Takikawa et al., 2010) which makes consuming 

pigmented rice beneficial for health. Pigmented rice is commonly consumed by people in South East 

Asia including Sri Lanka, Thailand, China, etc. (Sompong et al., 2011). 

Red Pigmented rice is amongst the rice varieties with high activity of antioxidants. Anthocyanins: the 

pigment in red rice comprised of several types cyanidin 3-glucoside, cyanidin 3-galactoside, cyanidin 

3-rutinoside, cyanidin 3,5-diglucoside and malvidin 3-galactoside, etc. (Goufo & Trindade, 2014). 

Numerous recent observational studies have evaluated the hypoglycemic effects of anthocyanin. A study 

conducted in an obese diabetic rat model has found that, anthocyanin suppresses lipogenesis,reduces 

hepatic steatosis in hepatocytes and plays a role in inhibiting fatty acid synthesis (Guo et al., 2011). 

Quality of the red pigmented rice might be enhanced by parboiling. Parboiled rice, obtained after 

soaking paddy in water, steaming to complete gelatinization and drying, has many advantages over raw 

rice (Figure 1). Strengthening of kernel integrity, increased milling recovery, prevention of the loss of 

nutrients during milling, reduced cooking time and improved shelf life as well as prevention of the 

proliferation of fungi and insects are some of the reasons for the increasing demand for parboiled rice 

(Hoover, 2010; Patindol et al., 2008). It is claimed that parboiling reduces the glycemic index by almost 

30% compared to its non parboiled variety due to starch retrogradation, high soluble fiber content and 

increased physical hardness of the grain for digestion (Larsen et al., 2000).  

 



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Figure 1. Red Pigmented Parboiled Rice 

 

Parboiling of red pigmented rice might have several advantages over other types of rice. Although no 

significant differences in macronutrient composition among the red pigmented and red pigmented 

parboiled rice have been observed there were differences in the glycemic indices and the soluble fibre 

contents (Table 1; Hettiarachchi, 2000). Due to the different levels of anthocyanic pigment differences in 

the digestibility has also been observed (Perera & Jansz, 2000). 

 

Table 1. Composition and Glycemic Indices of Cooked Red Pigmented and Red Pigmented 

Parboiled Rice 

Nutrient/glycemic index BW 351 BW272-6B BW 351* BW272-6B* 

Carbohydrates (g) 73.5 82.6 78 74 

Amylose/amylopectine 26.4/47.3 = 0.5 26.4/56.2 = 0.4 29.9/48.1 = 0.6 26.1/47.5 = 0.5 

Protein (g) 9.2 11.6 6.7 9.6 

Fat (g) 1.5 0.9 1.1 2.1 

Total fiber (g) 5.3 2.6 5.7 4.3 

Soluble fiber (g) 1.7 1.4 1.9 3.1 

Glycemic index 73 68 56 58 

Moisture (g) 14.7 13.7 12.2 13.7 

Macronutrients are calculated on dry basis. * denotes parboiled rice. 

 

A preliminary in vitro study with red pigmented parboiled rice has shown that there is alteration in the 

pigments in parboiling (Perera & Jansz, 2000). A lower glycemic response in red parboiled rice might 

be due to protein pigment complex permeating the starch gel causing inhibition of enzyme hydrolysis 

during parboiling (Perera & Jansz, 2000). Rice pigments and the antioxidant properties have been 

extensively investigated, yet interventional studies in human testing the physiological effects of red 

pigmented rice are few. 

Owing to certain characteristics postulated such as, presence of anti-oxidants, anti amylase activity and 

the ability to improve the soluble fibre content after parboiling and lower glyceamic index, consuming 



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red pigmented rice might be beneficial in health as well as in diabetics.  

The effect of consumption of red pigmented parboiled rice on lipid markers and BMI has not been 

ascertained in diabetic patients. Consuming red pigmented parboiled rice might favorably answer an 

emerging public health problem in the developing world by achieving the expected outcomes of 

diabetes mellitus in improving the lipid and glucose metabolism markers. 

