South Asian Indian Research Articles

The prevalence of metabolic syndrome among low-income South Asian Americans.

The purpose of the present paper is to examine the prevalence of metabolic syndrome (MetS) and its components using the harmonized definition in an interviewed sub-sample of diverse, low-income, adult South Asians (SA) of both sexes residing in Maryland. We also wanted to derive a BMI cut-off value that was highly correlated with the recommended waist circumference (WC) that we could apply to a larger sample of SA Americans for whom only BMI values were available from clinic files. We also examined differences in MetS prevalence among various Asian ethnic groups (defined by country of origin) and the clustering pattern of their MetS components. Clinical data extraction on subjects (n 1002) and interviewees (n 401) were used in a cross-sectional study of SA Americans. Two community health centres in Montgomery and Baltimore County, MD, USA. SA adult males and females (n 1403) aged 20-68 years. The prevalence of MetS using harmonized WC cut-offs (90 cm in men and 80 cm in women) was 47% in men and 54% in women. Using a BMI of 23.0 kg/m2 gave a similar prevalence of MetS for males (48%) and females (47%). Of the five MetS components, the prevalence pattern differed among the ethnic groups, particularly for SA Indians. The prevalence of MetS in a diverse, low-income, SA American immigrant group using the harmonized definition was 51%. Derived lowered BMI cut-off of 23.0 kg/m2 should be used by clinicians in studies on SA when WC values are not available for detecting metabolic risk. SA Indians had a higher prevalence of abnormal TAG and blood glucose values compared with other SA, and therefore results for SA Indians should not be generalized to all SA ethnic groups.

Reducing hypersensitivity reactions with HLA-B*5701 genotyping before abacavir prescription: clinically useful but is it cost-effective in Singapore?

Abacavir (ABC) is one of the more affordable antiretroviral drugs used for controlling HIV. Although with similar efficacy to current first-line drugs, its limited usage in Singapore can be attributed to its possible side effect of adverse hypersensitivity reactions (HSRs). HLA-B*5701 genotyping is a clinically relevant procedure for avoiding abacavir-induced HSRs. As patients who do not carry the risk allele are unlikely to develop HSRs, a simple rule can be developed to allow abacavir prescription for patients who are B*5701 negative. Here, we carry out a cost-effectiveness analysis of HLA-B*5701 genotyping before abacavir prescription in the context of the Singapore healthcare system, which caters predominantly to Han Chinese, Southeast-asian Malays, and South-asian Indians. In addition, we aim to identify the most cost-effective treatment regimen for HIV patients. A decision tree model was developed in TreeAge. The model considers medical treatment and genotyping costs, genotyping test characteristics, the prevalence of the risk allele, reduction in the quality of life, and increased expenditure due to side effects and other factors, evaluating independently over early-stage and late-stage HIV patients segmented by drug contraindications. The study indicates that genotyping is not cost-effective for any ethnicity irrespective of the disease stage, except for Indian patients with early-stage HIV who are contraindicated to tenofovir. Abacavir (as first-line) without genotyping is the cheapest and most cost-effective treatment for all ethnicities except for early-stage Indian HIV patients contraindicated to tenofovir. The HLA-B*5701 frequency, the mortality rate from abacavir-induced HSRs, and genotyping costs are among the major factors influencing the cost-effectiveness.

The Interplay of Diabetes, and Health Self Efficacy, Cognition and Compliance

Globesity has partially been responsible for an outbreak of diabetes which affects 340 million people in the world today1. Severe diabetes, which would have killed a patient fifty years ago, can now be managed for decades longer. So the number of diabetics is increasing both among the obese young and the elderly who live longer. Amongst diabetic adults, the cardiovascular disease (CVD) death rate has declined by 40% (95% CI 23–54), while the death rate from all other causes declined by 23% over a ten year period from 1997 to 2006. Not surprisingly therefore, the rate of diabetes and the concomitant disorders continues to grow. Diabetes can also lead to significant cognitive decline which leads to interference with compliance, socialization and quality of life. Diabetes causes an increase in cognitive impairment in vascular dementia. Type 2 Diabetes may act as a partial causal agent of some dementias, and the link between diabetes and Alzheimer’s has led a number of researchers to claim Alzheimer’s is in reality a Type 3 diabetes. A clear and statistically significant relationship exists between HbA1c levels and the duration of diabetes mellitus and cognitive dysfunction. While the causal mechanism remains unknown Type 2 Diabetes clearly causes cognitive impairment. This genetic predisposition to diabetes may be greatest amongst South Asian Indians, and Hispanics. While genetics is certainly not the sole determinant of diabetes, genetics likely plays a key role. Some type of brief cognitive screening battery needs to be developed to screen for Mild Cognitive Impairment, and Health Self Efficacy, both of which affect compiance. This information could be used to make treatment decisions, both in terms of compliance and in terms of recommendations which may affect an individual’s Quality of Life. With cognitive impairment and low Health Self Efficacy due to diabetes, screening can be a key tool in evaluating educational techniques which would aid patients, their communities and their families as to the type of interventions which may prove useful.

