Mithun Das

Rural urban differences of cardiovascular disease risk factors in adult Asian Indians

The prevalence of cardiovascular disease (CVD) risk factors in “People of Indian Origin” (PIO) is exceedingly high and strong relationships among elevated blood pressure, increased levels of lipoproteins, visceral obesity, physical inactivity and subsequent high occurrence of coronary heart disease, type 2 diabetes mellitus etc., were evident in many studies. Increasing urbanization with effective changes in lifestyles could be attributed to explain this exaggerated rate. The present community based cross‐sectional investigation was aimed to identify rural‐urban differences in prevalence of risk factors of CVD in the adult Asian Indians. A total of 350 adult (30 years and above) individuals (184 males and 166 females) belong to urban (n = 193, males = 104, and females = 89) and rural (n = 157, males = 80, and females = 77) areas participated in the study. Anthropometric measures, lipids profiles, fasting blood glucose and blood pressure measures were obtained from participants. The mean body mass index (kg/m2) for male and female was 22.37 ± 4.09 and 23.20 ± 4.37, respectively. There existed significant differences for anthropometric, metabolic, and blood pressure variables between rural and urban areas. Habitat (rural vs. urban) had significant impact on central adiposity, lipids, lipoproteins, and blood pressure measures even after adjusted for age and sex. Overall, 84.3% of females had lower HDL level compared with only 20.1% in males. It was also observed that the prevalence of metabolic syndrome was 56.2% in urban females compared with 36.4% in rural females. Effective urbanization and or modernization seem to influence CVD risk factors and warrants intervention as early as adulthood to check this menace. Am. J. Hum. Biol., 2008.

Association of metabolic syndrome with obesity measures, metabolic profiles, and intake of dietary fatty acids in people of Asian Indian origin

Objective: The present community-based cross-sectional study was aimed to examine the association of metabolic syndrome (MS) with obesity measures, metabolic profiles, and intake of dietary fatty acids in Asian Indian population. Patients and Methods: A total of 350 adult (30 years and above) individuals (184 males and 166 females) inhabiting in and around Kolkata, India participated in this study. MS was defined using the protocol specifically designed for Asian Indian population. Results: The prevalence of MS in the study was 31.4%. The prevalence was significantly higher (P < 0.01) in females (48.2%) as compared to males (16.3%). It was observed that males without MS had significantly higher mean waist circumference (WC P < 0.05); waist–hip ratio (WHR; P < 0.001); triglyceride (TG; P < 0.05); very low density lipoprotein cholesterol (VLDLc; P < 0.05) and fasting blood glucose (FBG; P < 0.01) as compared to females without MS. Significant differences were also observed for dietary intake of total fatty acids (TFA; P < 0.001); saturated fatty acids (SFA; P < 0.001) and polyunsaturated fatty acids (PUFA; P < 0.001) between individuals with and without MS. However, no significant association was observed in individuals with MS after controlling for age and sex. On the other, WC and body mass index (BMI) had significant correlation with SFA: mono unsaturated fatty acids (MUFA; P < 0.01) in individuals without MS even after controlling for age and sex. Conclusion: It seem reasonable to argue that while dealing with MS in Asian Indians, clinicians should consider obesity measures, metabolic profiles and dietary fatty acids simultaneously.

Angiotensin Converting Enzyme Gene Polymorphism (Insertion/Deletion) and Hypertension in Adult Asian Indians: A Population-Based Study from Calcutta, India

Abstract The angiotensin converting enzyme (ACE) gene insertion/deletion polymorphism has been identified as a potential genetic risk factor for essential hypertension. The purpose of the present study is to investigate the association of the insertion/deletion polymorphism of the ACE gene with essential hypertension in adult Asian Indians. Three hundred fifty (184 males and 166 females) adult (30 years and older) Asian Indians of Calcutta and its suburbs participated in this population-based cross-sectional study. Anthropometric measures, lipids profiles, blood glucose, and blood pressure measures were collected from participants. ACE insertion/deletion polymorphism was determined by agarose gel electrophoresis and D/D typing was further reconfirmed using insertion-allele-specific amplification. Essential hypertension was de-fined as a systolic blood pressure (SBP) greater than 160 mm Hg and/or a diastolic blood pressure (DBP) greater than 90 mm Hg or use of any antihypertensive treatment by participants. Significantly higher SBP, DBP, and mean arterial pressure were recorded in D/D subjects compared to I/I and I/D subjects. We also observed that the odds of being hypertensive were 7.483 (95% CI = 1.746, 30.192) in D/D individuals compared to those carrying one or no D alleles. This finding suggests that ACE insertion/deletion polymorphism is associated with essential hypertension in Asian Indians. Moreover, individuals who are homozygous for the D allele of the ACE gene are more likely to have essential hypertension.