Thus we hypothesized that red pigmented parboiled rice consumption lowers the glycemic response, 

improves the lipid profile and lowers the BMI in T2DM patients. The aim of this study was to 

investigate the effect of red parboiled rice consumption on the glycemic control, lipid profile and BMI 

in T2DM subjects. 

 

2. Method 

2.1 Ethics Statement 

Ethics Review Committee of the Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri 

Lanka specifically approved this study. Permission to conduct the study was obtained from the 

Commissioner of Prison, Prison Head Quarters, Welikada, Sri Lanka. Informed written consent was 

obtained from all participants before enrollment to the study and they were given the option of 

withdrawing from the study at any moment. The study was conducted according to the principles 

expressed in the Declaration of Helsinki. 

2.2 Participants and Study Design  

This analytical clinical trial (CTRI/2014/06/004666) was conducted at Welikada prison in Colombo, 

the capital of Sri Lanka, where more than 2000 prisoners with long-term imprisonment serve their 

sentences. The study evaluated the effects of pigmented parboiled rice consumption on blood glucose 

control, BMI and lipid profiles in T2DM patients for a period of 16 weeks. The list of all registered 

diabetes patients in Welikada prison was obtained from the prison hospital and they were invited for 

screening through posters displayed at the prison hospital and dispensary. All responded patients were 

screened according to the inclusion/exclusion criteria and their dietary habits, exercise patterns and 

presence of complications were assessed by an interviewer administered questionnaire.  

Out of 363 registered T2DM patients, 102, T2DM patients fulfilled the inclusion criteria and were 

recruited for the study following obtaining informed written consent. T2DM patients between the ages 

of 40 and 75 yrs, those who were not receiving medication for any disease other than diabetes were 

included.  

Those who had complications of diabetes, who received insulin therapy, whose medication regimen 

was altered during the study, those who had elevated cholesterol levels and blood glucose levels were 

excluded. Of an initial diabetic population of 102 only 69 were recruited as those patients who had 

elevated serum cholesterol (n = 12) and elevated FPG (n = 14) were removed from the study sample 

and referred for treatment and seven subjects opted out from the study. The usual diabetic diet in the 

prison comprised of cooked red pigmented rice (180 g), starchy vegetable 50 g, leafy vegetable 50 g 



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and fish or meat (100 g). In this intervention red pigmented parboiledrice was served instead of red 

pigmented rice. At 0 weeks, FPG, lipid profiles, HbA1c and BMI were assessed. These measurements 

were considered as baseline measurements. FPG and BMI were determined every 4 weeks from the day 

of commencement of the study whereas lipid profiles, and HbA1c were determined at the end of 16 

weeks (Figure 2).  

 

 

 

 

 

 

 

  

 

Figure 2. Time Points at Which Biochemical Parameters and BMI Were Assessed 

 

2.2.1 Activities 

Prisoners generally have a fixed daily routine of physical activities and all of them were following the 

same schedule of physical activities. 

2.2.2 Medication 

Patients on antidiabetic medication (sulfonylurea: n = 18, biguanides: n = 21, thiazolidiones: n = 8, and 

sulfonileurea + biguanides: n = 22) were included in the study. In case of change in medication during 

the course of the study, those subjects were removed from the study (n = 0). 

2.3 Data Collection 

Venous blood was collected after an overnight fast into EDTA tubes, sodium fluoride containing tubes 

and plain tubes for HbA1c, FPG and lipid profile respectively. Samples were transported immediately to 

the Nawaloka Metropolis Laboratory, Colombo 2, Sri Lanka and centrifuged at 4000 rpm for 10 

minutes. Plasma was stored until analysis at 2-80C up to a maximum of 1 week, unless analyzed 

immediately.  