Root canal morphology of South Asian Indian maxillary molar teeth.

Objective:The objective was to study the root canal morphology of South Asian Indian Maxillary molars using a tooth clearing technique.Materials and Methods:Hundred teeth each comprising of first, second, and third molars collected from different dental schools and clinics in India were subjected to standard dye penetration, decalcification and clearing procedure before being studied.Results:The first molar mesiobuccal roots exhibited 69% Type I, 24% Type II, 4% Type IV, 2% Type V, and 1% exhibited a Vertuccis Type VIII canal anatomy. In the group with three separate roots the second molar mesiobuccal roots in exhibited 80.6% Type I, 15.3% Type II, 2.7% Type IV, and 1.4% Type V canal anatomy while the third molars mesiobuccal roots exhibited 57.4% Type I, 32% Type II, 2.1% Type III, 8.5% Type IV, 1% had a Type V canal anatomy in the similar group.Conclusion:A varied root canal anatomy was seen in the mesiobuccal root canal of the maxillary molars.

Clinical applications and implications of common and founder mutations in Indian subpopulations.

South Asian Indians represent a sixth of the world's population and are a racially, geographically, and genetically diverse people. Their unique anthropological structure, prevailing caste system, and ancient religious practices have all impacted the genetic composition of most of the current-day Indian population. With the evolving socio-religious and economic activities of the subsects and castes, endogamous and consanguineous marriages became a commonplace. Consequently, the frequency of founder mutations and the burden of heritable genetic disorders rose significantly. Specifically, the incidence of certain autosomal-recessive disorders is relatively high in select Indian subpopulations and communities that share common recent ancestry. Although today clinical genetics and molecular diagnostic services are making inroads in India, the high costs associated with the technology and the tests often keep patients from an exact molecular diagnosis, making more customized and tailored tests, such as those interrogating the most common and founder mutations or those that cater to select sects within the population, highly attractive. These tests offer a quick first-hand affordable diagnostic and carrier screening tool. Here, we provide a comprehensive catalog of known common mutations and founder mutations in the Indian population and discuss them from a molecular, clinical, and historical perspective.

Evaluating the coverage and potential of imputing the exome microarray with next-generation imputation using the 1000 Genomes Project.

Next-generation genotyping microarrays have been designed with insights from large-scale sequencing of exomes and whole genomes. The exome genotyping arrays promise to query the functional regions of the human genome at a fraction of the sequencing cost, thus allowing large number of samples to be genotyped. However, two pertinent questions exist: firstly, how representative is the content of the exome chip for populations not involved in the design of the chip; secondly, can the content of the exome chip be imputed with the reference data from the 1000 Genomes Project (1KGP). By deep whole-genome sequencing two Asian populations that are not part of the 1KGP, comprising 96 Southeast Asian Malays and 36 South Asian Indians for which the same samples have also been genotyped on both the Illumina 2.5 M and exome microarrays, we discovered the exome chip is a poor representation of exonic content in our two populations. However, up to 94.1% of the variants on the exome chip that are polymorphic in our populations can be confidently imputed with existing non-exome-centric microarrays using the 1KGP panel. The coverage further increases if there exists population-specific reference data from whole-genome sequencing. There is thus limited gain in using the exome chip for populations not involved in the microarray design. Instead, for the same cost of genotyping 2,000 samples on the exome chip, performing whole-genome sequencing of at least 35 samples in that population to complement the 1KGP may yield a higher coverage of the exonic content from imputation instead.

