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Recent data indicate a rise in obesity both in children and adolescents in developing countries. The overall prevalence of overweight/obesity in urban children in New Delhi has shown an increase from 16% in 2002 to about 24% in 2006-2007. Our recent data show that the prevalence among adolescent children was 29% in private schools and 11.3% in government funded schools. While India already has highest number of patients with type 2 diabetes mellitus (T2DM) globally, rapid rise of obesity in children is the prime reason for increasing insulin resistance, the metabolic syndrome, dyslipidemia, polycystic ovarian syndrome and raised levels of C-reactive protein. Excess body fat, thick truncal subcutaneous fat, and abdominal adiposity are important predisposing factors for development of insulin resistance in Asian Indian children. As compared to other ethnic groups, children with ancestral origin in South Asia manifest adiposity, insulin resistance and metabolic perturbations earlier in life and these derangements are of higher magnitude than white Caucasian children. Since the metabolic syndrome and obesity track into adulthood, these clinical entities need to be recognized early for effective prevention of T2DM and coronary heart disease. Therapeutic lifestyle changes, maintenance of high levels of physical activity and normal weight are most important prevention strategies. Both high-risk surveillance and cost-effective population intervention programs are urgently needed. In this context, we have launched one of the largest program ("MARG", The Path) to curb childhood obesity in India.
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PMID:Childhood obesity in Asian Indians: a burgeoning cause of insulin resistance, diabetes and sub-clinical inflammation. 1829 30

Data on height and weight of 3,428 non-smoking healthy adult subjects, obtained during an earlier community-based study in Delhi, India, on chronic respiratory morbidity due to ambient air pollution was analyzed to study the distribution of body mass index (BMI) and its determinants among adults in Delhi. The sample was drawn by systematic sampling from rural and urban areas of Delhi. In urban areas, the sampling frame was restricted to areas around air quality-monitoring stations. However, the areas were spread across the city and reflected wide economic spectrum. Subjects were classified as underweight, normal, overweight, and obese as per the criteria of the World Health Organization for BMI. The mean BMI of the entire sample was 22.14 +/- 4.61. It was higher among females, urban residents, and the higher-income group. Overall, 49.7% of the 3,428 subjects had a normal nutritional status, 24.8% were underweight, 19.4% overweight, and 6.1% obese. The prevalence of underweight was higher in rural areas (38.5%) and among the lower-income group (39.9%), while overweight and obesity were more common in urban residents (22.7% and 7.5% respectively), among females (21.7% and 7.7%), and the higher-income group (31.8% and 11%) (p < 0.05). The adjusted odds for underweight were 2.02 for rural subjects and 4.00 for the lower-income group. For overweight or obesity, odds were 5.6 for the higher-income group, 3.62 for urban residents, and 2.5 for females. It was concluded that problems of both underweight and overweight and obesity exist among the adults of Delhi. While females, residents of urban areas, and economically-better-off were more likely to be overweight or obese, residents of rural areas and those from lower-income groups were more likely to be underweight.
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PMID:Distribution and determinants of body mass index of non-smoking adults in Delhi, India. 1833 62

BACKGROUND, Several studies have reported that the increased risk of hypertension is mainly due to alcohol intake, lack of physical activity, nutritional factors like high fat intake, anthropometric parameters like body weight and waist-to-hip ratio, and metabolic disorders like diabetes mellitus. However, the extensive review of literature suggests that in different parts of the world, the predictive risk factors are associated with risk of hypertension in different combinations.The main objectives of this study were to determine the predictors of hypertension in an urban population of India, using the variables depicting lifestyle, nutrition, and environment. METHODS AND RESULTS, Secondary data collected through a cross-sectional survey in a population proportionate sample were analyzed. Sample size was calculated using prevalence of one of the predictors (obesity) from previous studies.Subjects aged between 15 and 54 years, residing in New Delhi for at least one year were included in the study (n = 494). The WHO STEPS instrument for noncommunicable disease risk factors (Core and Expanded version 1.2) was used for data col-lection.Bivariate logistic regression analysis showed that hypertensive individuals were twice more likely to be male, of significantly higher age, and more likely, had received college education.The full model of logistic regression analysis showed that sex, age, education, weight, and pulse rate were significant predictors of hypertension. CONCLUSION, The most parsimonious regression model included age, sex, educational status, body mass index, physical inactivity, and hip girth as predictors of hypertension. Risk of hypertension may be predicted early in a population by suitable screening procedures.
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PMID:Predictors of hypertension in an urban Indian population. 1898 26

