Urban Asian Indians Research Articles

Lower Dietary Intake of Plant Protein Is Associated with Genetic Risk of Diabetes-Related Traits in Urban Asian Indian Adults.

The increasing prevalence of type 2 diabetes among South Asians is caused by a complex interplay between environmental and genetic factors. We aimed to examine the impact of dietary and genetic factors on metabolic traits in 1062 Asian Indians. Dietary assessment was performed using a validated semi-quantitative food frequency questionnaire. Seven single nucleotide polymorphisms (SNPs) from the Transcription factor 7-like 2 and fat mass and obesity-associated genes were used to construct two metabolic genetic risk scores (GRS): 7-SNP and 3-SNP GRSs. Both 7-SNP GRS and 3-SNP GRS were associated with a higher risk of T2D (p = 0.0000134 and 0.008, respectively). The 3-SNP GRS was associated with higher waist circumference (p = 0.010), fasting plasma glucose (FPG) (p = 0.002) and glycated haemoglobin (HbA1c) (p = 0.000066). There were significant interactions between 3-SNP GRS and protein intake (% of total energy intake) on FPG (Pinteraction = 0.011) and HbA1c (Pinteraction = 0.007), where among individuals with lower plant protein intake (<39 g/day) and those with >1 risk allele had higher FPG (p = 0.001) and HbA1c (p = 0.00006) than individuals with ≤1 risk allele. Our findings suggest that lower plant protein intake may be a contributor to the increased ethnic susceptibility to diabetes described in Asian Indians. Randomised clinical trials with increased plant protein in the diets of this population are needed to see whether the reduction of diabetes risk occurs in individuals with prediabetes.

Dietary fatty-acid profile of south Indian adults and its association with type 2 diabetes––CURES 151

Background: Both the quantity and the quality of fat are major determinants of chronic diseases risk. This paper looks at the fatty-acid composition of Indian foods reported in the diets of urban Asian Indians and its association with type 2 diabetes. Materials and Methods: Adults aged 20–80 years (n = 1688) were selected from the Chennai Urban Epidemiological Study. The dietary intake of the study subjects was assessed using a validated food frequency questionnaire. The fatty-acid profile of common foods reported by the population was measured from pooled food samples and substituted in nutrient database for calculation of daily foods, nutrient, and fatty-acid intake. Statistical analysis was performed using Statistical Package for the Social Sciences software. Results: Of the foods tested potato chips and Indian sweet mysorepak had the highest amount of fat 46.7g and 42.2g/100g, respectively, whereas the Indian sweet sweet pongal had the lowest fat of 3.9g/100g. Palmitic acid in saturated fatty acid (SFA), oleic acid in monounsaturated fatty acid (MUFA), and linoleic among poly unsaturated fatty acids (PUFA) were commonly reported fatty acids in most foods. Dietary fats provided almost 1/4th of the daily caloric intake of the subjects. Compared to national recommendations, the intake of MUFA and α linolenic acid was very low. Higher intake (>median) of calories (%E) from SFA (P = 0.007) and PUFA (P = 0.008) were associated with an increased risk of type 2 diabetes, whereas MUFA (P = 0.017) showed an inverse association. Conclusion: Improvement of the dietary fat profile in our population can be achieved by formulating and propagating guidelines on the selection and appropriate use of cooking oils, and increased consumption of nuts and oilseeds.

Causes and predictors of mortality in Asian Indians with and without diabetes-10 year follow-up of the Chennai Urban Rural Epidemiology Study (CURES - 150).

BackgroundThe incidence and prevalence of diabetes is increasing worldwide and it is the fifth leading cause of mortality accounting for over 3.8 million deaths annually. Despite the enormity of the diabetes-related health burdens, very few studies have evaluated the factors associated with mortality among people with diabetes in India. We sought to study the causes and predictors of mortality among urban Asian Indians with and without diabetes.Methods and findingsOf 2273 adults (27,850 person-years of follow-up) from the 10-year follow-up of the Chennai Urban Rural Epidemiology Study (CURES), the cause of death could be ascertained in 552 individuals out of the 671 who had died (response rate 82.3%). Verbal autopsy was obtained from the family members of the deceased and this was adjudicated by trained physicians. The age-standardized mortality rate was 28.2 (95%CI 25.9–30.6) per 100,000 population. Mortality rates were significantly higher in individuals with diabetes compared to those without [27.9(95% CI 25.5–30.6) vs. 8.0 (6.6–9.9) per 1000 person years]. Compared to individuals of normal body mass index, underweight individuals had higher risk of mortality (Hazard ratio 1.49; 95% CI 1.11–2.0), whereas overweight and obese individuals did not show a higher risk. The population-attributable risk for all-cause mortality in the entire study cohort was highest for ischemic heart disease and diabetes. The excess mortality attributable to diabetes was highest in the age group of 51 to 70 years, and was mostly accounted for by renal disease (Rate ratio 5.68, 95%CI 2.43–6.23), ischemic heart disease (4.23,2.78–6.67), and cerebrovascular disease (4.00,1.87–9.81).ConclusionUnderweight (but not overweight or obesity) was strongly associated with mortality in this Asian Indian population. Ischemic heart disease and diabetes contributed the most to risk for all cause mortality. Excess mortality due to diabetes was higher in relatively younger individuals and was mostly accounted for by renal disease.