The use of a collaborative structured methodology for the development of a multifaceted intervention programme for the management of asthma (the MIA project), tailored to the needs of children and families of South Asian origin: a community-based, participatory study

BackgroundAsthma is one of the most common chronic childhood illnesses in the UK. South Asian children are more likely to suffer from their asthma and be admitted to hospital. While this inequality needs to be addressed, standard behaviour-change interventions are known to be less successful in minority ethnic groups. Evidence suggests a need to enhance services provided to ethnic minority communities by developing culturally sensitive tailored interventions.ObjectivesThe Management and Interventions for Asthma (MIA) project aimed to test an iterative multiphase participatory approach to intervention development underpinned by the socioecological model of health, producing an intervention-planning framework and enhancing an evidence-based understanding of asthma management in South Asian and White British children.DesignInterviews and focus groups facilitated by community facilitators (CFs) were used to explore knowledge and perceptions of asthma among South Asian communities, children, families and healthcare professionals (HCPs). A smaller comparison group of White British families was recruited to identify aspects of asthma management that could be addressed either by generic interventions or by a tailored approach. Collaborative workshops were held to develop an intervention planning framework and to prioritise an aspect of asthma management that would be used as an exemplar for the development of the tailored, multifaceted asthma intervention programme.SettingThe community study was based in a largely urban environment in Leicester, UK.ParticipantsParticipants were recruited directly from the South Asian (Indian, Pakistani and Bangladeshi) and White British communities, and through the NHS. Children were aged between 4 and 12 years, with a range of asthma severity.Intervention developmentThe study had four phases. Phase 1 consisted of an evidence review of barriers and facilitators to asthma management in South Asian children. Phase 2 explored lay understandings of childhood asthma and its management among South Asian community members (n = 63). Phase 3 explored perceptions and experiences of asthma management among South Asian (n = 82) and White British families (n = 31) and HCP perspectives (n = 37). Using a modified intervention mapping approach incorporating psychological theory, phase 4 developed an intervention planning framework addressing the whole asthma pathway leading to the development of an exemplar multifaceted, integrated intervention programme called ‘ACT [Awareness, Context (cultural and organisational) and Training] on Asthma’.ResultsData on the social patterning of perceptions of asthma and a lack of alignment between the organisation of health services, and the priorities and competencies of British South Asian communities and families were produced. Eleven key problem areas along the asthma pathway were identified. A four-arm multifaceted tailored programme, ‘ACT on Asthma’, was developed, focusing on the theme ‘getting a diagnosis’. This theme was chosen following prioritisation by families during the collaborative workshops, demonstrating the participatory, iterative, phased approach used for the intervention design.ConclusionsThe MIA study demonstrated barriers to optimal asthma management in children at the family, provider and healthcare system levels and across the whole asthma pathway. Interventions need to address each of these levels to be effective. Minority ethnic communities can be successfully engaged in collaborative intervention development with a community-focused and culturally sensitive methodology.Future workFurther research is required to (1) assess the feasibility and effectiveness of the proposed ‘ACT on Asthma’ programme, (2) develop methods to increase active participation of children in research and service development, (3) develop and test strategies to enhance public understanding of asthma in South Asian communities and (4) identify effective means of engaging the wider family in optimising asthma management.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Insights into the genetic structure and diversity of 38 South Asian Indians from deep whole-genome sequencing.

South Asia possesses a significant amount of genetic diversity due to considerable intergroup differences in culture and language. There have been numerous reports on the genetic structure of Asian Indians, although these have mostly relied on genotyping microarrays or targeted sequencing of the mitochondria and Y chromosomes. Asian Indians in Singapore are primarily descendants of immigrants from Dravidian-language–speaking states in south India, and 38 individuals from the general population underwent deep whole-genome sequencing with a target coverage of 30X as part of the Singapore Sequencing Indian Project (SSIP). The genetic structure and diversity of these samples were compared against samples from the Singapore Sequencing Malay Project and populations in Phase 1 of the 1,000 Genomes Project (1 KGP). SSIP samples exhibited greater intra-population genetic diversity and possessed higher heterozygous-to-homozygous genotype ratio than other Asian populations. When compared against a panel of well-defined Asian Indians, the genetic makeup of the SSIP samples was closely related to South Indians. However, even though the SSIP samples clustered distinctly from the Europeans in the global population structure analysis with autosomal SNPs, eight samples were assigned to mitochondrial haplogroups that were predominantly present in Europeans and possessed higher European admixture than the remaining samples. An analysis of the relative relatedness between SSIP with two archaic hominins (Denisovan, Neanderthal) identified higher ancient admixture in East Asian populations than in SSIP. The data resource for these samples is publicly available and is expected to serve as a valuable complement to the South Asian samples in Phase 3 of 1 KGP.

