Obesity in South Asia: Phenotype, Morbidities, and Mitigation

Misra, Anoop; Jayawardena, Ranil; Anoop, Shajith

doi:10.1007/s13679-019-0328-0

Cited by 83 publications

(56 citation statements)

References 91 publications

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“…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%

“…Assessing association between body mass index (BMI) and hypertension has important public health implications in South Asian countries, where the burden of hypertension is high and obesity is increasing at the population level. 9–11 In addition, looking at the association in subgroups defined by sex, age, urbanicity, and socioeconomic status is crucial to understand how consistent the association between BMI and hypertension is across different groups. There is no study, to the best of our knowledge, which looked at the association of BMI with hypertension across different groups in nationally-representative samples from South Asian countries.…”

Section: Introductionmentioning

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: Introductionmentioning

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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show abstract

“…Propensity to develop diabetes at a lower BMI stems from the presence of greater insulin resistance and subclinical inflammation at younger ages than in other ethnic groups. The effect on insulin resistance could be contributed by truncal and abdominal subcutaneous adipose tissue, deep subcutaneous adipose tissue, intra‐abdominal adipose tissue, and non‐alcoholic fatty liver disease (NAFLD), as well as possibly high pancreatic fat content . Because of these adverse body composition and metabolic attributes, different definitions of adiposity measures (BMI levels and waist circumference cut‐off points lower than for Whites) have been advocated .…”

Section: Distinctive Points Regarding Diabetes In Developing Countriesmentioning

confidence: 99%

Diabetes in developing countries

Misra

Gopalan

Jayawardena

et al. 2019

Journal of Diabetes

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152

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Highlights• Diabetes in developing countries is increasing and often undiagnosed. In South Asians, diabetes and related metabolic abnormalities develop at a younger age and at a lower body mass index and waist circumference than in Whites. • Overall glycemic control and management of diabetes is suboptimal, driven by multiple factors (eg, unawareness, cost of drugs and insulin etc.), and the load of complications is high. • To stem this epidemic, strong actions for prevention and management are required using innovative and low-cost approaches. AbstractThere has been a rapid escalation of type 2 diabetes (T2D) in developing countries, with varied prevalence according to rural vs urban habitat and degree of urbanization. Some ethnic groups (eg, South Asians, other Asians, and Africans), develop diabetes a decade earlier and at a lower body mass index than Whites, have prominent abdominal obesity, and accelerated the conversion from prediabetes to diabetes. The burden of complications, both macro-and microvascular, is substantial, but also varies according to populations. The syndemics of diabetes with HIV or tuberculosis are prevalent in many developing countries and predispose to each other. Screening for diabetes in large populations living in diverse habitats may not be cost-effective, but targeted high-risk screening may have a place. The cost of diagnostic tests and scarcity of health manpower pose substantial hurdles in the diagnosis and monitoring of patients. Efforts for prevention remain rudimentary in most developing countries. The quality of care is largely poor; hence, a substantial number of patients do not achieve treatment goals. This is further amplified by a delay in seeking treatment, "fatalistic attitudes", high cost and non-availability of drugs and insulins. To counter these numerous challenges, a renewed political commitment and mandate for health promotion and disease prevention are urgently needed. Several low-cost innovative approaches have been trialed with encouraging outcomes, including training and deployment of non-medical allied health professionals and the use of mobile phones and telemedicine to deliver simple health messages for the prevention and management of T2D.

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“…Assessing association between body mass index (BMI) and hypertension has important public health implications in South Asian countries, where the burden of hypertension is high and obesity is increasing at the population level [11–13]. In addition, looking at the association in subgroups defined by sex, age, urbanicity, and socioeconomic status is crucial to understand how consistent the association between BMI and hypertension is across different groups.…”

Section: Introductionmentioning

confidence: 99%

Association between body mass index (BMI) and hypertension in south Asian population: evidence from nationally-representative surveys

et al. 2019

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BackgroundAlthough there has been a well-established association between overweight-obesity and hypertension, whether such associations are heterogeneous for South Asian populations, or for different socioeconomic groups is not well-known. We explored the associations of overweight and obesity using South Asian cut-offs with hypertension, and also examined the relationships between body mass index (BMI) and hypertension in various socioeconomic subgroups.MethodsWe analysed the recent Demographic and Health Survey (DHS) data from Bangladesh, India, and Nepal, with a total of 821,040 men and women. Hypertension was defined by 2017 ACC/AHA cut-offs and by Joint National Committee 7 (JNC7) cut-offs for measured blood pressure and overweight and obesity were defined by measured height and weight. We used multiple logistic regressions to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) of hypertension for overweight and obesity as well as for each 5-unit increase in BMI.ResultsThe prevalence of hypertension using JNC7 cut-offs among participants increased by age in all three countries. The prevalence ranged from 17.4% in 35–44 years to 34.9% in ≥55 years in Bangladesh, from 4.6% in 18–24 years to 28.6% in 45–54 years in India, and from 3.8% in 18–24 years to 39.2% in ≥55 years in Nepal. Men were more likely to be hypertensive than women in India and Nepal, but not in Bangladesh. Overweight and obesity using both WHO and South Asian cut-offs were associated with higher odds of hypertension in all countries. For each 5 kg/m2 increase in BMI, the ORs for hypertension were 1.79 (95% CI: 1.65–1.93), 1.59 (95% CI: 1.58–1.61), and 2.03 (95% CI: 1.90–2.16) in Bangladesh, India, and Nepal, respectively. The associations between BMI and hypertension were consistent across various subgroups defined by sex, age, urbanicity, educational attainment and household’s wealth index.ConclusionsOur study shows that the association of BMI with hypertension is stronger for South Asian populations at even lower cut-offs points for overweight and obesity. Therefore, public health measures to reduce population-level reduction in BMI in all population groups would also help in lowering the burden of hypertension.

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Obesity in South Asia: Phenotype, Morbidities, and Mitigation

Cited by 83 publications

References 91 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

Diabetes in developing countries

Association between body mass index (BMI) and hypertension in south Asian population: evidence from nationally-representative surveys

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