Low Prevalence of AHA-Defined Ideal Cardiovascular Health Factors: A Study of Urban Indian Men and Women.

Coronary heart disease risk factors are widely prevalent among urban subjects in India but the prevalence of good cardiovascular health is unknown. This multisite study sought to determine the prevalence of American Heart Association-defined ideal cardiovascular health factors. The study was performed in 11 cities using cluster sampling. Middle-class urban subjects ages 20 to75 years (N= 6,198; men: 3,426; women: 2,772, response: 62%) were evaluated for socioeconomic, biophysical, and biochemical factors. Prevalence of ideal cardiovascular health using 7-factor American Heart Association metric (nonsmoking, moderate or greater physical activity, low-fat, high-fruit/vegetable diet, body mass index <25 kg/m2, untreated blood pressure <120/<80 mm Hg, cholesterol <200 mg/dl, and fasting glucose <100 mg/dl) was determined. Descriptive statistics are reported. Age-adjusted prevalences of ideal health factors in men and women, respectively, were non-tobacco use in 72.0% and 89.6%, moderate physical activity in 20.1% and 20.6%, healthy diet in 10.6% and 10.6%, normal body mass index in 57.7% and 52.8%, normotension in 17.1% and 22.4%, normocholesterolemia in 72.4% and 72.7%, and normoglycemia in 57.4% and 59.5%. Prevalence of all the 7 health factors was in <1.0% in both men and women, any 6 in 3.4% and 3.5%, any 5 in 12.7% and 17.8%, any 4 in 36.9% and 44.7%, any 3 in 67.2% and 70.8%, any 2 in 89.1% and 92.4%, and 1 in 98.2% and 99.1%. Cardiovascular health was poor (1 to 3 factors) in 62.4% of men and 54.9% of women, average (4 to 5 factors) in 34.1% and 41.5%, and good (≥6 factors) in 3.5% and 3.6%. With increasing age, the behavioral health factors (tobacco use, physical activity, healthy diet) did not change, whereas others declined (ptrend < 0.01). Clustering of average and good health factors also declined with age (ptrend < 0.01). There were no socioeconomic status-related differences in prevalence of good cardiovascular health. Good cardiovascular health factors-physical activity, healthy diet, and desirable body mass index, blood pressure, and glucose levels-are low in urban Asian Indians.

Vitamin D-binding protein, vitamin D status and serum bioavailable 25(OH)D of young Asian Indian males working in outdoor and indoor environments.

Urban Asian Indians generally have low serum 25(OH)D. Information on serum bioavailable 25(OH)D and the effect of prolonged sun-exposure in them is not known. We assessed serum 25(OH)D and bioavailable 25(OH)D in males with varying durations of sun-exposure in Delhi during August-September. Serum 25(OH)D, vitamin D-binding protein (DBP), bioavailable 25(OH)D, free 25(OH)D index, iPTH, ionized calcium and sun-index were assessed in outdoor, mixed outdoor-indoor and indoor workers (n=88, 32 and 74, respectively). The mean sun-index (12.0±6.25, 4.3±2.20 and 0.7±0.62, respectively; P<0.001) was highest outdoors and lowest indoors. Serum 25(OH)D (29.0±8.61, 19.1±5.73 and 10.9±4.19ng/ml, respectively; P<0.001), bioavailable 25(OH)D and free 25(OH)D index were maximum in outdoor workers followed by mixed-exposure and indoor workers. Their mean serum DBP levels (241.2±88.77, 239.3±83.40 and 216.6±63.93µg/ml, respectively; P=0.12) were comparable. Mean serum iPTH was significantly lower in outdoor than indoor workers and showed inverse correlations with serum 25(OH)D, bioavailable 25(OH)D and free 25(OH)D index (r=-0.401, -0.269 and -0.236, respectively; P<0.001 in all). Daily dietary-calorie intake was higher and calcium lower in outdoor than indoor workers. On regression analysis, sun-exposure was the only significant variable, increasing serum 25(OH)D by 2.03ng/ml per hour of sun-exposure (95% confidence interval 1.77-2.28; P<0.001). Outdoor workers with prolonged sun-exposure were vitamin D-sufficient, with higher serum bioavailable 25(OH)D than the indoor workers during summer. Use of serum DBP levels did not affect the interpretation of their vitamin D status.