Management of type 2 diabetes in Asian Indians: a review of the literature.

Type 2 diabetes mellitus (T2DM) is increasing in Asian Indians globally. In this article, we review published studies of interventions designed to prevent T2DM or improve self-management in South Asian Indians. A PubMed, CINAHL, Medline, EMBASE, Psycinfo, Family & Society Studies Worldwide, Web of Science, and Consumer Health Complete search was conducted using the following search terms: type 2 diabetes mellitus, Asian Indian continental ancestry group, therapy, treatment, management, care, intervention, self-care, exercise, diet, and lifestyle. The review included pilot or full intervention studies examining the prevention and/or management of T2DM and qualitative studies analyzing the influence of various ethnic factors on the prevention and management of T2DM. Seventeen studies met the inclusion criteria. They examined the influence of culture and religion and the effectiveness of individual and community-based education and lifestyle improvement programs, exercise, and complementary therapies. Few programs led to the improved long-term management of T2DM. Further research is needed to develop ethnic-specific interventions.

Ancestry-based pharmacogenomics, adverse reactions and carbamazepine: is the FDA warning correct?

In an effort to prevent potentially fatal adverse reactions to carbamazepine, the US Food and Drug Administration (FDA) issued an alert in 2007 containing pharmacogenomic information, which is still in effect today. The alert states that carbamazepine-induced skin reactions are significantly more common in patients with the human leukocyte antigen (HLA)-B*1502 allele and that these people are almost exclusively from 'broad areas of Asia, including South Asian Indians.' This study reviews the medical evidence relied upon by the FDA and finds that the alert does not accurately reflect the medical evidence relied upon in 2007 or evidence that has been generated over the last 5 years since the label was created. The FDA drug labeling should be modified to reflect current medical evidence.

Intergenerational Narratives on Face: A South Asian Indian American Perspective

This study investigates the meaning construction of the South Asian Indian term izzat or face in intergenerational contexts. Interpretive thematic analysis revealed six themes. Key findings indicate: (1) for both older and younger South Asian Indian American (SAIA) generations, family izzat is of primary importance; (2) the motif of “respect” is central to both SAIA generations' in their narratives of izzat; (3) both older and younger SAIAs use the concealment-preventative and diversion-restorative facework strategies to save face. These findings uncover intergenerational communication challenges concerning the shifting boundary parameters of izzat in the diasporic Indian community in the US.

Correlates of Lifestyle: Physical Activity Among South Asian Indian Immigrants

South Asian immigrants are at increased risk for cardiovascular disease and diabetes, but little is known about their physical activity patterns. In this cross-sectional study, 110 participants were recruited to describe lifestyle physical activity behavior of this at-risk population. Education (p = .042), global health (p = .045), and self-efficacy (p = .000) had significant positive independent effects on leisure-time physical activity. Depression (p = .035) and waist circumference (p = .012) had significant negative independent effects, and frequency of experiencing discrimination a significant positive independent effect (p = .007) on daily step counts. Culture-sensitive physical activity interventions need to target South Asian Indian immigrants who are less educated, in poor health, concerned about racial discrimination, and have low self-efficacy.