2.4 Assessment of BMI and Blood Pressure 

Weight was measured using a digital weighting scale (Chyo Mu-150K, Japan), to the nearest 0.1 kg 

while standing with barefoot on the center of the scale-platform, keeping the hands at sides and looking 

straight. Height was measured only at 8 weeks to the nearest 0.1 cm, using stadiometer (No. 265M), 

 

FB

G, 

BM

I 

FB

G, 

BM

I 

Intervention with red pigmented parboiled rice 16 wks 

 

 

 

0 wks 

BMI 

FPG 

HBA1c 

Lipid 

profile 

 

 

 

4 wks 

BMI 

FPG 

 

8 wks 

BMI 

FPG 

 

12 wks 

BMI 

FPG 

 

16 wks 

BMI 

FPG 

HBA1c 

Lipid 

FB

G, 

BM

I 

FB

G, 

Hb

A1c 

lipi

d 

prof

ile 

BM

I 



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while standing up straight against the backboard, with barefoot, heels together, toes apart, and the head, 

shoulder blades, buttocks and heels in contact with the backboard with the head kept in the Frankfurt’s 

horizontal plane. BMI was calculated by determining the weight to height squared ratio. As a base line 

investigation systolic and diastolic blood pressure was determined using the sphigmomanometer. 

2.5 Analytical Methods 

Blood samples for FBG were analyzed by glucose oxidase method which is an adaptation of the 

hexokinase-glucose-6-pospate dehydrogenase method, in a fully automated biochemistry analyzer 

(SIEMENS Dimension: CT. DF 40 USA).  

HbA1c was analyzed by D-10 HbA1c program which utilizes the principles of ion-exchange 

High-Performance Liquid Chromatography (HPLC), using fully automated analyzer by 

Immunoturbidimetric method (Roche Hitachi (902) Cobas System) (Yasmeen et al., 2011). 

Blood samples for lipid profiles were analyzed by enzymatic method using fully automated SIEMENS 

Dimension CT. DF 27 (USA) instrument (Flegg, 1973; Rautela & Liedtke, 1978). 

2.6 Statistical Analyses 

FBG and, BMI, at 0 weeks were compared with values obtained at 4, 8, 12 and 16 weeks (Table 2, 

Figure 2, Figure 3), using ANOVA repeated measures, General Linear Model (GLM). HbA1c and lipid 

profiles at 0 weeks were compared with values obtained at 16 weeks (Table 2, Figure 2, Figure 3), 

using ANOVA repeated measures, GLM. The values at 0 weeks was considered as the baseline for 

RPPR intervention. All analyses were performed using SPSS (version 17.0) software and a P value < 

0.05 was taken as statistically significant. 

 

3. Results  

Base line characteristics: The mean (SEM) age of the study group was 50.72 years (1.08). There 

were 17 Females and 52 males in the study group. At 0 weeks Subjects’ mean (SEM) of weight, 

height and BMI were 62.98 kg (0.97), 1.62 m (0.01) and 23.88 kg/m2 (0.29), respectively. At 0 

weeks their mean (SEM) diastolic blood pressure was 83.18 (0.70) and the mean (SEM) systolic 

blood pressure was 128.19 (1.20).  

Body weight significantly decreased after consumption of RPPR compared to 0 weeks. Hence BMI was 

significantly decreased after consumption of RPPR for 8 (p = 0.028) and 16 weeks (p = 0.003) compared 

to 0 weeks. 

3.1 Glycemic Control 

After the intervention with RPPR consumption, FPG was significantly reduced at 8 (p = 0.006), 12 (p = 

0.002), and 16weeks (p = 0.005) compared to 0 weeks (Table 2, Figure 3). Although there was a 

decreasing trend, the HBA1c did not show a significant change at 16 weeks compared to the 0 week 

value (Table 2). 

 

 



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Table 2. Assessment of Biochemical Parameters and BMI of T2DM after Consuming Red 

Pigmented Parboiled Rice (n = 69) 

Parameter 
Consumption of red pigmented parboiled rice at 

0 weeks 4 weeks 8 weeks 12 weeks 16weeks 

BMI 23.88  2.39 23.87  2.40 23.82  2.36 23.81  2.30 23.78  2.29 

FPG mg/dL 1.12  26.39 1.06  24.25 1.03  18.13 1.02  18.51 1.03  16.95 

LDLmg/dL* 1.27  30.11    1.14  27.03 

HDLmg/dL* 41.82  10.59    42.47  10.40 

TCmg/dL* 1.95  45.02    1.83  37.43 

TGmg/dL* 1.63  84.57    1.52  66.16 

TC/HDL* 4.93  1.51    4.50  1.27 

HbA1c (%)* 6.37  1.40    6.31  1.20 

Note. Mean +/-SD. *Parameters were assessed at 0 and 16 weeks. 