Cholesterol lipoproteins and prevalence of dyslipidemias in urban Asian Indians: a cross sectional study.

To determine levels of cholesterol lipoproteins and prevalence of dyslipidemias in urban Asian Indians. Population based 6123 subjects (men 3388) were evaluated. Mean±1SD of various cholesterol lipoproteins (total, HDL, LDL and non-HDL cholesterol) and triglycerides were reported. Subjects were classified according to US National Cholesterol Education Program. Age-adjusted levels in men and women were cholesterol total 178.4±39 and 184.6±39, HDL 44.9±11 and 51.1±11, LDL 102.5±33 and 106.2±33, total:HDL 4.15±1.2 and 3.79±1.0 and triglycerides 162.5±83 and 143.7±83mg/dl. Age-adjusted prevalence (%) in men and women, respectively were, total cholesterol ≥200mg/dl 25.1 and 24.9, LDL cholesterol ≥130mg/dl 16.3 and 15.1 and ≥100mg/dl 49.5 and 49.7, HDL cholesterol <40/<50mg/dl 33.6 and 52.8, total:HDL cholesterol ≥4.5 29.4 and 16.8, and triglycerides ≥150mg/dl 42.1 and 32.9%. Cholesterol level was significantly greater in subjects with better socioeconomic status, body mass index and waist circumference while triglycerides were more among those with high socioeconomic status, fat intake, body mass index and waist circumference (p<0.05). Hypercholesterolemia awareness (15.6%), treatment (7.2%) and control (4.1%) were low. Mean cholesterol and LDL cholesterol are low and triglycerides were high in urban Asian Indians. Most prevalent dyslipidemias are borderline high LDL, low HDL and high triglycerides. Subjects with high socioeconomic status, high fat intake and greater adiposity have higher total and LDL cholesterol and triglyceride and lower HDL cholesterol.

Vitamin D Insufficiency Is Associated with Abdominal Obesity in Urban Asian Indians Without Diabetes in North India

We evaluated the associations of serum 25-hydroxyvitamin D [25(OH) D] levels with clinical, biochemical, and anthropometric profiles and total abdominal adipose tissue (TAAT), subcutaneous abdominal adipose tissue (SCAT), and intraabdominal adipose tissue (IAAT) depots in Asian Indians without diabetes residing in north India. In this cross-sectional study (n=137; 74 males and 63 females; 18-60 years of age), anthropometric (body mass index, waist and hip circumferences, and skinfold thickness at four sites) and biochemical (fasting plasma glucose, lipid profile, and fasting insulin levels) assessments were done. Measurement of percentage body fat was done by dual energy x-ray absorptiometry, and areas of TAAT, SCAT and IAAT were measured at the L2-L3 intervertebral level by single-slice magnetic resonance imaging. Levels of 25(OH) D were measured by radioimmunoassay. Correlation analysis was used to assess relationships among clinical, biochemical, and anthropometric profiles, areas of TAAT, SCAT, and IAAT, and 25(OH) D levels. The mean concentration of 25(OH) D was 40.5 ± 8.6 ng/mL. Overall, 6.6% had vitamin D deficiency (<10 ng/mL), 87.6% had insufficiency (<30 ng/mL), and 5.8% had a sufficient level (>30 ng/mL). Levels of 25(OH) D did not correlate with demographic, biochemical, and anthropometric profiles or with abdominal fat depots (TAAT, SCAT, and IAAT). In the correlation regression model, 25(OH) D was associated with TAAT in obese subjects. In obese urban Asian Indians without diabetes, higher values of total abdominal fat at the L2-L3 intervertebral level were associated with low 25(OH) D levels.

Association of dietary fiber intake with serum total cholesterol and low density lipoprotein cholesterol levels in Urban Asian-Indian adults with type 2 diabetes.