Ethnic Differences and β-Cell Changes

Ethnic differences in diabetes prevalence have led to investigations in the pathophysiologic mechanism that underlie the development of hyperglycemia among various races (1, 2). The pathogenesis of type 2 diabetes mellitus (T2DM) is closely associated with obesity and concomitant insulin resistance, sedentary lifestyle, and decreased insulin secretion (3). Asians have increased risk and rates of T2DM but, unlike Caucasians, are leaner yet more insulin-resistant. Studies of insulin secretion and resistance among South Asians (Indians) and East Asians (Chinese, Koreans, Filipino, and Japanese), who typically have lower mean body mass index (BMI) and waist circumference as compared with Caucasians of similar BMI and waist circumference, demonstrated reduced insulin secretion and increased insulin resistance (3). Studies in Asians identified the characteristic of increased visceral adiposity that has since become recognized as the abnormality that belies insulin resistance despite leaner BMI (4). For example, Filipino women in California with a normal Asian-adjusted BMI ( 23 kg/m) had a greater volume of intra-abdominal fat compared with white or African American women also with a normal BMI ( 25 kg/m) (5). Therefore, the available evidence argues that Asian ethnicity may predispose to greater deposition of fat in the visceral depot. Induced with modest weight gain, abnormal adipose tissue changes the expression of a number of adipocytokines and impedes the response of target organs liver, muscle, and kidney to insulin (3). A small BMI change but with adipose tissue distributed viscerally increases compensatory insulin secretion similar to changes seen in other ethnic groups with greater weight gain. The capacity of -cells to respond to insulin resistance appears to be different among Asians compared with Caucasians and suggests that the development of hyperglycemia and manifest diabetes are also ethnically different in the pancreas (6). Investigations of -cell mass or islet changes of the pancreas in humans are very difficult, and the clinical assessment of insulin secretions associated with cellular changes of the -cell is even more challenging. Studies that evaluate a stimulated response of and -cells provide invaluable assessment of overall capacity and/or dysfunction but do not offer insight to cellular changes that may account for the abnormal response. The preservation of pancreas tissue at autopsy offer an opportunity to examine morphohistologic changes and quantitate cellular mass and regenerative processes in disease and nondisease states among various ethnic groups. For this purpose, several reports have shown that -cell mass increases in obese individuals and decreases in diabetic individuals as compared with lean nondiabetic subjects. A reduction of approximately 50% of -cell mass has been reported by a number of investigators (7–10). These findings appear congruent with the conceptual understanding of the compensatory increase in -cell function observed with physiological demand such as pregnancy or abnormal demand in obesity and insulin resistance that precede reduced -cell mass and secretion in the development of T2DM and hyperglycemia (11). These findings suggest that cellular changes in the pancreas follow a pathway of similar processes from lean to obese to diabetic states in various ethnic groups. The study by Kou et al (12) in this issue presents results of a case-control study of nondiabetic, lean and obese Japanese individuals, characterizing differences in and -cells in pancreatic tissue. Eligible cases were identified postmortem (age 20–69 years with no history of diabetes or pancreatic disease or glucocorticoid use and autopsy performed within 24 hours), and pancreatic tissues were cytohistochemically examined and quantified for comparative analysis using standard statistical methods. Pancre-

Prevalence, awareness, and control of hypertension among Asian Indians living in urban Singapore and rural India

Hypertension is a major modifiable risk factor associated with cardiovascular morbidity and mortality. We compared the epidemiology of hypertension in South Asian Indians living in two geographic regions with vastly different socioeconomic settings (urban Singapore and rural India). We analyzed data from two large population-based studies: the Singapore Indian Eye Study (SINDI, n = 3228, aged 40-80 years, 49.2% women) and the Central India Eye and Medical Study (CIEMS, n = 3591, aged ≥40 years, 52.6% women). Hypertension was defined as SBP at least 140 or DBP at least 90 mmHg or self-reported history/treatment for hypertension. The age-adjusted prevalence of hypertension in SINDI and CIEMS were 58.6 and 25.3%. After adjusting for potential confounders, increasing age, overweight/obese, and diabetes status showed a positive association and 'never drinking alcohol' showed a protective association with hypertension in both populations. Current smoking and being female showed a protective association and no formal education showed a positive association with hypertension in SINDI. Among those with hypertension in SINDI and CIEMS, 72.4 and 25.3% were aware of their condition of whom 85 and 31.6% were on treatment for hypertension. The blood pressure control was similar between the two populations (48.7% in SINDI and 46.9% in CIEMS). The prevalence of hypertension, the level of awareness, and treatment for hypertension was higher in Indians living in Singapore than in rural Indians. Socioeconomic and metabolic factors explain some of the observed differences between the two populations, which may provide insights to develop public health strategies.

Are C-Reactive Protein Associated Genetic Variants Associated with Serum Levels and Retinal Markers of Microvascular Pathology in Asian Populations from Singapore?