Obesity has emerged as an epidemic worldwide. The present study was conducted to assess the prevalence of overweight and obesity amongst children in the age group of 5-18 years belonging to low, middle and high income group in National Capital Territory NCT of Delhi. A total of 16,595 children (LIG 5087, MIG 5134 and HIG 6368) were covered in the present study. Overweight and obesity were assessed using Body Mass Index (BMI) and Triceps Skin Fold Thickness (TSFT) utilizing age and sex specific cut off points. Considering the BMI cut off points, the prevalence of obesity and overweight in Low Income Group (LIG) school children was 0.1 and 2.7 percent respectively, amongst Middle Income Group (MIG) school children it was 0.6 and 6.5 percent and in High Income Group (HIG) school children was 6.8 and 15.3 percent respectively (p<0001). With regard to the TSFT criteria, the prevalence of obesity and overweight in LIG school children was 1.2 and 2.4 percent, amongst MIG school children it was 2.5 and 4.9 percent and in children belonging to HIG schools was 9.3 and 13.1 percent respectively (p<0.001). The present study documented that the prevalence of overweight and obesity was higher in the HIG children as compared to the MIG and the LIG for all age groups, highlighting the possible role of change in the dietary pattern and physical activities with increase in income levels.
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PMID:Prevalence of overweight and obesity amongst school children in Delhi, India. 1911 95

There is paucity of data on the association of various risk factors of the metabolic syndrome in urban Asian Indian adolescents. This cross-sectional study included 948 subjects (527 males; 421 females) aged 14-19 y, selected randomly from New Delhi, India. Principal component factor analysis included variables such as: body mass index (BMI), waist circumference (WC), triceps (TR) and subscapular (SS) skinfold thickness, systolic and diastolic blood pressures, fasting blood glucose, serum triglycerides, high-density lipoprotein cholesterol and fasting insulin. Factor scores were used to generate a cumulative risk scale and identify independent correlates of high cumulative risk. Three factors namely: obesity/insulin factor (BMI, WC, TR, SS and fasting insulin) explained 40.9% and 35.5%, 'blood pressure' factor explained 14.1% and 14.2%, and the 'metabolic' factor (glucose/triglycerides) explained 10.4% and 10.8% of the variance data in males and females, respectively. Overweight and hyperinsulinemia in both genders and high SS in males were independently associated with high cumulative risk. More than one factor is associated with the metabolic syndrome in Asian Indian adolescents. Obesity (generalized, abdominal and truncal sub-cutaneous) accounts for the maximum variance in clustering and appears to be the stronger correlate of high cumulative risk rather than hyperinsulinemia.
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PMID:Factor analysis of the metabolic syndrome components in urban Asian Indian adolescents. 1971 91

This paper reports the results of formative and outcome evaluation of two ongoing community-based intervention programmes for integrated non-communicable disease (NCD) prevention and control in urban low-income settings of Ballabgarh near New Delhi, India, and in Depok, West Java Province of Indonesia. At both sites, a coalition of community members facilitated by academic institution and the World Health Organization, planned and implemented the intervention since 2004. The intervention consisted of advocacy and mediation with stakeholders, training of volunteers and school teachers, communication campaigns, risk assessment camps and reorientation of health services. The formative evaluation was based on the review of documents, and outcomes were assessed using the standardized surveys for NCD risk factors in 2003-2004 and 2006-2007. The baseline surveys showed that tobacco use, low intake of fruits and vegetable, suboptimal levels of physical activity and obesity were prevalent in both the communities. A frequent change in local administrators and lack of perceived priority for health and NCDs limited their involvement. Pre-existing engagement of community-based organizations and volunteers in health activities facilitated its implementation. The reach of the programme among the population was modest (25-32%). Health system interventions resulted in increased diagnosis and better management of NCDs at health facilities. Early outcome measures showed mixed results of change in different risk factors. The experiences gained are being used in both countries to expand and provide technical support to national efforts. This paper adds to the knowledge base on the feasibility of designing and implementing large-scale community-based interventions for integrated prevention of NCDs through modification of risk factors.
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PMID:Evaluation of community-based interventions for non-communicable diseases: experiences from India and Indonesia. 2107 58

The present study examines the secular trends in prevalence of overweight and obesity among urban Asian Indian adolescents in New Delhi (North India). The data were derived from cross-sectional sampling of children, 3493 in year 2006 and 4908 in year 2009, aged 14-17 years studying in privately-funded and government-funded schools. Age, gender and Asian Indian-specific cut offs of body mass index (BMI) were used to define overweight and obesity. The prevalence of obesity increased significantly from 9.8% in 2006 to 11.7% in 2009 (p<0.01), whereas underweight decreased from 11.3% to 3.9% (p<0.001). There was a significantly higher risk of being overweight (OR 1.28; 95% CI, 1.15-1.42) and obese (OR 1.44; 95% CI, 1.24-1.66) in year 2009 than 2006, after adjusting for age, gender and type of school. Males and privately-funded school children had significantly higher increase in prevalence and risk of being overweight and obese over the three years. In conclusion, this study showed an increasing trend in prevalence of overweight and obesity in urban Asian Indian adolescents. More specifically, the study showed the association of this increasing trend of overweight and obesity prevalence with male gender and high socio-economic status, calling for an urgent need for immediate and targeted preventive measures.
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PMID:Secular trends in prevalence of overweight and obesity from 2006 to 2009 in urban asian Indian adolescents aged 14-17 years. 2138 40