 

 

Figure 3. Variations in FPG and BMI during the Intervention Period 

 

3.2 Lipid Profile 

At the end of 16weeks of consuming RPPR, LDL (p = 0.001) and TC (p = 0.013) were significantly 

reduced compared to the 0 weeks value (Table 2, Figure 4). There was no change in the HDL or TG 

concentration. However the TC/HDL ratio (p = 0.032) was significantly reduced compared to the 0 

weeks value. 



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Figure 4. Changes in Lipid Parameters during the Intervention Period 

 

4. Discussion 

Investigations to identify rice varieties which produce a low glycemic response have been carried out 

worldwide. The chemical composition of red rice has been extensively investigated. Anti oxidant and 

lipid lowering effects of pigmented rice has been reported. However no interventions determining the 

effect of consuming red pigmented rice were reported on T2DM patients. The present study is the only 

study to report on glycemic response, lipid profile and BMI on consuming red pigmented parboiled rice 

in T2DM patients. A reduction in the fasting plasma glucose was seen with RPPR consumption at 4 (p 

= 0.236), 8 (p = 0.006), 12 (p = 0.002), and 16 (0.005) weekscompared to 0weeks. However at the end 

of 16 weeks the HbA1c concentration was unchanged in spite of a decreasing trend. Probably 

consuming RPRR for a longer duration, for more than 16 weeks, might reduce the HbA1c concentration. 

In contrast during consumption of pre germinated brown rice for 16 weeks in people with impaired 

glucose tolerance the HbA1c concentration compared to white rice was reduced (Bui et al., 2014). In 

another study comparing pre germinated brown rice with white rice consumption for a similar time 

duration, a reduction of fructosamine concentration was observed (Hsu et al., 2008). This may be 

because in both studies pregerminated brown rice was compared with white rice whereas the present 

study compared the basal blood glucose concentration. A study which substituted brown rice for white 

rice for 16 week did not show conclusive evidence in improvement in the metabolic risk factors such as 

FPG, HBA 1c, HDL, TC and TG (Zhang et al., 2011). 

Although the brown rice contain a higher fibre content compared to white rice the 16 weeks duration of 

consumption of brown rice might be inadequate. Similarly even though the fibre content in red 

pigmented parboiled rice is high to observe a difference in HBA1c probably a the duration of 

consumption should be more than 16 weeks. 



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At the end of 16 weeks after consuming of red pigmented parboiled rice lipid markers such as LDL 

cholesterol (p = 0.001, total cholesterol (p = 0.013) and TC/HDL ratio (p = 0.032) werereduced 

compared to the basal level. This might be attributed to the presence of anthocyanin in red pigmented 

rice. Supplementation of anthocyanin for 12 weeksin a double-blind, randomized, placebo-controlled 

trial in dyslipideamic subjects has shown an improvement in serum LDL- and HDL-cholesterol 

concentrations (Qin et al., 2009). 

As proven by many prospective studies it is clear that the risk of diabetes increases with white rice 

consumption implying red pigmented parboiled rice might be an alternative for white rice (Villegas et 

al., 2007). 

Consuming pre germinated brown rice compared to white rice, for a period of 16 weeks produced a 

lower LDL and triglyceride level and significantly higher HDL cholesterol level, in Vietnamese women 

with impaired glucose tolerance. However the TC concentration was not reduced (Bui et al., 2014). 

Another study in patients with diabetes and individuals with impaired glucose tolerance in Taiwan also 

proved the improvement on levels of serum TCl, Tri-Acylglycerol (TG) and HDL-Cholesterol (HDL-C) 

with pregerminated brown rice for 16 weeks (Hsu et al., 2008). This implies that the changes in the lipid 

profile occur due to consuming pre germinated brown rice unlike white rice. Thus red pigmented 

parboiled rice can be suggested as another alternative to be recommended to improve the lipid profile in 

diabetes mellitus in prison.  