IntroductionC-reactive protein (CRP) levels are associated with cardiovascular disease and systemic inflammation. We assessed whether CRP-associated loci were associated with serum CRP and retinal markers of microvascular disease, in Asian populations.MethodsGenome-wide association analysis (GWAS) for serum CRP was performed in East-Asian Chinese (N = 2,434) and Malays (N = 2,542) and South-Asian Indians (N = 2,538) from Singapore. Leveraging on GWAS data, we assessed, in silico, association levels among the Singaporean datasets for 22 recently identified CRP-associated loci. At loci where directional inconsistencies were observed, quantification of inter-ethnic linkage disequilibrium (LD) difference was determined. Next, we assessed association for a variant at CRP and retinal vessel traits [central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE)] in a total of 24,132 subjects of East-Asian, South-Asian and European ancestry.ResultsSerum CRP was associated with SNPs in/near APOE, CRP, HNF1A and LEPR (p-values ≤4.7×10−8) after meta-analysis of Singaporean populations. Using a candidate-SNP approach, we further replicated SNPs at 4 additional loci that had been recently identified to be associated with serum CRP (IL6R, GCKR, IL6 and IL1F10) (p-values ≤0.009), in the Singaporean datasets. SNPs from these 8 loci explained 4.05% of variance in serum CRP. Two SNPs (rs2847281 and rs6901250) were detected to be significant (p-value ≤0.036) but with opposite effect directions in the Singaporean populations as compared to original European studies. At these loci we did not detect significant inter-population LD differences. We further did not observe a significant association between CRP variant and CRVE or CRAE levels after meta-analysis of all Singaporean and European datasets (p-value >0.058).ConclusionsCommon variants associated with serum CRP, first detected in primarily European studies, are also associated with CRP levels in East-Asian and South-Asian populations. We did not find a causal link between CRP and retinal measures of microvascular disease.

A Systematic Review of Overweight, Obesity, and Type 2 Diabetes Among Asian American Subgroups

This systematic review synthesizes data published between 1988 and 2009 on mean BMI and prevalence of overweight, obesity, and type 2 diabetes among Asian subgroups in the U.S. We conducted systematic searches in Pub- Med for peer-reviewed, English-language citations that reported mean BMI and percent overweight, obesity, and diabetes among South Asians/Asian Indians, Chinese, Filipinos, Koreans, and Vietnamese. We identified 647 database citations and 23 additional citations from hand-searching. After screening titles, abstracts, and full-text publications, 97 citations remained. None were published between 1988 and 1992, 28 between 1993 and 2003, and 69 between 2004 and 2009. Publications were identified for the following Asian subgroups: South Asian (n=8), Asian Indian (n=20), Chinese (n=44), Filipino (n=22), Korean (n= 8), and Vietnamese (n=3). The observed sample sizes ranged from 32 to 4245 subjects with mean ages from 24 to 78 years. Among samples of men and women, the lowest reported mean BMI was in South Asians (22.1 kg/m(2)), and the highest was in Filipinos (26.8 kg/m(2)). Estimates for overweight (12.8-46.7%) and obesity (2.1-59.0%) were variable. Among men and women, the highest rate of diabetes was reported in Asian Indians with BMI ≥ 30 kg/m(2) (32.9%, age and sex standardized). This review suggests heterogeneity among U.S. Asian populations in cardiometabolic risk factors, yet comparisons are limited due to variability in study populations, methods, and definitions used in published reports. Future efforts should adopt standardized methods to understand overweight, obesity and diabetes in this growing U.S. ethnic population.

Home or away? The significance of ethnicity, class and attainment in the housing choices of female university students

Given the financial implications for studying at a higher education institution, students are faced with many decisions both in terms of the topics they wish to study but also the decision of whether to remain at home or move away. The aim of this article is to compare the experiences of South Asian (Indian, Bangladeshi and Pakistani) female students to White females, to identify similarities and differences between women from the three Asian groups and also compare changes over time. This article is focused on the term-time accommodation status of these students, i.e. the decision to move away or stay residing in the parental/guardian home during their first year of university. Understanding students’ accommodation choices is important as it can limit the other choices they have to make such as which course to choose and students who are limited to their local institutions can only study what is offered by those particular institutions. We examine this issue by using binary logistic regression to analyse administrative enrolment data on HE students in England for academic years 1998/99 and 2005/06 from the Higher Education Statistics Agency (HESA).