Prevalence of cardiovascular disease risk factors in people of Asian Indian origin: Age and sex variation.

Background: No study has been undertaken on people of Asian Indian origin to investigate the age and sex variation in the prevalence of cardiovascular disease (CVD) risk factors. Objectives: To investigate the age and sex variation in the prevalence of CVD risk factors among the people of Asian Indian origin. Materials and Methods: A total of 682 (302 males and 380 females) participants aged 25–85 years took part in the study. The subjects were categorized into 4 groups, namely, Group I (25–34 years), Group II (35–44 years), Group III (45–54 years), and Group IV (55 years and above). Height, weight, and the circumferences of minimum waist (MWC) and maximum hip were collected using standard techniques. Waist–hip ratio (WHR) was then calculated. Percentage of body fat (%BF) and body mass index (BMI) were measured using an Omron body fat analyzer. Left arm systolic (SBP) and diastolic (DBP) blood pressure were taken from each participant with the help of an Omron MI digital electronic blood/pulse monitor. Metabolic profiles, namely, total cholesterol (TC), triglyceride (TG), high (HDL), low (LDL), very low-density lipoprotein (VLDL), and fasting blood glucose (FBG) were also measured using an autoanalyzer. Results: One-way analysis of variance revealed significant differences for age, BMI, MWC, WHR, SBP, DBP, TC, TG, LDL, VLDL, and TC:HDL and TG:HDL ratios across the groups. It was observed that there were significant sex-specific group differences (male [χ2 (12)] =29.22, P < 0.01 and female [χ2 (12)] =56.69, P < 0.001) for obesity, high BP, high TC, high TG, and high FBG. But no significant group-specific sex difference was evident for either of the risk factors, except for Group IV. Conclusion: Age irrespective of sex modulates CVD risk factors and warranted prevention as early as middle age.

Family history of type 2 diabetes and prevalence of metabolic syndrome in adult Asian Indians

Background: Our objective was to test the association between familial risk of type 2 diabetes mellitus (T2DM) and the prevalence of metabolic syndrome (MS) in adult Asian Indians. Materials and Methods: A total of 448 adult (>30 years) individuals (257 males and 191 females) participated in the study. Familial risk of T2DM was classified into three groups viz., 1=both parents affected; 2=parent and/or siblings affected and 3=none or no family history for T2DM. Anthropometric measures, blood pressures, fasting blood glucose and metabolic profiles were studied using standard techniques. MS was defined accordingly. The prevalence of MS phenotypes was estimated and compared among the three familial risk strata. Results: Individuals with a history of both parents affected from diabetes had significantly higher (P<0.001) body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and fasting blood glucose (FBG; P=0.035) than individuals having no family history of T2DM. Significant difference was also noticed between individuals with and without MS according to the family history of diabetes (P<0.001). Differences were evident between individuals who fulfilled all the MS criteria (P=0.001) and individuals with only one or two criteria (phenotypes) according to family history of T2DM. Conclusion: Family history of T2DM had significant effect on individuals with MS as compared to their counterparts (individuals having no family history of T2DM). It therefore seems reasonable to argue that family history of T2DM could be useful as a predictive tool for early diagnosis and prevention of MS in Asian Indian population.

Clustering of cardiometabolic risk factors in Asian Indian women: Santiniketan women study.

Objective: The aim of the present cross-sectional study was to investigate the clustering of cardiometabolic risk factors in premenopausal and postmenopausal Asian Indian women. Methods: A total of 214 healthy women (25-65 y) from the Bolpur-Santiniketan area, West Bengal, India, took part in the study. The women were categorized into two groups, namely, premenopausal (n = 161) and postmenopausal (n = 53). Anthropometric measures, namely, minimum waist circumference (WC) and the sum of four (biceps + triceps + subscapular + suprailiac) skinfolds (SF4), were measured accordingly. Intra-abdominal visceral fat (IVF) was also measured. Left arm systolic (SBP) and diastolic (DBP) blood pressure was taken in participants. Metabolic profiles, namely, total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), fasting plasma glucose (FPG), insulin, testosterone, and estrogen, were measured accordingly. Results: The four factors identified in premenopausal women were factor 1: WC, SF4, IVF, TC, and TG; factor 2: HDL, SBP, DBP, and insulin; factor 3: TC, TG, LDL, and testosterone; and factor 4: FPG, testosterone, and estrogen. These four factors cumulatively explained 72.97% of the total phenotypic variation. In postmenopausal women, the four factors identified were factor 1: TC, TG, HDL, LDL, and DBP; factor 2: FPG, SBP, and DBP; factor 3: WC, SF4, and IVF; and factor 4: FPG, insulin, testosterone, and estrogen. These four factors together explained 90.71% of the total phenotypic variation in cardiometabolic risk factors. Conclusions: No common underlying physiological variables in premenopausal and postmenopausal women indicate that a single risk axis for clustering of cardiometabolic phenotypes is highly unlikely.

