Indian Journal of Medical Specialities 7 (2016) 95–99

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Indian Journal of Medical Specialities

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Original article

A report on body composition and fitness profile of young men of

Toto community: An endangered tribe of India
Pallav Sengupta *
Department of Physiology, Vidyasagar College for Women, University of Calcutta, 39, Sankar Ghosh Lane, Kolkata 700 006, West Bengal, India

A R T I C L E I N F O A B S T R A C T

Article history: Background and aim: Toto is an endangered tribe comprising of miniscule population of the Madarihat
Received 23 October 2015 Block in Northern West Bengal. The male members of this community who undergo hardships to sustain
Received in revised form 22 May 2016 their families, are suffering from ill health and poor economic conditions. As studies regarding their
Accepted 23 June 2016
fitness profile are unavailable, this study is the first ever attempt to investigate their fitness status and
Available online 28 June 2016
prevalence of malnutrition by morphometrics.
Methods: The study was conducted in young Toto men (mean age 23.7 years). Measurements of body
Keywords:
composition included several anthropometric variables; while physical efficiency parameters were
Physical fitness
Harvard step test
physical fitness index (PFI), VO2max, energy expenditure and anaerobic power.
Anaerobic power Results: Analysis of data highlighted that 50% of the Toto men are mild underweight with lower fat mass,
Body fat waist-to-hip ratio and conicity index. However, they were found to have excellent physical fitness [83.1
Toto (4.44)%] which is positively correlated with their family income (R2 = 0.550) and level of education
(R2 = 0.508).
Conclusion: This study reports that most of the Toto men are underweight may be due to their poor
nutritional status but the fitness level is not yet affected may be due to the acquired physical strength by
their continuous hardships.
ß 2016 Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd on behalf of Indian Journal of
Medical Specialities.

1. Background
Toto, an endangered tribe with scanty existing population,
resides at the Madarihat Block of Jalpaiguri District in Northern
part of West Bengal, just to the south of the borderline between
Bhutan and West Bengal, in a small enclave called Totopara. This
distinct backward socio-cultural unit, at the foot of the Himalayas
has fallen victim of several health problems owing to their very low
literacy rate (Table 1), male having as less as 36.36% and the total
being 30.35% with poor economic status [1]. According to the first
census after independence of India (1951), Totos were almost
becoming extinct with population of 321 members, but now the
population has increased to 1387 (census 2011) [1]. Though
Government is pursuing several policies to save Totos [2],
extensive studies are essential to find out their exact social and
health problems. As this tribe is so diminutive, the attempts to
prevent them from perishing completely should be made from
every aspect. One of such aspects might be to focus on their fitness
* Tel.: +91 33 22418887.
E-mail address: sunny_pallav_1984@yahoo.co.in
level and analyze the accurate level of fitness so that the data might
help to determine the exact required degree of improvement of
their fitness profile, along with data on their physical, physiological
and anthropological attributes.
The Toto men undergo several hardships to afford their
minimum living. They are mostly laborers who carry oranges
from Bhutan to Madarihat market, and also cultivate betel nuts,
bamboo, ginger, black pepper, turmeric, jackfruits and pineapple
[3]. Despite such laborious occupations, the food habit of Toto men
comprise mostly of parched rice, plenty of goat or pig flesh
(without proper sanitary processing) and Eu (a fermented drink
made from fermented marua, rice powder and malt). In addition to
their inadequate and unhygienic food habit, they still stick to their
own traditional cultural practice in treatment of diseases such as
ulcers and headache, bleeding from wounds, blood pressure and
labor pain [4]. As mentioned above, the vital reason behind these
ignorance and indifferences to their own health is their extremely
low literacy. Very few research works have so far dealt with the
health issues of the Toto men, one of which revealed that the
occurrence of Thalassemia is very high among Totos (45%) which is
the result of their custom marriage within the community may be
to conserve their distinct community [5,6]. But, there is no detailed

