Original articleEffect of obesity on cardiometabolic risk factors in 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)
- et al.
Abdominal obesity, an independent cardiovascular risk factor in Indian subcontinent: a clinico epidemiological evidence summary
J Cardiovasc Dis Res
(2011) - et al.
Coronary risk factors in South Asians: a prevalence study in an urban populace of Eastern India
CVD Prev Control
(2010) - et al.
Prevalence and risk factors for diabetes and impaired glucose tolerance in Asian Indians: a community survey from urban Eastern India. Diab Met Syndr
Clin Res Rev
(2012) - et al.
Metabolic cardiovascular risk factors worsen continuously across the spectrum of body mass index in Asian Indians
Indian Heart J
(2012) - et al.
Metabolic obesity: a new therapeutic target for cardio-metabolic risk reduction
CVD Prev Control
(2010) - et al.
High prevalence of obesity and associated risk factors in urban children in India and Pakistan highlights immediate need to initiate primary prevention program for diabetes and coronary heart disease in schools
Diabetes Res Clin Pract
(2006) - et al.
Nationally representative surveys show recent increases in the prevalence of overweight and obesity among women of reproductive age in Bangladesh, Nepal, and India
J Nutr
(2009) - et al.
Prevalence and risk factors for metabolic syndrome in Asian Indians: a community study from urban Eastern India
J Cardiovasc Dis Res
(2012) - et al.
Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss
Arterioscler Thromb Vasc Biol
(2006) - et al.
Fitness and fatness as predictors of mortality from all causes and from cardiovascular disease in men and women in the lipid research clinics study
Am J Epidemiol
(2002)
Body-mass index and mortality in a prospective cohort of U.S. adults
N Engl J Med
Body mass index and cardiovascular disease in the Asia–Pacific region: an overview of 33 cohorts involving 310 000 participants
Int J Epidemiol
Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies
Lancet
Association between body-mass index and risk of death in more than 1 million Asians
N Engl J Med
Type 2 Diabetes in South Asains
Obesity-related non-communicable diseases: South Asians vs White Caucasians
Int J Obes (Lond)
The genetics of non-insulin dependent diabetes mellitus in South India. An overview
Annu Mediaev
Regional variations in cardiovascular risk factors in India: India heart watch
World J Cardiol
Surveillance of cardiovascular disease risk factors in India: the need & scope
Indian J Med Res
The need for obtaining accurate nationwide estimates of diabetes prevalence in India – rationale for a national study on diabetes
Indian J Med Res
Prevalence and predictors of adult hypertension in an urban eastern Indian population
Heart Asia
Obesity is major determinant of coronary risk factors in India: Jaipur Heart Watch studies
Indian Heart J
Effect of obesity on cardiovascular risk factors in urban population in South India
Heart Asia
Anthropometric measurements for the prediction of the metabolic syndrome: a cross-sectional study on adolescents and young adults from Southern India
Heart Asia
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