It was demonstrated in diabetic rats that the hypocholesterolemic effects of germinated brown rice were 

partly mediated through the upregulation of the LDL-R and APO A1 genes (Ithnin, 2013). It was shown 

that the pre germinated brown rice bran contains a Y-oryzanol which are effective in lowering 

hyperlipideamia (Sugano & Tsuji, 1997). Pre-Germinated Brown Rice (PGBR) is obtained by allowing 

the rice kernels to slightly germinate once soaked in water. Although it is a common practice in Japan 

most people might not be familiar in preparing PGBR.  

Although a low glycemic indices were found in, easy-cook long-grain rice and white basmati, long 

term physiological effects of consuming these varieties were not determined (Hsu et al., 2008). 

Improvement of lipid markers after consuming pre-germinated brown rice for 16 weeks has been also 

attributed tophysical shape of the rice grain causing delayed digestion and high fibre content (Hsu et al., 

2008). It is reported that the glycemic response in rice: is influenced by the physical texture, chemical 

structure amylose amylopectine ratio and soluble fibre content, anti amylase activity and antioxidants, 

etc. (Björck & Elmståhl, 2003; Gunaratne et al., 2013). Parboiling of the red pigmented rice has 

increased in the soluble fibre content, lowered the digestibility and the glycemic index. This might be a 

added factor which increase its efficacy (Hettiarachchi, 2000; Hettiarachchi et al., 2001; Larsen et al., 

2000; Perera & Jansz, 2000).  

This prospective study ascertains the efficacy of consuming red pigmented parboiled rice as a staple 

while maintaining other ingredients in the diet relatively constant. Our hypothesis was tested in a group 

of people having a generally fixed dietary menu throughout the study period. Due to presence of a fixed 



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dietary menu, and organized daily physical activities of prison in-mates, it was assumed that energy 

expenditure did not vary in the intervention period as before. Hence reduction of the BMI at 8 weeks (p 

= 0.028) and 16 weeks (p = 0.003) compared to basal level might be attributed to consumption of red 

pigmented parboiled rice. 

Similar to consuming red pigmented parboiled, consuming pre germinated brown rice compared to 

white rice, for a period of 16 weeks produced a significant reduction in the BMI in Vietnamese women 

with impaired glucose tolerance. Thus red pigmented parboiled rice might be prescribed in patients with 

diabetes mellitus although the previous study data is from individuals withimpaired glucose tolerance.  

Controlling energy expenditure to a scientifically acceptable degree throughout the intervention period 

was one of the strengths of this study. 

Dietary habits of the prison inmates did not vary except for introducing red pigmented parboiled rice 

and the fact that assessors and lab technicians were blind on the variety of rice were strengths of this 

study. During the intervention medications were not changed among the final study population which 

was taken for analysis. 

When compared to other intervention studies with rice, the sample size of this study was larger and the 

total diabetics in the prison were considered and this was strengths of this study. 

Firstly due to the financial and time constrains intervention period was limited to 16 weeks and this 

would have preferably been longer to see changes in HbA1c concentration.  

Secondly due to the practical difficulties groups of prison inmates could not be randomized to an 

intervention and non intervention group. Future randomized clinical trial in diabetics with a longer 

duration is suggested. To ascertain the actual effect of consuming red pigmented parboiled rice on 

HbA1c the duration would have to be lengthened to more than 16 weeks. 

In conclusion, this study proves that, consuming red pigmented parboiled rice for 16 weeks can 

significantly reduce the blood glucose level. Furthermore, consuming red pigmented parboiled rice for 

16 weeks can produce a significant reduction in the glycemic response, lipid profile and BMI. Due to 

the impact of red pigmented parboiled rice on these markers this variety might be recommended for 

T2DM patients. Considering the unique physiological and physiochemical properties as discussed 

before, further prospective studies may confirm that red pigmented parboiled rice consumption might 

even besuitable for the general community. 

 

Acknowledgement 

We are grateful to the prison inmates who volunteered and the staff of the prison including the 

Commissioner General of prison for their assistance given in conducting the study in the prison 

premises. 

 

 

 



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