http://dx.doi.org/10.1016/j.injms.2016.06.004
0976-2884/ß 2016 Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd on behalf of Indian Journal of Medical Specialities.
96 P. Sengupta / Indian Journal of Medical Specialities 7 (2016) 95–99
Table 1
Socio-demographic data of Totopara, Jalpaiguri District.
Area 8.08 km2
Location 898200 E and 268500 N
Total population (as per 2011 census) 1387
Total males 737
Total females 650
Growth (2001–2011) 19.88%
Per capita income (Rs. per month) 1966.66
Average family size 5.16
Literacy rate Male: 36.36%; female: 23.53%;
total: 30.35%
report on the overall physiological, health and fitness status of Toto
people.
As tremendous physical efforts are required to sustain their
lives and family, the evaluation of the physiological status along
with the fitness profile of the Toto men is essential, which is not a
simple task owing to their language, cultural and location barriers.
However, the present study is the first to report the overall fitness
and health status of Toto men based on the morphometric indices.
2. Subjects and methods
Respondents of this cross-sectional study included fifty young
Toto men (age of 23.7  2.91 years) of Totopara, Jalpaiguri, West
Bengal. The experiments were carried out after properly explaining the
entire protocol to the participants to allay their apprehensions, taking
their individual consent and following Institutional ethical permission.
According to the instructions, the subjects had their last meal at least
two hours before conducting the test to avoid the specific dynamic
action (SDA) of food. Temperature of 20–25 8C and relative humidity of
about 45–50% in winter season in India, were maintained during the
experiments to avoid the seasonal influence on fitness pattern. Each
measurement was performed thrice to minimize the experimenter
bias, and the mean was represented as the final result.
Measurement of the body mass index (BMI) was done by the
following formula [7,8]: BMI = weight (kg)/square of height
(m2). Body fat percentage was also estimated by a predictive
formula using BMI, age, and gender [9]: adult body fat %
(PBF) = (1.20  BMI) + (0.23  Age)  10.8  5.4 (for male sub-
jects). This formula has the variability of 5–10% [9]. Formula of
Banerjee and Sen [10] was used to calculate body surface area
(BSA).
Resting heart rate was recorded at carotid pulse after five
minutes of complete rest. When two successive recording of heart
rate scores turn equal then it was considered as resting heart rate
[11]. Arterial blood pressure was taken using a sphygmomanome-
ter following standard procedure [12].
Physical fitness index (PFI) was calculated by measuring heart
rate after performing Harvard step test (HST) developed by Brouha
et al. [13]. It was first developed in the Harvard Fatigue
Laboratories using long form of PFI equation. But, following
modified HST under Indian condition, using a stool of 51 cm high
stepping up and down with a rate of 30 cycles/min for 3 min or up
to exhaustion. Exhaustion is defined as when the subject cannot
maintain the stepping rate for 15 s. After completion of the test,
peak heart rate was recorded, and the recovery pulse was counted
at 1–1.5, 2–2.5 and 3–3.5 min of recovery. Then the duration of
exercise (in seconds) was divided by the sum of recovery heart
rates to get the PFI. This is generally expressed in percent values. It
has also provided a reference range that if the PFI value (%) is below
40, the fitness of the subject is very poor, if it is 41–50, the physical
fitness is poor, if it is 51–60, the fitness is average, 61–70 indicates
good fitness, 71–80 indicates very good physical fitness and PFI
value (%) above 80 shows excellent fitness. Harvard step test for PFI
has the variability of 5–10% [13].
To calculate the anaerobic power, Margaria Double Step test
was carried out [14]. It is a short-term anaerobic test or a power
test in which the subject is climbing two steps at a time; the height
of the stairs is measured by measuring tape. To calculate the
anaerobic power; the height of ascent, the body weight, and the
duration (seconds) are noted by the stopwatch. The work done is
calculated by the following formulae: Work done (kg/m) = body
weight  height of ascent  0.002342. Then the work done was
divided by the duration of the work (in seconds) to get anaerobic
power (kg m1 s1). Margaria Double Step test for anaerobic power
have the variability of 5–6% [14].
VO2max was estimated by using peak and resting heart rates
[15]. Total energy expenditure (TEE) has also been determined by
another predictive formula [16] using peak heart rate scores
recorded during HST: TEE (kcal min2) = 1.42 + (0.045  peak
heart rate).
Circumference measures were taken around the midpoint of
upper arm (MUAC), thigh (TC), calf muscle (CC), waist (WC) and
buttock (BC) by anthropometric tape. WC and BC are used to
predict the body fat content. Eleven derived variables: body
surface area (BSA), body mass index (BMI), body adiposity index
(BAI), fat mass (FM), fat mass index (FMI), fat free mass (FFM), fat
free mass index (FFMI), waist-to-height ratio (WHTR), waist-to-hip
ratio (WHR), MUAC-to-height ratio (MHR) and conicity index (CI)
were included. All anthropometric measurements were made by
using traditional anthropometric techniques [17] and calculated
by using standard formulae [18].
Results were expressed as mean (SD). To calculate corrcoef and
to carry out the linear regression SPSS v.15.0 and MS-Excel v.2013
were used. A value of P < 0.001 was interpreted as statistically
significant [19].
3. Results
Table 1 describes the socio-demographic data of the Toto
community. Table 2 represents physiological parameters as well as
morphometric and adiposity measures. The height (cm) and body
weight (kg) of young Toto men are 161.8  5.24 and
54.6  3.44 respectively. The results not only indicate lower body
weight with respect to their height in Toto men (according to WHO
weight-to-height tables), but the same is the case with fat
distribution. The cutoff points for obesity were adopted as
recommended by Dudeja et al. [20]; for PBF (30.0%), Dasgupta
and Hazra [21]; for WC (72.0 cm) and WHR (0.85). The adiposity
measures reflect lower fat content among the young Toto men, as
reflected in body adiposity index (BAI) (20.07  4.02). Relevantly the
fat mass (kg), and conicity index (CI) were all found to be considerably
lower in the Toto men. Lower buttocks circumference (BC) and waist
circumference (WC) signify lower central body fat distribution among
the young Toto men.
The physiological parameters most importantly, the PFI was
found to be interestingly higher in young Toto men (83.1  4.44)
whereas the cut off values are between 61 and 70. The systolic blood
pressure (mmHg) and diastolic blood pressure (mmHg) were found to
be lower in the Toto men whereas the anaerobic power (kg m1 s1)
and VO2max (ml/kg/min) were noticeably higher and the energy
expenditure (kcal min2) for a specific task given were low in the
young Toto men. Strenuous physical activity requires enormous
bodily movement produced by the skeletal muscles that requires
energy expenditure. Individuals who use less energy than others for a
specific kind of work are said to be more fit.
Table 3 portrays the prevalence of obesity and thinness where it
is observed that the overall prevalence of obesity (BMI >30.00) was
completely absent in the young Toto men; 50% of the Toto men
were found to be mildly underweight (BMI 18.49), 12% were
found to be moderately underweight (BMI 17.0–18.49) and 2%
 P. Sengupta / Indian Journal of Medical Specialities 7 (2016) 95–99 97