Context:There is little data correlating dietary fibre (DF) intake and cardiovascular risk in Asian Indians with diabetes.Aim:To assess the DF intake and its association with lipid profile (total serum cholesterol and low density lipoprotein [LDL] - cholesterol levels) in urban Asian Indians with diabetes.Subjects and Methods:Dietary assessment using validated Food Frequency Questionnaire was conducted in 1191 free-living adults with known diabetes in the Chennai Urban Rural Epidemiology Study. Subjects taking medication for dyslipidemia, and those with cardiovascular disease and implausible energy intake (n = 262) were excluded, leaving 929 participants. Anthropometric and relevant biochemical parameters were measured using standardized techniques.Results:Diabetic individuals who consumed DF < median intake (29 g/day) had a higher prevalence of hypercholesterolemia (49.5% vs. 40.1% [P = 0.01]) and higher LDL cholesterol (46.2% vs. 35.5% [P = 0.001]) than those in the > median intake of DF group. The risk of hypercholesterolemia (odds ratio [OR] =1.38 [95% confidence interval [CI]: 1.02–1.85], P = 0.04), and high LDL cholesterol (OR: 1.43 [95% CI: 1.06–1.94], P = 0.02) was higher among those whose DF intake was less than the median. Serum triglycerides and high density lipoprotein cholesterol were not associated with DF intake. The main sources of DF were vegetables and legumes.Conclusion:In urban Asian Indians with diabetes, lower DF intake is positively related to total cholesterol and LDL cholesterol levels.

Clustering of cardiac risk factors associated with the metabolic syndrome and associations with psychosocial distress in a young Asian Indian population

The metabolic syndrome is a precursor for coronary heart disease. However, its pathophysiology is not clear, its phenotypic expression may vary by region; also, the phenotypic manifestation may be exacerbated by psychosocial distress and family history. The purpose of the current study was to assess the factor structure of the metabolic syndrome in young urban Asian Indians. Asian Indian youth (N=112) were evaluated for body mass index (BMI), waist-hip ratio, blood pressure (systolic: SBP; diastolic: DBP), blood sugar, triglycerides, cholesterol, insulin, psychosocial distress and family health history. Factor analyses were computed on components of the metabolic syndrome. Three factors were identified for the entire sample: hemodynamic-obesity (SBP, DBP, waist-hip ratio), Lipid (cholesterol, triglyceride), and insulin-obesity (blood sugar, BMI, insulin). Similar to previous research with this population, three distinct factors with no overlap were identified. Factors did not correlate with psychosocial distress or family history. Lack of correlation with family history and psychosocial distress may be a function of the young age and demographics of the sample.

Dietary beliefs and eating patterns influence metabolic health in type 2 diabetes: A clinic-based study in urban North India

Background:Almost 15% of India's urban adult populace now lives with type 2 diabetes. This study aimed to characterize the eating patterns, knowledge, beliefs, and determinants of food choice, and assess associations with the metabolic health among urban Asian Indians with type 2 diabetes.Materials and Methods:A cross-sectional study of 258 individuals (mean age 55.7 ± 10 years; body mass index 27.1 ± 4.8 kg/m2; diabetes duration 10.1 ± 6.5 years) attending two out-patient clinics in New Delhi, India. Food-related information was collected during a semi-structured interview. Clinical, anthropometric, and biochemical data were recorded.Results:Beliefs related to health and diabetes played a role determining food choice and dietary patterns; erroneous views were associated with the poor food choices and greater metabolic perturbations. Average consumption of fruits/vegetables was low. Intakes were positively associated with intentions to manage diabetes; inversely associated with the waist circumference and negatively correlated with one's degree of personal responsibility for food choice. Household saturated fat usage was common. High fat intakes were positively associated with the taste preference, ratings of perceived “health-value;” waist circumference, glycosylated haemoglobin percentage (HbA1c%) and lipids.Conclusions:Strategies to enhance diabetes control among Asian Indians are required and should encourage fruit/vegetable intake, personal accountability, and consider individual beliefs and preferences. Greater emphasis and resources directed to regular dietary and behavioral counseling may assist.

Normotension, Prehypertension, and Hypertension in Urban Middle-Class Subjects in India: Prevalence, Awareness, Treatment, and Control

