Abstract
Obesity and dyslipidemia are emerging as major public health challenges in South Asian countries. The prevalence of obesity is more in urban areas than rural, and women are more affected than men. Further, obesity in childhood and adolescents is rising rapidly. Obesity in South Asians has characteristic features: high prevalence of abdominal obesity, with more intra-abdominal and truncal subcutaneous adiposity than white Caucasians. In addition, there is greater accumulation of fat at “ectopic” sites, namely the liver and skeletal muscles. All these features lead to higher magnitude of insulin resistance, and its concomitant metabolic disorders (the metabolic syndrome) including atherogenic dyslipidemia. Because of the occurrence of type 2 diabetes, dyslipidemia and other cardiovascular morbidities at a lower range of body mass index (BMI) and waist circumference (WC), it is proposed that cut-offs for both measures of obesity should be lower (BMI 23–24.9 kg/m2 for overweight and ≥25 kg/m2 for obesity, WC ≥80 cm for women and ≥90 cm for men for abdominal obesity) for South Asians, and a consensus guideline for these revised measures has been developed for Asian Indians. Increasing obesity and dyslipidemia in South Asians is primarily driven by nutrition, lifestyle and demographic transitions, increasingly faulty diets and physical inactivity, in the background of genetic predisposition. Dietary guidelines for prevention of obesity and diabetes, and physical activity guidelines for Asian Indians are now available. Intervention programs with emphasis on improving knowledge, attitude and practices regarding healthy nutrition, physical activity and stress management need to be implemented. Evidence for successful intervention program for prevention of childhood obesity and for prevention of diabetes is available for Asian Indians, and could be applied to all South Asian countries with similar cultural and lifestyle profiles. Finally, more research on pathophysiology, guidelines for cut-offs, and culturally-specific lifestyle management of obesity, dyslipidemia and the metabolic syndrome are needed for South Asians.
Highlights
Non-communicable diseases (NCDs) are emerging as a major health challenge in South Asians, which encompass residents of India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan and Maldives, constituting 24% of the world‟s population [1]
The medical search engines, Pub med (National Library of Medicine, Bethesda, MD, USA) and Google Scholar; and Governmental websites of South Asians were used for literature search using the key words, “Obesity, abdominal obesity, overweight, dyslipidemia, type 2 diabetes mellitus, insulin resistance, coronary heart disease, cholesterol, triglycerides, low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), adipose tissue, non-alcoholic fatty liver disease, intra myocellular lipids, adipocyte, South Asians, and Asian Indians” from 1966 to December 2012
The truncal fat includes fat over chest and abdomen both subcutaneous abdominal adipose tissue (SCAT) and intra-abdominal adipose tissue (IAAT), all of which are more in Asian Indians than in white Caucasians [9,27,75,76]
Summary
Non-communicable diseases (NCDs) are emerging as a major health challenge in South Asians, which encompass residents of India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan and Maldives, constituting 24% of the world‟s population [1]. About 44% of the diabetes burden and 23% of the CVD burden is attributable to overweight and obesity; and mortality due to obesity occurs in 2.8 million adults each year [7,9,10,11,12,13]. It has been observed that 65% of the world‟s population lives in countries where overweight and obesity are responsible for higher mortality than is underweight. 2. Definitions “South Asians” denote residents of India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan and Maldives constituting 24% of the world‟s population. Buildings, narrowness or faulty arrangement of street, lack of ventilation, light, or sanitation facilities or any combination of these factors which are detrimental to the safety and health [17]
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