Original article
Effect of obesity on cardiometabolic risk factors in Asian Indians

https://doi.org/10.1016/j.jcdr.2012.09.002Get rights and content

Abstract

Objectives

To determine the prevalence of overweight and obesity and their effects on cardiometabolic risk factors in a representative sample of urban population in Eastern India.

Materials and methods

A population-based survey was conducted among a randomly selected study population aged 20–80 years in an urban population of Berhampur city of Eastern India. Both anthropometric and biochemical information were collected, in addition to detailed information on classical cardiometabolic risk factors. Both descriptive and inferential statistical analyses were performed. Obesity and overweight were defined based on the revised Asian–Pacific population criteria (Body mass index [BMI] ≥25 kg/m2 and ≥23 kg/m2, respectively).

Results

The age-standardized rates of obesity and overweight are 36.8% (Males: 33.2%; Females: 40.8%) and 17.6%, (Males: 20.4%; Females: 15.1%) respectively, i.e., over half are either obese or overweight in this study population. Compared to the World Health Organization (WHO) standard cutoff criteria of overweight [BMI ≥25 kg/m2] and obesity [BMI >30 kg/m2], the cardiometabolic risk factors studied showed a significant incremental rise even with the lower cutoffs of the revised Asia–Pacific criteria. Older age, female gender, family history of diabetes, being hypertensive, hypertriglyceridemia, hypercholesterolemia, physical inactivity and middle to higher socioeconomic status significantly contributed to increased obesity risk among this urban population.

Conclusion

One-third of the urban populations are obese in Eastern India – an underestimate compared to the standard BMI cutoff criteria. Nevertheless, significant associations of the classical cardiometabolic risk factors with obesity were observed using the revised Asia–Pacific criteria clearly indicating a more aggressive cardiovascular prevention strategy for Asian Indians.

Introduction

Obesity is a well-recognized cardiovascular risk factor that exerts effects on the heart and circulation both directly and indirectly through its influence on known risk factors such as hyperlipidemia, hypertension, hyperglycemia, prothrombotic state and proinflammatory mediators.1 There are also some unrecognized mechanisms of obesity-related cardiovascular risk. Overweight and obesity together predispose to long-term cardiovascular disorders (CVD) such as coronary heart disease, heart failure, and sudden death.1 Distinct regional and ethnic patterns in obesity associated cardiometabolic disorders are also reported.2

Impaired cardiovascular fitness is commonly associated with obesity in physically inactive individuals contributing to additional cardiovascular risk independent of the degree of obesity. Thus both “fatness” and “fitness” are important independent and modifiable risk factors for heart disease.3 Obesity – as an independent cardiometabolic risk factor is unclear. Methodological issues, such as variations both in the measurement and definition of obesity add further challenges in proving the validity of this apparent relationship. Obesity often occurs in a cluster with established cardiometabolic risk factors and, thereby making it more difficult to establish whether the presence and pattern of obesity is an independent cardiometabolic risk factor or not.

Relationship of cardiometabolic risk factors with Body mass index (BMI) has been studied in multiple populations across European, North American and Asian–Pacific countries.4, 5, 6, 7 These studies have shown that the risk of cardiovascular disease increases continuously with increasing BMI. But few comparable prospective data are currently available for South Asian region, even though South Asians are at a higher risk than White Caucasians for the development of obesity and obesity-related cardiometabolic disorders for the same level of increase in BMI levels.8, 9 They also seem to have a peculiar body phenotype known as South Asian Phenotype, predisposing them to increased cardiometabolic risk. There could also be unique genetic markers which make South Asians more susceptible to diabetes.8, 9, 10

Data from various mortality statistics and morbidity surveys indicate significant regional variations in cardiovascular risk factors prevalence across Indian subcontinent.11 Furthermore, data from the Registrar General of India reported greater age-adjusted cardiovascular mortality in southern and eastern states of the country.11 But regrettably, accurate recent data on a national scale are not available in India.12, 13 Earlier we reported that the state of Orissa, one of the poorest states of Eastern India bordering a prosperous state of Andhra Pradesh of Southern India, showed interesting variations in classical coronary risk factors among an urban population.14, 15, 16 Such a distinctive geographic location opens up to cultural and socioeconomic interactions. Obesity is a lifestyle disease and factors contributing to changing patterns in obesity prevalence in this geographic region may provide significant insights into tackling the ever-rising burden of obesity and its effect on cardiovascular risk factors in South Asians. The present study aims at updating on changing patterns of obesity in this urban Eastern Indian population and quantifying factors significantly contributing to any observed underlying pattern. Increased BMI has been shown to be associated with increased cardiometabolic risk in urban Indian populations from North and South India.17, 18, 19, 20 Likewise to correlate BMI with multiple cardiometabolic risk factors in Eastern India we analyzed data using regression-based statistical techniques.

Section snippets

Study design and setting

The present study was a population-based survey of cohort under Berhampur Municipal corporation with an estimated population of 307,724 in 2001, in Orissa one of the poorest states of Eastern India bordering a prosperous state of Andhra Pradesh of Southern India. So the residents here are diverse mix of socioeconomic class, language, faith and customs.