Synergistic effects of ACE (I/D) and ApoE (HhaI) gene polymorphisms among the adult Asian Indians with and without metabolic syndrome

A total of 350 (184 males and 166 females) adults participated in the study. A sample of 138 individuals was selected randomly for genotyping. The synergistic effect of ACE (I/D) and ApoE (HhaI) on metabolic syndrome (MS) showed that individuals with e4/4+D/D combination had the highest occurrence of metabolic abnormalities.

Apolipoprotein E gene polymorphism and dyslipidaemia in adult Asian Indians: A population based study from Calcutta, India.

AIM: The study was aimed to determine the association of Apolipoprotein E (apo E) gene polymorphisms on lipid levels in Asian Indian population. METHODS: A total of 350 (184 males and 166 females) adult (30 years and above) Asian Indians of Calcutta and suburb participated in the study. Anthropometric measures, lipids profiles, and blood glucose measures were collected. Out of 350 subjects, a sample of 70 individuals was selected randomly for genotyping after adjusting for age and sex. The apo E gene polymorphisms were determined by agarose gel electrophoresis. RESULTS: The apo E polymorphism showed significant association with dyslipidaemia (P=0.0135) with ε3/4 combination has had the highest occurrence of dyslipidaemia and metabolic syndrome (MS) followed by ε4/4 <ε3/3 <ε2/4 <ε2/3 in decreasing order. CONCLUSIONS: The ε4 allele of apo E gene independent of other risk factors is associated with dyslipidaemia in particular with low HDLc and high TC: HDLc ratio.

Factor analysis of risk variables associated with metabolic syndrome in adult Asian Indians

Background: Several studies hinted about the clustering of risk variables of the metabolic syndrome (MS) and suggested that the underlying genetic polymorphisms could be responsible for the increasing incidence of coronary heart disease (CHD) in people of Indian origin. Therefore, identification of the components of the MS along with the genetic factors could be one of the aspects to make an attempt to prevent the increasing incidence of CHD. Materials and Methods: Principal component factor analysis (PCFA) was undertaken to identify the components or factors of the MS among the adult (≥30 years) Asian Indians living in and around Calcutta, India. The study comprised 350 adult Asian Indians. Anthropometric measurements were taken, and lipid profiles, blood pressure and fasting blood glucose were measured for each participant. Two genetic polymorphisms, namely, angiotensin converting enzyme (ACE) gene polymorphism (insertion/deletion [I/D]) or ACE (I/D) and apolipoproteinE (Hha I) were also studied. Results: PCFA revealed 3 factors that cumulatively explained 65.39% of the observed variance of the MS by measured variables. The 3 factors identified were lipids and lipoprotein (Factor 1), centripetal fat and blood pressure (Factor 2), and ACE (I/D) polymorphism with blood pressure (Factor 3). Moreover, the first 2 factors, that is, lipids, lipoprotein, centripetal fat, and blood pressures cumulatively explained ~46% (45.94%) of the observed variance of MS in this population. Conclusions: Since more than 1 factor was identified for the MS phenotype, more than 1 physiogenetic mechanism could be accounted for MS in the Asian Indian population.

Interaction of physical activity level and metabolic syndrome among the adult Asian Indians living in Calcutta, India.

ObjectivesThe present community-based cross-sectional study was aimed to study the interaction of physical activity level (PAL) and metabolic syndrome (MS) among the adult Asian Indians.MethodsA total of 448 adult (> 30 years) individuals (males and females) inhabiting in and around Calcutta, India participated in the study. Anthropometric measures, blood pressure, metabolic profiles and intake of dietary fatty acids were obtained from participants using standard guidelines. Metabolic syndrome (MS) was defined accordingly. The dietary intake (gram/week) of fatty acids namely total fat (TFA); saturated fatty acids (SFA); monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA) were obtained using nutritive values of Indian foodstuffs. Physical activity level (PAL) was categorized in to three different level: 1) high PAL — who exercised regularly and had physically demanding occupation 2) moderate PAL — who either exercised regularly or had physically demanding occupation, and 3) low PAL — who neither exercised regularly nor had physically demanding occupation.ResultsThe prevalence of MS was found to be inversely related with PAL. Individuals with low PAL had higher prevalence of MS as compared to their counterparts. Moreover individuals with low PAL had significantly higher BMI, WC, WHR as well as TFA and SFA than individuals with moderate and high PAL.ConclusionPAL is playing a vital role in the constellation of risk factors associated with MS. Habitual physical activity may be beneficial to prevent growing incidence of MS phenotypes in people of Asian Indian origin.