Obesity and dyslipidemia in South Asians

Abstract

Obesity and dyslipidemia are emerging as major public health challenges in South Asian countries. The prevalence of obesity is more in urban areas than rural, and women are more affected than men. Further, obesity in childhood and adolescents is rising rapidly. Obesity in South Asians has characteristic features: high prevalence of abdominal obesity, with more intra-abdominal and truncal subcutaneous adiposity than white Caucasians. In addition, there is greater accumulation of fat at "ectopic" sites, namely the liver and skeletal muscles. All these features lead to higher magnitude of insulin resistance, and its concomitant metabolic disorders (the metabolic syndrome) including atherogenic dyslipidemia. Because of the occurrence of type 2 diabetes, dyslipidemia and other cardiovascular morbidities at a lower range of body mass index (BMI) and waist circumference (WC), it is proposed that cut-offs for both measures of obesity should be lower (BMI 23-24.9 kg/m(2) for overweight and ≥ 25 kg/m(2) for obesity, WC ≥ 80 cm for women and ≥ 90 cm for men for abdominal obesity) for South Asians, and a consensus guideline for these revised measures has been developed for Asian Indians. Increasing obesity and dyslipidemia in South Asians is primarily driven by nutrition, lifestyle and demographic transitions, increasingly faulty diets and physical inactivity, in the background of genetic predisposition. Dietary guidelines for prevention of obesity and diabetes, and physical activity guidelines for Asian Indians are now available. Intervention programs with emphasis on improving knowledge, attitude and practices regarding healthy nutrition, physical activity and stress management need to be implemented. Evidence for successful intervention program for prevention of childhood obesity and for prevention of diabetes is available for Asian Indians, and could be applied to all South Asian countries with similar cultural and lifestyle profiles. Finally, more research on pathophysiology, guidelines for cut-offs, and culturally-specific lifestyle management of obesity, dyslipidemia and the metabolic syndrome are needed for South Asians.

Figure 1

Comparative pictures of enlarged adipocytes from South Asian (left) and White (right) volunteers. Both images are obtained with SPOT digital camera using 10 magnification. Note: this figure is reproduced with permission from [74]. Copyright Chandalia et al., 2007.

Figure 2

Age-adjusted ORs and 95% CIs for prevalence of cardiovascular risk factors in different groups of women (rural-urban, urban and urban-rural migrants) as compared with the rural women, high prevalence of high waist circumference ≥80 cm, and hypercholesterolemia ≥200 mg/dL among rural-urban migrants and urban women. The prevalence declines among the urban-rural migrants. Note: this figure is reproduced with permission from [49]. Copyright the BMJ Publishing Group Ltd., 2011.

Figure 3

Complex interactions of genetic, perinatal, nutritional and other acquired factors in development of insulin resistance, type-2 diabetes and coronary heart disease in South Asians. T2DM, type 2 diabetes mellitus; CRP, C-reactive protein; CHD coronary heart disease. Adapted from [9].