Epidemiology and determinants of type 2 diabetes in south Asia

Hills, Andrew P.; Arena, Ross; Khunti, Kamlesh; Yajnik, Chittaranjan S; Jayawardena, Ranil; Henry, Christiani Jeyakumar; Street, Steve; Soares, Mário J.; Misra, Anoop

doi:10.1016/s2213-8587(18)30204-3

Cited by 189 publications

(152 citation statements)

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“…28 BMI has been found to be associated with hypertension, diabetes, and other NCDs in South Asian populations, at a much lower threshold level than the level for other populations. 20,21,29 The possible reasons for such differences could be genetic and metabolic variations, as well as clustering of environmental, dietary, and social factors associated with hypertension. 9,27–29 Previous studies looking at the relationship between adiposity and hypertension in this population were heterogeneous in terms of definitions used for overweight and obesity.…”

Section: Discussionmentioning

confidence: 99%

“…20,21,29 The possible reasons for such differences could be genetic and metabolic variations, as well as clustering of environmental, dietary, and social factors associated with hypertension. 9,27–29 Previous studies looking at the relationship between adiposity and hypertension in this population were heterogeneous in terms of definitions used for overweight and obesity. 11,21–23 We looked at the association using both WHO and South Asian cutoffs and also for each 5 kg/m 2 increase in BMI.…”

Section: Discussionmentioning

confidence: 99%

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Association between body mass index (BMI) and hypertension in South Asian population: Evidence from Demographic and Health Survey

Hossain

Shawon

Adhikary

et al. 2019

Preprint

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1Although there has been a well-established association between adiposity and 2 hypertension, whether such associations are heterogeneous for South Asian 3 populations or for different socioeconomic groups is not well-known. We analysed 4 the recent Demographic and Health Survey (DHS) data from Bangladesh, India, and 5Nepal to estimate the age-specific prevalence of hypertension and the association of 6 body mass index (BMI) with hypertension. We used multiple logistic regressions to 7 estimate the odds ratios (ORs) with 95% confidence intervals (CIs) of hypertension 8 for overweight and obesity as well as for each 5-unit increase in BMI. The overall 9 prevalence for hypertension among participants aged 35-44 years were 17.4%, 20%, 10 and 22.5% for Bangladesh, India, and Nepal, respectively. For all age groups, men 11 were more likely to be hypertensive than women in India and Nepal, but not in 12Bangladesh. Overweight and obesity were associated with higher odds of 13 hypertension in all countries. For each 5 kg/m 2 increase in BMI, the ORs for 14 hypertension were 1.79 (95% CI: 1.65-1.93), 1.59 (95% CI: 1.58-1.61), and 2.03 15 (95% CI: 1.90-2.16) in Bangladesh, India, and Nepal, respectively. The associations 16 between BMI and hypertension were consistent across various subgroups defined by 17 sex, age, urbanicity, educational attainment and household's wealth index. Our study 18shows that the association of BMI with hypertension is stronger for South Asian 19 populations, and public health measures to reduce population-level reduction in BMI 20 would also help in lowering the burden of hypertension. population level. [9][10][11] In addition, looking at the association in subgroups defined by 15 sex, age, urbanicity, and socioeconomic status is crucial to understand how 16 consistent the association between BMI and hypertension is across different groups. 17There is no study, to the best of our knowledge, which looked at the association of 18 BMI with hypertension across different groups in nationally-representative samples 19from South Asian countries. 20In this study, we aim to examine the age-specific prevalence of hypertension in three 21 South Asian countries, namely Bangladesh, India, and Nepal. We also systematically 22 assess the association between overweight-obesity and hypertension using different 23 cut-offs, and how the association between BMI and hypertension varies across a 24wide variety of subgroups of population. 25 METHODS 1 Study design and data sources 2This study is based on three South Asian countries, namely Bangladesh, India, and 3Nepal. Recent Demographic and Health Survey (DHS) data for these countries had 4 information on both blood pressure and anthropometry for adult population. 5 DHS are periodical nationally-representative household surveys which provide data 6 for a wide range of variables on population, health, and nutrition. These surveys 7 usually are conducted by a national implementing agency with technical assistances 8 provided by the DHS program. Surveys are based on tw...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association between body mass index (BMI) and hypertension in South Asian population: Evidence from Demographic and Health Survey

Hossain

Shawon

Adhikary

et al. 2019

Preprint

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“…Given the limited evidence from South Asian populations for risk estimates for childhood obesity that are attributable to maternal diabetes in utero, further studies in these populations were identified as an important research need [31]. South Asians present with greater metabolic risk at lower levels of BMI compared with other ethnic groups, with type 2 diabetes developing at a younger age and rapidly progressing to other complications [32–34]. Many studies have shown that being obese in childhood and adolescence is associated with obesity in the adult life, and overweight in adolescence is considered an important predictor of long-term morbidity and mortality [28,35–38].…”

