Obesity is major determinant of coronary risk factors in India: Jaipur Heart Watch studies.

OBJECTIVE: The impact of rising population-wide obesity on cardiovascular risk factors has not been well studied in low-income countries. To correlate the prevalence of obesity with risk factors we performed epidemiological studies in India. METHODS: Multiple cross-sectional epidemiological studies, Jaipur Heart Watch (JHW), were performed in India in rural and urban locations. From these cohorts, subjects aged 20-59 years (men 4102, women 2872) were included. Prevalence of various risk factors: smoking/tobacco use, overweight/obesity (body mass index > or = 25 kg/m2) truncal obesity (waist:hip > or = 0.95 men, > or = 0.85 women), hypertension, dyslipidemias, metabolic syndrome and diabetes was determined. Trends were examined using least squares regression. RESULTS: Smoking/tobacco use was more in rural men (50.0% vs 40.6%) and urban women (8.9% vs 4.5%, p < 0.01). Obesity, truncal obesity, hypertension, hypercholesterolemia, diabetes, and metabolic syndrome were more in urban cohorts (p < 0.001). Age-adjusted prevalence (%) of obesity in various cohorts, rural JHW, and urban JHW-1, JHW-2, JHW-3, and JHW-4 respectively, in men was 9.4, 21.1, 35.6, 54.0, and 50.9 (r2 = 0.92, p = 0.009) and in women 8.9, 15.7, 45.1, 61.5, and 57.7 (r2 = 0.88, p = 0.018). Prevalence of truncal obesity in men was 3.2, 19.6, 39.6, 41.4, and 31.1 (r2 = 0.60, p = 0.124) and in women 10.1, 49.5, 42.1, 51.7, and 50.5 (r2 = 0.56, p = 0.1467). In successive cohorts increasing trends were observed in the prevalence of hypertension (r2 = 0.93, p = 0.008) and metabolic syndrome (r2 = 0.99, p = 0.005) with weaker trends for hypercholesterolemia (r2 = 0.41, p = 0.241) and diabetes (r2 = 0.79, p = 0.299) in men. In women, significant trends were observed for hypertension (r2 = 0.98, p = 0.001) and weaker trends for others. Increase in generalized obesity correlated significantly with hypertension (two-line regression r2, men 0.91, women 0.88), hypercholesterolemia (0.53, 0.44), metabolic syndrome (0.87, 0.94) and diabetes (0.84, 0.93). Truncal obesity correlated less strongly with the risk factors like hypertension (0.50, 0.57), hypercholesterolemia (0.88, 0.61), metabolic syndrome (0.76, 0.33), and diabetes (0.75, 0.33). CONCLUSIONS: In Asian Indian subjects, escalating population-wide generalized obesity correlates strongly with increasing cardiovascular risk factors.

Body-mass index, waist-size, waist-hip ratio and cardiovascular risk factors in urban subejcts.

BACKGROUND AND OBJECTIVE: Influence of obesity as determinant of cardiovascular risk factors has not been well studied. To determine association of obesity, measured by body-mass index (BMI), waist-size or waist-hip ratio (WHR), with multiple risk factors in an urban Indian population we performed an epidemiological study. METHODS: Randomly selected adults > or = 20 years were studied using stratified sampling. Target sample was 1800 (men 960, women 840). 1123 subjects (response 62.4%) were evaluated and blood samples were available in 532 men and 559 women (n=1091, response 60.6%). Measurement of anthropometric variables, blood pressure, fasting blood glucose and lipids was performed. Atherosclerosis risk factors were determined using current guidelines. Pearson's correlation coefficients (r) of BMI, waist and WHR with various risk factors were determined. BMI was categorized into five groups: <20.0 Kg/m2, 20.0-22.9, 23.0-24.9, 25.0-29.9, and > or = 30 Kg/m2; waist size was divided into five groups and WHR into six groups in both men and women. Prevalence of cardiovascular risk factors, smoking, hypertension, diabetes, metabolic syndrome and dyslipidaemias was determined in each group and trends analyzed using least-squares regression. RESULTS: There is a significant positive correlation of BMI, waist-size and WHR with systolic BP (r= 0.46 to 0.13), diastolic BP (0.42 to 0.16), fasting glucose (0.15 to 0.26), and LDL cholesterol (0.16 to 0.03) and negative correlation with physical activity and HDL cholesterol (-0.22 to -0.08) in both men and women (p<0.01). With increasing BMI, waist-size and WHR, prevalence of hypertension, diabetes, and metabolic syndrome increased significantly (p for trend <0.05). WHR increase also correlated significantly with prevalence of high total and LDL cholesterol and triglycerides (p <0.05). CONCLUSIONS: There is a continuous positive relationship of all markers of obesity (body-mass index, waist size and waist hip ratio) with major coronary risk factors- hypertension, diabetes and metabolic syndrome while WHR also correlates with lipid abnormalities.