We conducted a multisite study to determine the prevalence and determinants of normotension, prehypertension, and hypertension, and awareness, treatment, and control of hypertension among urban middle-class subjects in India. We evaluated 6,106 middle-class urban subjects (men 3,371; women, 2,735; response rate, 62%) in 11 cities for sociodemographic and biological factors. The subjects were classified as having normotension (BP < 120/80), prehypertension (BP 120-139/80-89), and hypertension (documented or BP ≥ 140/90). The prevalence of other cardiovascular risk factors was determined and associations evaluated through logistic regression analysis. The age-adjusted prevalences in men and women of normotension were 26.7% and 39.1%, of prehypertension 40.2% and 30.1%, and of hypertension 32.5% and 30.4%, respectively. The prevalence of normotension declined with age whereas that of hypertension increased (P-trend < 0.01). A significant association of normotension was found with younger age, low dietary fat intake, lower use of tobacco, and low obesity (P < 0.05). The prevalence of hypercholesterolemia, diabetes, and metabolic syndrome was higher in the groups with prehypertension and hypertension than in the group with normotension (age-adjusted odds ratios (ORs) 2.0-5.0, P < 0.001). The prevalences in men and women, respectively, of two or more risk factors were 11.1% and 6.4% in the group with normotension, 25.1% and 23.3% in the group with prehypertension, and 38.3% and 39.1% in the group with hypertension (P < 0.01). Awareness of hypertension in the study population was in 55.3%; 36.5% of the hypertensive group were receiving treatment for hypertension, and 28.2% of this group had a controlled BP (< 140/90 mm Hg). The study found a low prevalence of normotension and high prevalence of hypertension in middle-class urban Asian Indians. Significant associations of hypertension were found with age, dietary fat, consumption of fruits and vegetables, smoking, and obesity. Normotensive individuals had a lower prevalence of cardiometabolic risk factors than did members of the prehypertensive or hypertensive groups. Half of the hypertensive group were aware of having hypertension, a third were receiving treatment for it, and quarter had a controlled BP.

High Prevalence of Abdominal, Intra-Abdominal and Subcutaneous Adiposity and Clustering of Risk Factors among Urban Asian Indians in North India

ObjectiveTo assess the prevalence of abdominal obesity including intra-abdominal and subcutaneous adiposity along with other cardiometabolic risk factors in urban Asian Indians living in New Delhi.MethodsWe conducted a cross-sectional epidemiological descriptive study with 459 subjects (217 males and 242 females), representing all socio-economic strata in New Delhi. The anthropometric profile [body mass index (BMI), waist circumference (WC) and skinfold thickness], fasting blood glucose (FBG) and lipid profile were recorded. Percent body fat (%BF), total abdominal fat (TAF), intra-abdominal adipose tissue (IAAT) and subcutaneous abdominal adipose tissue (SCAT) were quantified using predictive equations for Asian Indians.ResultsThe overall prevalence of obesity was high [by BMI (>25 kg/m2), 50.1%]. The prevalence of abdominal obesity (as assessed by WC) was 68.9%, while that assessed by TAF was 70.8%. Increased IAAT was significantly higher in females (80.6%) as compared to males (56.7%) (p = 0.00) with overall prevalence being 69.3%. The overall prevalence of high SCAT was 67.8%, more in males (69.1%) vs. females (66.5%, p = 0.5). The prevalence of type 2 diabetes, the metabolic syndrome and hypertension was 8.5%, 45.3% and 29.2%, respectively. Hypertriglyceridemia, hypercholesterolemia and low levels of HDL-c were prevalent in 42.7%, 26.6% and 37% of the subjects, respectively. The prevalence of hypertriglyceridemia was significantly higher in males (p = 0.007); however, low levels of HDL-c were more prevalent in females as compared to males (p = 0.00).ConclusionHigh prevalence of generalized obesity, abdominal obesity (by measurement of WC, TAF, IAAT and SCAT) and dysmetabolic state in urban Asian Indians in north India need immediate public health intervention.

Appropriate Values of Adiposity and Lean Body Mass Indices to Detect Cardiovascular Risk Factors in Asian Indians

The objective of this study was to determine the gender-specific appropriate values of direct measurements of adiposity and lean body mass in Asian Indians. Data was collected cross-sectionally in 168 healthy urban Asian Indian individuals. Dual-energy X-ray absorptiometry and anthropometry were used to measure various body composition and fat distribution parameters. Blood pressure, serum lipids, fasting blood glucose, and 2-h glucose in an oral glucose tolerance test were used to identify the cardiovascular risk factors. Subjects were classified according to the presence of two or more of these cardiovascular risk factors. Appropriate cutoff values for total body fat (%), fat mass (kg), total lean mass (%), lean mass (kg), and fat free mass (kg) were 25.5, 15.1, 73.7, 46.3, and 48.8 for males and 38.0, 20.3, 59.0, 32.6, and 34.8 for females. Corresponding values for fat arm (%), fat mass arm (kg), fat leg (%), fat mass leg (kg), fat trunk (%), and fat mass trunk (kg) were 19.8, 1.4, 21.9, 4.1, 30.1, and 8.8 for males and 43.3, 3.1, 38.9, 6.9, 38.5, and 9.5 for females. Stepwise logistic regression analysis confirmed the relatively strong and independent association of fat mass trunk in men and fat mass arm in women with the clustering of cardiovascular risk factors. Gender-specific cutoffs of direct indices of adiposity and lean body mass are presented in this article, which could be used for clinical and research purpose to detect cardiovascular risk and for categorizing obesity and truncal adiposity in urban Asian Indians.