Body fat, cholesterol, triglycerides, and adipokines as predictors of waist circumference in overweight and obese adults Comment to: Diversity of metabolic syndrome criteria in association with cardiovascular diseases – a family medicine-based investigation Dragica Ivezić-Lalić, Biserka Bergman Marković, Ksenija Krančević, Josipa Kern, Davorka Vrdoljak, Jasna Vučak Med Sci Monit, 2013; 19: 571–78

Dear Editor, The study by Ivezic-Lalic et al. compared the association between 3 definitions of metabolic syndrome and the risk of cardio-vascular disease [1]. The authors mentioned that among variables measured, the waist circumference [WC] is not a sufficient indicator of general obesity, even though it is recognized as useful in assessing abdominal fat, particularly visceral fat [2]. The present study included 67 persons, of whom 5 were overweight (BMI ≥25 kg/m2) and 62 were obese (BMI ≥30 kg/m2). Their ages were between 20 and 55 years (group mean ±SD, 36.0±11.0 years) and there were 35 females in the group. The body composition was measured by the BIA method, total cholesterol and triglycerides were measured by spectrophotometry, and serum leptin and adiponectin levels were estimated by radioimmunoassay. The study aimed to determine whether total body fat (a measure of general obesity), total cholesterol, triglyceride levels, leptin, and/or adiponectin could predict the waist circumference (WC), and hence central adiposity. Multiple regression analysis using SPSS version 18 was carried out with WC as the dependent variable and with total body fat, total cholesterol, triglycerides, leptin, and adiponectin as independent variables. Multiple regression showed a significant prediction of the variables [F=19.72, DF (5, 61), p<0.001, adjusted R2=0.587]. However, of the 5 independent variables studied, body fat (kg) alone was a significant predictor of WC [p<0.001, t=9.53, β=0.800; multi-collinearity statistics (tolerance) =0.891]. Triglycerides and total cholesterol were not significant predictors of the WC, but an earlier report emphasized that high levels of both are associated with metabolic syndrome [3]. Leptin and adiponectin were also not predictors of WC. WC is increasingly regarded as a simple way of measuring central adiposity and, more specifically, visceral fat [1]. The present results suggest that higher total body fat, measured as a part of body composition analysis, can predict higher WC in this population of South Asian Indians. It would be useful to study this association in a larger sample and in different ethnic groups, so that the usefulness of body composition in assessing central obesity can be understood.

Examining the role of acculturation in the physical activity experiences and behaviours of South Asians living in Canada

South Asian Indians are recognised as being at high risk of cardiovascular disease, diabetes, obesity, as well as being less likely to engage in preventative health measures, such as physical activity (PA), compared to European Canadians or other western born individuals.

Sex Hormone-Binding Globulin and The Risk for Metabolic Syndrome in Children of South Asian Indian Origin

To determine whether the plasma level of sex hormone-binding globulin (SHBG) identifies South Asian Indian children at risk for metabolic syndrome. Adults and their children aged 5 to 9 years were recruited at the annual health fair at the Hindu temple serving the South Asian Indian community in Louisville, Kentucky. Anthropometric data were collected in adults and children, and blood pressure, lipid, and glucose levels were measured in adults. SHBG levels were measured in children using a fingerstick blood sample. In adults, metabolic syndrome was diagnosed according to the International Diabetes Federation criteria. Twelve months later, follow-up anthropometric data were obtained for a portion of the children. The study included 30 sets of parents and 30 children. The prevalence of metabolic syndrome among 310 adults attending the health fair was 42% in men and 39% in women. Children with 1 parent with metabolic syndrome had 24% lower SHBG levels that increased to 55% if both parents had metabolic syndrome. SHBG levels were inversely related to waist circumference and to body mass index percentile. Both SHBG and waist circumference predicted weight gain over 1 year in children. CONCLUSIONS Low SHBG levels were found in South Asian Indian children whose parents had attributes of metabolic syndrome. The dose dependency of SHBG is consistent with inheritance of a genetic trait, and if the results are applicable to other racial/ethnic groups, SHBG may be a useful marker to identify at-risk children for early intervention.