High prevalence of multiple coronary risk factors in Punjabi Bhatia community: Jaipur Heart Watch-3.

BACKGROUND: Studies among emigrant Indian populations have shown a high prevalence of obesity and many coronary risk factors in Bhatia community. To determine the prevalence of risk factors in this community within India we performed an epidemiological study. METHODS AND RESULTS: An ethnic-group sample survey to determine prevalence of cardiovascular risk factors was performed using community registers for enrollment. Methodology used was similar to Jaipur Heart Watch studies performed in 1995 and 2002. We invited 600 randomly selected subjects listed in Punjabi Bhatia community registers and could examine 458 (76.7%) persons (men 226, women 232). Evaluation for coronary risk factors, anthropometric measurements, blood pressure, electrocardiogram, fasting blood glucose and serum lipids was performed using standard definitions. Mean age was 43.2 +/- 14.6 years in men and 44.7 +/- 15.3 years in women. In both men and women there was a high prevalence of family history of coronary heart disease in 45 (19.9%) and 50 (21.6%), family history of diabetes in 96 (42.5%) and 77 (33.2%), sedentary habits in 82 (36.3%) and 73 (31.5%), smoking or tobacco use in 59 (26.1%) and 4 (1.7%), overweight or obesity (body mass index > or = 25 kg/m2) in 123 (54.0%) and 161 (69.4%), severe obesity (body mass index >30 kg/m2) in 47 (20.8%) and 75 (32.3%), truncal obesity (waist-hip ratio: men >0.9, women >0.8) in 175 (77.4%) and 186 (80.2%), increased waist (waist size: men >102 cm, women >88 cm) in 78 (34.5%) and 129 (55.6%), hypertension (blood pressure > or = 140/90 mmHg) in 116 (51.3%) and 120 (51.3%), diabetes in 40 (17.7%) and 33 (14.2%), hypercholesterolemia (total cholesterol > or = 200 mg/dl) in 75 (33.2%) and 67 (28.9%), high triglycerides in 55 (24.3%) and 34 (14.7%), low high-density lipoprotein cholesterol in 169 (74.8%) and 155 (66.8%), and the metabolic syndrome (defined by American National Cholesterol Education Program) in 84 (36.2%) and 111 (47.8%) respectively. Body mass index correlated significantly with (age-adjusted r2 value--men, women) waist diameter (0.52, 0.12), waist-hip ratio (0.21, 0.10), truncal obesity (0.54, 0.60), systolic blood pressure (0.19, 0.16), diastolic blood pressure (0.12, 0.16), hypertension (0.19, 0.31), and metabolic syndrome (0.28, 0.44) (p<0.05). There was a significant linear relationship of body mass index with the prevalence of hypertension, hypercholesterolemia, diabetes (women), and the metabolic syndrome (chi2 for trend p<0.05). Prevalence of these risk factors was the lowest in subjects with body mass index <20 kg/m2. A multivariate ordinal logistic regression analysis revealed that obesity was independently associated with multiple risk factors characterized by metabolic syndrome after adjustment for age, hypertension, and diabetes in both men (odds ratio 2.45, 95% confidence intervals 1.69, 3.57) as well as in women (odds ratio 2.93, 95% confidence intervals 1.86, 4.61) (p<0.01). CONCLUSIONS: There is a high prevalence of obesity, abdominal obesity, hypertension, diabetes, lipid abnormalities and the metabolic syndrome in this community that is significantly greater than reported studies in Jaipur and urban populations elsewhere in India. Obesity correlates strongly with multiple coronary risk factors of which it is an important determinant.