Difference in prevalence of diabetes, obesity, metabolic syndrome and associated cardiovascular risk factors in a rural area of Tamil Nadu and an urban area of Delhi

This study compared difference in diabetes, obesity, metabolic syndrome (MetS), C-reactive protein (hs-CRP), homocysteine, and other cardiovascular risk factors between rural and urban Asian Indians using similar/standardized field measurements. The design used a cross-sectional and population-based study among rural (Tamil Nadu) and urban (Delhi) Asian Indians aged 18 years and older. 574 rural Indians and 508 urban Indians completed face-to-face interviews, and anthropometric measurements. Fasting venous blood samples were obtained for fasting plasma glucose and serum lipid tests. The mean age was 42.6 ± 11.8 y (urban) and 39.5 ± 13.9 y (rural). Although the prevalence of type 2 diabetes (T2DM) was lower in rural (8.4%) than urban (13.6%) areas, rural Asian Indians had a higher percent of undiagnosed cases (25%), poorer glycemic control, and unawareness of diabetes than their urban peers. Urban Indians had elevated rates of the MetS (as defined by NCEP and IDF criteria), hs-CRP, total cholesterol, LDL, and hypertension than their rural peers. Females in general had significantly higher central obesity and lower HDL-C than males. Homocysteine levels (measured only among urban respondents) was higher among males than females (p = .04). Prevalence of hypertension increased with age (r = .37, p < .001) and correlated with respondents’ blood glucose levels (r = .11, p < .001). There was a step-wise worsening of risk factors as individuals progressed from normal to IFG to T2DM. High burden of diabetes and other cardiovascular risk factors in urban and rural Asian Indians provide basis for tailored and cost-effective prevention and intervention programs, in such resource-constrained settings.

Association of PPARγ2 (Pro12Ala) and neuropeptide Y (Leu7Pro) gene polymorphisms with obstructive sleep apnea in obese Asian Indians.

Background: Obstructive sleep apnea (OSA) is prevalent in 7.5% in urban Asian Indians. Peroxisome proliferator activated receptor gamma2 (PPARγ2) has been implicated in adipocyte differentiation. Neuropeptide Y (NPY) is also considered as a candidate gene for excess body fat accumulation. The association of PPARγ2 (Pro12Ala) and NPY (Leu7Pro) gene polymorphisms with OSA has not been studied in Asian Indians. Objective: To study the distribution of PPARγ2 (Pro12Ala) and NPY (Leu7Pro) polymorphism in Asian Indians with and without OSA. Methods and results: This study was carried out in 252 obese subjects [(body mass index (BMI > 25 kg/m2)]; 142 with OSA and 110 without OSA. Measurements included anthropometric and biochemical parameters (fasting blood glucose, lipid profile, various circumferences and skin-fold thicknesses). PPARγ2 (Pro12Ala) and NPY (Leu7Pro) gene polymorphisms were studied in all subjects. The frequency of the variant allele (Ala12) of PPARγ2 gene was significantly higher in subjects with OSA (14.4%) when compared with subjects without OSA (5.5%; χ2 = 9.7; p = 0.001). The distribution of the variant allele (Pro7) of NPY gene was comparable in subjects with OSA (3.5%) and without OSA (3.6%; χ 2 = 0.001, p = 0.94). Conclusion: This study reveals a significantly higher frequency of PPARγ2 (Ala12) allele in obese Asian Indians with OSA when compared to obese Asian Indians without OSA.

Imbalanced Dietary Profile, Anthropometry, and Lipids in Urban Asian Indian Adolescents and Young Adults

Objective: To analyze the macronutrient, micronutrient, food intake pattern, anthropometry, and lipid profile of urban Asian Indian adolescents and young adults and compare it with the nutrient profile of rural Asian Indian and American adolescents.Methods: This was a cross-sectional, epidemiologic descriptive study. Body mass index (BMI), percentage body fat, waist and hip circumferences, skinfold thickness, serum lipids, and dietary intake were assessed in 1236 subjects (607 males, 629 females) aged 13–25 years from schools and colleges of a metropolitan city of India.Results: The mean age and BMI of study subjects were 17.6 ± 2.4 years (range 13–25 years) and 19.8 ± 3.3 kg/m2 (range 11.9–35.9 kg/m2), respectively. The mean daily percentages of total energy contributed by carbohydrates, total fats, proteins, saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), ω-3 PUFAs, ω-6 PUFAs, and trans-fatty acids for all subjects were 53%, 34%, 11%, 11%, 10%, 9%, 1%, 8%, and 0.3%, respectively. The absolute daily intake of total fat was 84 ± 29 g/d in males and 72 ± 21 g/d in females, which was approximately 4 times the recommended dietary allowance for Asian Indians (20–22 g/d). Among food groups, a high intake of milk, milk products, roots, and tubers was observed. In these young individuals, the prevalence of hypercholesterolemia (males ≥169 mg/dl; females ≥181 mg/dl) and overweight (BMI ≥23.1 kg/m2) was 14.4% and ∼16%, respectively. On comparison with rural Asian Indian adolescents, an inappropriately high intake of total fat was observed in our subjects. On the other hand, the percentage of energy intake of SFAs in Asian Indian and American adolescents was at par.Conclusions: High total fat and SFA intake and a low intake of MUFAs and ω-3 PUFAs showed imbalanced nutrition, which could be responsible for the increasing prevalence of obesity and insulin resistance in urban Asian Indian adolescents and young adults. Nutritional strategies for reducing SFA intake and balancing the ω-3/ω-6 PUFAs ratio should be urgently applied in Asian Indian adolescents and are also presented in this paper.