Recent studies have identified common genetic variants that are unequivocally associated with central adiposity, BMI, and/or fasting plasma glucose among individuals of European descent. Our objective was to evaluate these associations in a population of Asian-Indians. We examined 16 single-nucleotide polymorphisms (SNPs) from loci previously linked to waist circumference, BMI, or fasting glucose in 1,129 Asian-Indians from New Delhi and Trivandrum. Trained medical staff measured waist circumference, height, and weight. Fasting plasma glucose was measured from collected blood specimens. Genotype-phenotype associations were evaluated using linear regression, with adjustments for age, gender, religion, and study region. For gene-environment interaction tests, total physical activity (PA) during the past 7 days was assessed by the International Physical Activity Questionnaire (IPAQ). The T allele at the FTO rs3751812 locus was associated with increased waist circumference (per allele effect of +1.58 cm, P(trend) = 0.0015) after Bonferroni adjustment for multiple testing (P(adj) = 0.04). We also found a nominally statistically significant FTO-PA interaction (P(interaction) = 0.008). Among participants with <81 metabolic equivalent (MET)-h/wk of PA, the rs3751812 variant was associated with increased waist size (+2.68 cm; 95% confidence interval (CI) = 1.24, 4.12), but not among those with 212+ MET-h/wk (-1.79 cm; 95% CI = -4.17, 0.58). No other variant had statistically significant associations, although statistical power was modest. In conclusion, we confirmed that an FTO variant associated with central adiposity in European populations is associated with central adiposity among Asian-Indians and corroborated prior reports indicating that high PA attenuates FTO-related genetic susceptibility to adiposity.
Obesity (Silver Spring) 2012 Sep
PMID:Common genetic variants and central adiposity among Asian-Indians. 2179 82

With changing demographic profile India has more older women than men as life expectancy for women is 67.57 as against 65.46 for men. Gender differences in the aging process reflect biological, economic, and social differences. Both social and health needs of the older women are unique and distinctive as they are vulnerable. The social problems revolve around widowhood, dependency, illiteracy and lack of awareness about the policies and programmes from which they can benefit. Among the medical problems, vision (cataract) and degenerative joint disease top the list, followed by neurological problems. Lifestyle diseases form another single-most important group of health problems in the elderly women. The risk of cardiovascular disease doubles with the outcome being poorer than men. The most common causes of death among women above the age of 60 years are stroke, ischemic heart disease and COPD. Hypertensive heart disease and lower respiratory tract infections contribute to mortality in these women. Common malignancies viz. Cervical, breast and uterus in women are specific to them and account for a sizeable morbidity and mortality. In a study done at Lady Hardinge medical college in Delhi, Hypertension (39.6%) and obesity (12-46.8%) were very common in postmenopausal women. Half or more women had high salt and fat intake, low fruit and vegetable intake and stress. There is a need to recognize the special health needs of the women beyond the reproductive age, to be met through strengthening and reorienting the public health services at all levels starting from primary health care to secondary till tertiary care level with adequate referral linkages. All policies and programs need to have a gender perspective. At present there is lack of sensitization and appropriate training of the health personnel in dealing with the needs of elderly. Women too need to be aware to adopt healthy lifestyle and seek timely care.
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PMID:Women's health: beyond reproductive years. 2229 32

Aggarwal Baniyas were found to have a high prevalence of high blood pressure. Genetic and environmental influences may be implicated for this risk factor of cardiovascular disease. The aim of this study was to investigate the potential for common genetic and environmental influences on blood pressure measures (systolic and diastolic blood pressure (SBP, DBP)). The population-based sample was comprised of 309 Aggarwal Baniya families, including 1214 individuals (271 fathers, 307 mothers, 311 sons and 325 daughters) from New Delhi, India. The prevalence of obesity in this community was found to be high (BMI: fathers, 26.1 kg/m2; mothers, 29.4 kg/m2; sons, 16.9-22.4 kg/m2; and daughters, 16.3-22.7 kg/m2). Correlation and heritability were estimated. Most sibling-sibling correlations were larger than the parent-offspring correlations, and all parent-offspring and sibling-sibling correlations were larger than the corresponding spouse correlation (SBP=0.026; DBP=0.029). The maximum heritability was estimated as 44.6% for SBP and 62.8% for DBP. The lack of a significant spouse correlation is consistent with little or no influence of the common familial environment. However, the high heritability estimate for both SBP and DBPs reinforces the importance of the non-shared environmental effect.
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PMID:Genetic and environmental influences on blood pressure in an urban Indian population. 2289 51


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