Table 2 cultivation, and toil for almost the entire day without sufficient
Body compositions and physiological parameters indicating physical fitness and
rest and thus may suffer from severe chronic energy deficiency
endurance of the studied population.
(CED). Anthropometric and physiological evaluations lead to a
Toto men precise prediction of the nutritional status of a community, since
Mean SD nutrition reflects the overall social standard [11,23].
Age (years) 23.7 3.72
The physical parameters of the young Toto male were observed
Body composition to be lower from the cut-off values of Indian males [20,21] as their
BMI (kg/m2) 19.9 2.42 immensely low body weight reflects malnutrition which also
PBF (%) 17.5 2.54 attributes to their low BMI values (Table 2). BMI was also found to
BSA (m2) 1.70 0.14
be positively correlated with PBF (P < 0.001), BSA (P < 0.01), BAI
Physiological parameters
Resting heart rate (beats/min) 76.5 4.05 (P < 0.01), WHR (P < 0.001), CI (P < 0.05) and other adiposity
Systolic blood pressure (mmHg) 117.6 2.07 measures, whereas it is negative correlated with fitness measures,
Diastolic blood pressure (mmHg) 79.0 3.03 like PFI. Fitness index is also found to be significantly correlated
PFI (%) 83.1 4.44 with anaerobic power (P < 0.01) and VO2max (P < 0.001) and
Anaerobic power (kg m1 s1) 15.1 3.06
negatively correlated with adiposity indices.
VO2max (ml/kg/min) 36.0 3.07
Energy expenditure (kcal min2) 4.64 0.42 As BMI is a better index to assess malnutrition or obesity
Adiposity measures occurrence, the parameters such as height and weight were not
Fat mass (kg) 8.04 3.63 shown individually. The BMI is a useful index to determine
Fat mass index (kg/m2) 3.08 1.41
whether the observed body weight varies from standard value of
Fat free mass (kg) 37.2 4.21
Fat free mass index (kg/m2) 16.20 1.12 healthy subject of a specific height [24]. The low BMI may indicate
Body adiposity index (BAI) 20.07 4.02 improper diet and monotonous long duration strenuous work of
Waist-to-hip ratio (WHR) 0.90 0.06 Toto men. Table 3 particularizes the statement in a better sense,
Waist-to-height ratio (WHTR) 0.46 0.02 which reveals 2% of the Toto men are severely, 12% are moderately
MUAC-for-height (MHR) 0.15 0.02
and 50% are mildly underweight which must be given fruitful
C-index 1.04 0.03
Morphometric characters attention. The low body fat content of the young Toto male might
Mid upper arm circumference (cm) 23.5 2.70 have been observed from their low PBF, BSA, FMI, WHR and BAI.
Thigh circumference (cm) 45.4 3.11 Men, due to their physical hardships, must have adequate energy
Calf circumference (cm) 29.8 2.07
storage in the working tissues as well as in the form of essential fat
Waist circumference (cm) 72.6 4.60
Buttock circumference (cm) 79.2 2.01
in their body. Low body fat along with improper diet may lead to
innumerable physiological problems such as bone loss, chronic
Values are mean  SD (n = 50).
fatigue, reduction in testosterone level, decreased sperm produc-
tion as well as loss of sexual desire [25,26].
Working tissues depend on oxygen supply by blood circulation
were severely underweight (BMI 16.0–16.99). Here it should be for which cardiorespiratory fitness is essential which may be
mentioned that all these estimations are based on an indirect judged by estimating the VO2max and changes in the blood pressure
technique, i.e., anthropometry and the International Classification [27]. Observations showed low systolic and diastolic blood
of BMI cut-off points [22]. pressure in young Toto male suggesting their long duration hard
Fig. 1 shows the correlation between family income (A), level of work without adequate intake of energy. The high VO2max and high
education (B) and family size with fitness status. Average family PFI value of the young Toto male may lead to infer that the Toto
income (R2 = 0.550) and level of education (R2 = 0.508) are found to men have physiologically adapted their body to their regular
be positively correlated with fitness index of Toto men with practice in strenuous long duration energy-demanding work
regression coefficients of 0.741 (SE = 1.61) and 0.712 (SE = 1.69) which trained their working tissues for the performance
respectively. Conversely, fitness status is found to be declining (Table 2). But, continuous labor without proper nutrition obviously
with regression coefficient of 0.764 (R2 = 0.584, SE = 1.55) per would lead to chronic ill effects on the working tissues as the poor
individual. body composition may suggest that the young Toto men are
undernourished. In the present study, though Toto men perform
4. Discussion work related to strength, they were seen to possess less MUAC, TC,
CC, WC and BC, the estimates of energy storage and protein mass of
The present study is concerned with drawing attention to the the body which signify an indirect estimate of the strength
physical attributes of the under privileged backward endangered [28]. The inappropriately low body weight, low body fat, improper
tribe, Toto, by precise assessing the anthropological parameters as body composition and thereby poor health condition would have
well as fitness parameters of the Toto men to bring them in rendered the young Toto men incapable of hard labor. Although,
knowledge of the elite world in order to achieve some betterment the long duration toil from childhood made their working tissues
of this tribe. This cross-sectional study, for the first time, highlights adapted to the stress, the poor health status would have chronic
the fitness status of Toto men who are engaged in labor work and effects on their body. The need to work hard despite of ill health