Younger age of escalation of cardiovascular risk factors in Asian Indian subjects

BackgroundCardiovascular risk factors start early, track through the young age and manifest in middle age in most societies. We conducted epidemiological studies to determine prevalence and age-specific trends in cardiovascular risk factors among adolescent and young urban Asian Indians.MethodsPopulation based epidemiological studies to identify cardiovascular risk factors were performed in North India in 1999–2002. We evaluated major risk factors-smoking or tobacco use, obesity, truncal obesity, hypertension, dysglycemia and dyslipidemia using pre-specified definitions in 2051 subjects (male 1009, female 1042) aged 15–39 years of age. Age-stratified analyses were performed and significance of trends determined using regression analyses for numerical variables and Χ2 test for trend for categorical variables. Logistic regression was used to identify univariate and multivariate odds ratios (OR) for correlation of age and risk factors.ResultsIn males and females respectively, smoking or tobacco use was observed in 200 (11.8%) and 18 (1.4%), overweight or obesity (body mass index, BMI ≥ 25 kg/m2) in 12.4% and 14.3%, high waist-hip ratio, WHR (males > 0.9, females > 0.8) in 15% and 32.3%, hypertension in 5.6% and 3.1%, high LDL cholesterol (≥ 130 mg/dl) in 9.4% and 8.9%, low HDL cholesterol (<40 mg/dl males, <50 mg/dl females) in 16.2% and 49.7%, hypertriglyceridemia (≥ 150 mg/dl) in 9.7% and 6%, diabetes in 1.0% and 0.4% and the metabolic syndrome in 3.4% and 3.6%. Significantly increasing trends with age for indices of obesity (BMI, waist, WHR), glycemia (fasting glucose, metabolic syndrome) and lipids (cholesterol, LDL cholesterol, HDL cholesterol) were observed (p for trend < 0.01). At age 15–19 years the prevalence (%) of risk factors in males and females, respectively, was overweight/obesity in 7.6, 8.8; high WHR 4.9, 14.4; hypertension 2.3, 0.3; high LDL cholesterol 2.4, 3.2; high triglycerides 3.0, 3.2; low HDL cholesterol 8.0, 45.3; high total:HDL ratio 3.7, 4.7, diabetes 0.0 and metabolic syndrome in 0.0, 0.2 percent. At age groups 20–29 years in males and females, ORs were, for smoking 5.3, 1.0; obesity 1.6, 0.8; truncal obesity 4.5, 3.1; hypertension 2.6, 4.8; high LDL cholesterol 6.4, 1.8; high triglycerides 3.7, 0.9; low HDL cholesterol 2.4, 0.8; high total:HDL cholesterol 1.6, 1.0; diabetes 4.0, 1.0; and metabolic syndrome 37.7, 5.7 (p < 0.05 for some). At age 30–39, ORs were- smoking 16.0, 6.3; overweight 7.1, 11.3; truncal obesity 21.1, 17.2; hypertension 13.0, 64.0; high LDL cholesterol 27.4, 19.5; high triglycerides 24.2, 10.0; low HDL cholesterol 15.8, 14.1; high total:HDL cholesterol 37.9, 6.10; diabetes 50.7, 17.4; and metabolic syndrome 168.5, 146.2 (p < 0.01 for all parameters). Multivariate adjustment for BMI, waist size and WHR in men and women aged 30–39 years resulted in attenuation of ORs for hypertension and dyslipidemias.ConclusionLow prevalence of multiple cardiovascular risk factors (smoking, hypertension, dyslipidemias, diabetes and metabolic syndrome) in adolescents and rapid escalation of these risk factors by age of 30–39 years is noted in urban Asian Indians. Interventions should focus on these individuals.