Sampling design and sample size

The urban population of Berhampur city of Eastern India spread across 37 electoral wards constituted the sampling frame. Thirty wards were

Results

A total of 1178 subjects participated in the study. Of them 516 were obese; 217 were overweight. The general characteristics of our study outcomes are summarized below.

Discussion

This cross-sectional study of adequate statistical power and representativeness (n = 1178) was conducted among an apparently urban healthy population in Eastern India, a region with distinctive lifestyles and culture. A very high age-standardized prevalence of obesity and overweight at 36.82% and 17.65% were observed in this study population. Higher the BMI levels greater the levels and rates of the several cardiometabolic risk factors were noted. Females in general showed relatively both lower

Conclusion

More than one-third of the urban population studied was found to be obese in this study – higher than several past and recent estimates in similar population settings elsewhere. We also quantified several cardiovascular risk factors significantly being associated with obesity which are known modifiable classical risk factors. Such findings are timely and are considered useful as a major source of information for planning primary prevention strategies to prevent and control obesity.

Although,

Conflicts of interest

All authors have none to declare.

Acknowledgments

Prof. Sonamali Bag, Director of Medical Education and Training, Government of Odisha, Bhubaneshwar, India.

Ms. Pearline Suganthy, Statistical Consult, Perth, Australia.

Dr. B.K. Sahu, Professor of Marine Sciences, Berhampur University, Berampur, Orissa, India.

Mrs. Mohini Sahu, Child Development Project Officer, Berhampur, Orissa, India.

Dr. K. Revathi Devi, Medical Officer, Sudhir Heart Centre, Berhampur, Orissa, India.

References (48)

  • E.E. Calle et al.

    Body-mass index and mortality in a prospective cohort of U.S. adults

    N Engl J Med

    (1999)
  • C. Ni Mhurchu et al.

    Body mass index and cardiovascular disease in the Asia–Pacific region: an overview of 33 cohorts involving 310 000 participants

    Int J Epidemiol

    (2004)
  • G. Whitlock et al.

    Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies

    Lancet

    (2009)
  • W. Zheng et al.

    Association between body-mass index and risk of death in more than 1 million Asians

    N Engl J Med

    (2011)
  • V. Mohan et al.

    Type 2 Diabetes in South Asains

    (2007)
  • A. Misra et al.

    Obesity-related non-communicable diseases: South Asians vs White Caucasians

    Int J Obes (Lond)

    (2011)
  • A.H. Graham et al.

    The genetics of non-insulin dependent diabetes mellitus in South India. An overview

    Annu Mediaev

    (1992)
  • R. Gupta et al.

    Regional variations in cardiovascular risk factors in India: India heart watch

    World J Cardiol

    (2012)
  • B. Shah et al.

    Surveillance of cardiovascular disease risk factors in India: the need & scope

    Indian J Med Res

    (2010)
  • R.M. Anjana et al.

    The need for obtaining accurate nationwide estimates of diabetes prevalence in India – rationale for a national study on diabetes

    Indian J Med Res

    (2011)
  • D.S. Prasad et al.

    Prevalence and predictors of adult hypertension in an urban eastern Indian population

    Heart Asia

    (2012)
  • R. Gupta et al.

    Obesity is major determinant of coronary risk factors in India: Jaipur Heart Watch studies

    Indian Heart J

    (2008)
  • S. Tharkar et al.

    Effect of obesity on cardiovascular risk factors in urban population in South India

    Heart Asia

    (2010)
  • S.K. Vasan et al.

    Anthropometric measurements for the prediction of the metabolic syndrome: a cross-sectional study on adolescents and young adults from Southern India

    Heart Asia

    (2011)
  • Cited by (9)

    • Do parental coronary heart disease risk factors (non-modifiable) effect their young ones?

      2015, Asian Pacific Journal of Tropical Biomedicine
      Citation Excerpt :

      Thus incidence of chronic diseases due to changes in the dietary patterns and physical activity are on the rise among Indians. The prevalence of cardiovascular risk factors such as HTN, diabetes and obesity are very high among Indian adults in the age group of 30-65 years old[13]. Furthermore, 12.6% of hypercholesterolemia, 18.4% of body mass index (BMI) (>24 kg/m2) and 5.8% of diabetic were reported among 975 middle aged males of 35-39 years old[14].

    • Gender differences in central obesity: Implications for cardiometabolic health in South Asians

      2020, Indian Heart Journal
      Citation Excerpt :

      Childhood obesity and adult adiposity are growing public health challenges internationally. Earlier, we have reported an increased obesity prevalence of 37% in a specific urban adult population in Eastern India, with distinct ethnic and cultural characteristics, employing revised Asia–Pacific criteria.1 In the same community, we have also demonstrated the methodological limitations of body mass index(BMI),2 which may not be considered an ideal metric of adipoisty in South Asians, who generally have a characteristic South Asian phenotype, with relatively lower BMI but a higher level of central obesity and body fat.3,4

    • Obesity

      2017, Health of South Asians in the United States: An Evidence-Based Guide for Policy and Program Development
    View all citing articles on Scopus
    View full text