Table 3
Distribution of BMI and prevalence of thinness and obesity among tribal men of Toto community from Totopara, Jalpaiguri.

Group Sample size Overweight (and obesity) Normal Underweight (thinness)

Grade III: Grade II: Grade I: mild Grade I: mild Grade II: Grade III:
severe moderate moderate severe
(BMI >40) (BMI 30– (BMI 25– (BMI 18.5– (BMI 18.49) (BMI 17.0– (BMI 16.0–
39.99) 29.9) 24.9) 18.49) 16.99)

Toto men 50 (100) 0 (0.00) 0 (0.00) 0 (0.00) 18 (36.00) 25 (50.00) 6 (12.00) 1 (2.00)

Figures in parenthesis indicate percentage.

98 P. Sengupta / Indian Journal of Medical Specialities 7 (2016) 95–99
Fig. 1. Plots of physical fitness index as functions of family income (A), level of
education (B) and family size (C). Regression lines (straight lines) and their 95%
confidence levels (curved lines) are superimposed.
further accentuates the poor condition and low quality of food
intake continuing the spell of malnutrition evokes the fear of their
extinction.
In Toto men, positive relationship was obtained between fitness
status and family income (Fig. 1A) and educational levels (Fig. 1B),
but it is negatively correlated with the family size (Fig. 1C).
According to the Sociologists, the rates of obesity and undernutri-
tion correlate with economic class, i.e. the poorer the community;
they are more likely to be underweight due to less access to
nutrient rich foods [29]. The similar observations are documented
among Toto community (Coefficient = 0.741, SE = 1.61, R2 = 0.550)
whose average family income is 1966.66 INR per month (Table 1).
Among Toto community, Toto men are only 36.36% literate
[1,3]. The average family size of Toto community is 5.16 persons
per family. As the number of family members increase less fitness
is observed among Toto men, this may be attributed to less
availability of sufficient food as per their demand.
5. Conclusion
The present study is the first scientific attempt made to
determine the physiological attributes of the Toto men in terms of
body composition, anthropometric parameters and fitness profile.
The outcome suggests that the male members of this tribe have
been suffering from fragile state of health and attention must be
bestowed upon them to upgrade them economically, socially
which would reflect through their nutrition, in turn rendering
them healthier. Further research works are appreciated to
highlight the health issues of this tribe and prevention of their
extinction.
Funding
None declared.
Conflicts of interest
The author has none to declare.
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