Correlation of a [13C]Glucose Breath Test With Surrogate Markers of Insulin Resistance in Urban and Rural Asian Indians

High rates of insulin resistance (IR), which contribute to a high prevalence of cardiovascular disease (CVD), have been noted in Asian Indians. Rapid, effective measures of IR could identify individuals at risk for CVD in this population. A [(13)C]glucose breath test has been shown to correlate significantly with invasive measures of IR in a Caucasian cohort. We hypothesized that the breath test would correlate significantly with surrogate measures of IR in Asian Indians. A total of 49 urban and 49 rural Asian Indian subjects underwent the (13)C breath test and 2-hour oral glucose tolerance testing. Correlations were performed between the breath test results and surrogate measures of IR including the homeostasis model of insulin resistance (HOMA). These two indices were also correlated with body mass index (BMI). In the overall cohort, the breath test correlated significantly with HOMA (r = -0.40; P < 0.0001), waist circumference (WC) (r = -0.70; P < 0.0001), and BMI (r = -0.59; P < 0.0001). The breath test correlated significantly with BMI in the urban and rural cohorts (r = -0.65; P < 0.0001 and r = -0.36; P = 0.01) and with HOMA (r = -0.55; P = 0.0001) in the urban cohort. There was no significant correlation between the breath test and HOMA (r = -0.07; P = 0.61) in the rural cohort. When corrected for WC and BMI, the correlation between the breath test and HOMA in the urban cohort was no longer significant (r = -0.08; P = 0.57). The (13)C breath test correlated significantly with HOMA values in urban but not in more insulin-sensitive rural subjects and yielded no incremental information over BMI. Further refinement of the [(13)C]glucose breath test is necessary prior to its use as a screening test for IR in Asian Indians.

Refined grain consumption and the metabolic syndrome in urban Asian Indians (Chennai Urban Rural Epidemiology Study 57)

The objective of the study was to evaluate the association of refined grains consumption with insulin resistance and the metabolic syndrome in an urban south Indian population. The study population comprised 2042 individuals aged ≥20 years randomly selected from the Chennai Urban Rural Epidemiology Study (CURES), a cross-sectional study on a representative population of Chennai, southern India. The metabolic syndrome was defined according to modified Adult Treatment Panel III guidelines; and insulin resistance, by the homeostasis assessment model. The mean refined grain intake was 333 g/d (46.9% of total calories) in this population. After adjustment for age, sex, body mass index, metabolic equivalent, total energy intake, and other dietary factors, higher refined grain intake was significantly associated with higher waist circumference (8% higher for the highest vs the lowest quartile, P for trend < .0001), systolic blood pressure (2.9%, P for trend < .0001), diastolic blood pressure (1.7%, P for trend = .03), fasting blood glucose (7.9%, P for trend = .007), serum triglyceride (36.5%, P for trend < .0001), low high-density lipoprotein cholesterol (−10.1%, P for trend < .0001), and insulin resistance (13.6%, P < .001). Compared with participants in the bottom quartile, participants who were in the highest quartile of refined grain intake were significantly more likely to have the metabolic syndrome (odds ratio, 7.83; 95% confidence interval, 4.72-12.99). Higher intake of refined grains was associated with insulin resistance and the metabolic syndrome in this population of Asian Indians who habitually consume high-carbohydrate diets.

Centiles of Anthropometric Measures of Adiposity for 14- to 18-Year-Old Urban Asian Indian Adolescents

This study aimed to develop age- and sex-specific reference values for body mass index (BMI), percentage body fat (%BF), waist circumference, waist-to-hip circumference ratio, and triceps and subscapular skinfold thicknesses for 14- to 18-year-old urban Asian Indians and to develop BMI cut-off points using specific centiles linked to the adult BMI cut-off points. A cross-sectional population survey of adolescents and young adults (14-25 years of age) in North India included 684 boys and 541 girls. Smoothed 5(th), 10(th), 25(th), 50(th), 75(th), 85(th), 90(th), and 95(th) percentiles for the various anthropometric parameters were derived using the least mean squares (LMS) method for constructing normalized growth standards. Age-sex specific cut-off values for body mass index for 14-17 years were obtained corresponding to the centiles that pass through BMI (kg/m(2)) of 23, 25, 27.5, and 30 at 18 years of age. In most instances, the centiles of BMI and waist circumference were lower and those of %BF and triceps and subscapular skinfolds were higher than those recorded in the populations of United States and Canada. The age- and sex-specific BMI cut-off points in 14- to 18-year-old Asian Indian adolescents are also described for the first time. These reference data could be used to identify adolescents with an elevated risk of developing obesity-related disorders and provide a baseline for future studies of temporal trends.