Section: Introductionmentioning

confidence: 99%

Intrauterine exposure to hyperglycaemia in pregnancy and risk of adiposity in the offspring at 10 years of age – A community based retrospective cohort study in Sri Lanka

Herath¹,

Herath

Wickremasinghe

2019

Preprint

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BackgroundIntrauterine exposure to a hyperglycemic environment can cause long term changes in body composition resulting in increased adiposity and cardio metabolic risk in the offspring. The aim of this study was to determine the association between hyperglycaemia in pregnancy (HIP) and risk of adiposity in the offspring at 10-11 years of age.MethodsA retrospective cohort study was conducted in the Colombo district, Sri Lanka. 7205 children who were born in 2005 were identified through schools and Public Health Midwives in the community. Mothers of these children still possessing antenatal records were interviewed and relevant data were extracted from medical records to identify eligible participants. Exposure status (hyperglycaemia in pregnancy) was ascertained based on client held antenatal records. 159 children of mothers with HIP (exposed) and 253 children of mothers with no HIP (non-exposed) were recruited. Height, weight, waist circumference and triceps skin fold thickness (TSFT) of participants were measured to ascertain outcome status.ResultsThe mean ages (SD) of exposed and non-exposed groups were 10.9 (0.3) and 10.8 (0.3) years respectively. The median BMI (17.6 vs 16.1, p<0.001), waist circumference (63cm vs 59.3 cm, p<0.001) and triceps skinfold thickness (13.7mm vs 11.2mm, p< 0.001) were significantly higher in the exposed group than in the non-exposed group.Children who were exposed to intrauterine hyperglycaemia were more likely to be overweight (aOR=2.5, 95% CI 1.3-4.7), have abdominal obesity (aOR=2.9, 95% CI 1.2-6.8) and high TSFT > 70th centile (aOR=2.1, 95% CI 1.2-3.9) at 10-11 years of age than children who were not exposed after adjusting for maternal BMI, birth weight and birth order.ConclusionsIntrauterine exposure to HIP is associated with significantly higher risk of adiposity in the offspring at 10 years of age.

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“…As well-reflected in the current IDF estimates of 2018, with 72.95 million resident T2D populations, India is one of the most severely afflicted countries with the epidemic. Urbanization and change of lifestyle are attributed as the major underlying causes of this rising epidemic 1,3,4 .…”

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confidence: 99%

Yoga-based lifestyle treatment and composite treatment goals in Type 2 Diabetes in a rural South Indian setup- a retrospective study

Arumugam

Nagarathna

Majumdar

et al. 2020

Sci Rep

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This multicentre retrospective study examined the effects of adjunct yoga-treatment in achieving composite cardiovascular goals for type 2 diabetes (T2D), set forth by the American Diabetes Association (ADA) in rural Indian settings. Records were extracted for 146 T2D patients, aged ≥20-70 years, and treated under the "Apollo Total Health Programme" for rural diabetes management, for the period April 2016 to November 2016. The study cohort comprised of two treatment groups (n = 73 each); non-yoga group (standard of care) and yoga group (adjunct yoga-treatment). Propensity score matching was applied between the study groups to define the cohort. Composite cardiovascular scores were based on the combination of individual ADA goals; A1c < 7%, blood pressure (BP) < 140/90 mmHg, stringent BP (<130/80 mmHg) and lipid, LDL-C < 100 mg/dl [risk factor for atherosclerotic cardiovascular disease]. Logistic regression was used to compare between the two treatment groups. Compared to standard of care, adjunct yoga-treatment was found to significantly facilitate the attainment of ADA composite score by 8-fold; A1c, ~2-fold; LDL-C, ~2-fold; BP < 140/90 mmHg and <130/80 mmHg by ~8-and ~6-fold respectively. This study provides the first evidence for significant efficacy of adjunct yoga-treatment for the attainment of favourable treatment goals for T2D in rural Indian settings. Clinical Trial Registration Number: CTRI/2020/02/0232790

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Epidemiology and determinants of type 2 diabetes in south Asia

Cited by 189 publications

References 124 publications

Association between body mass index (BMI) and hypertension in South Asian population: Evidence from Demographic and Health Survey

Association between body mass index (BMI) and hypertension in South Asian population: Evidence from Demographic and Health Survey

Intrauterine exposure to hyperglycaemia in pregnancy and risk of adiposity in the offspring at 10 years of age – A community based retrospective cohort study in Sri Lanka

Yoga-based lifestyle treatment and composite treatment goals in Type 2 Diabetes in a rural South Indian setup- a retrospective study

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