Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for asian indians and recommendations for physical activity, medical and surgical management.

Asian Indians exhibit unique features of obesity; excess body fat, abdominal adiposity, increased subcutaneous and intra-abdominal fat, and deposition of fat in ectopic sites (liver, muscle, etc.). Obesity is a major driver for the widely prevalent metabolic syndrome and type 2 diabetes mellitus (T2DM) in Asian Indians in India and those residing in other countries. Based on percentage body fat and morbidity data, limits of normal BMI are narrower and lower in Asian Indians than in white Caucasians. In this consensus statement, we present revised guidelines for diagnosis of obesity, abdominal obesity, the metabolic syndrome, physical activity, and drug therapy and bariatric surgery for obesity in Asian Indians after consultations with experts from various regions of India belonging to the following medical disciplines; internal medicine, metabolic diseases, endocrinology, nutrition, cardiology, exercise physiology, sports medicine and bariatric surgery, and representing reputed medical institutions, hospitals, government funded research institutions, and policy making bodies. It is estimated that by application of these guidelines, additional 10-15% of Indian population would be labeled as overweight/obese and would require appropriate management. Application of these guidelines on countrywide basis is also likely to have a deceleration effect on the escalating problem of T2DM and cardiovascular disease. These guidelines could be revised in future as appropriate, after another large and countrywide consensus process. Till that time, these should be used by clinicians, researchers and policymakers dealing with obesity and related diseases. ©

Distribution and cutoff points of fasting insulin in Asian Indian adolescents and their association with metabolic syndrome.

AIM: To evaluate the levels and appropriate cutoff points of fasting insulin, and their association with the metabolic syndrome (MS) in Asian Indian adolescents. METHODS: This cross-sectional, population based study included 948 (527 males & 421 females) adolescent subjects aged 14-19 years selected randomly from New Delhi, India. Cutoff points of fasting insulin were defined using Receiver Operating Characteristics curve analysis against overweight, abdominal obesity and high subscapular skinfold thickness. The MS was defined according to NCEP, ATP III and IDF criteria using age-, gender- and ethnicity-specific cutoff points. RESULTS: Fasting insulin levels peaked at 16 y and reduced subsequently in both genders. The derived cutoff points for fasting insulin (pmol/L) were: 14-15 y- 128.5 and 164.8; 16-17 y- 126.1 and 152.8; 18-19 y- 121.2 and 162.4 in males and females, respectively. Prevalence of fasting hyperinsulinemia (39.1%) and MS (NCEP 2.2%, IDF 1.5%) was highest in age group 16-17 years. CONCLUSION: The data from this first study describing the distribution and cutoff points of fasting insulin in Asian Indian adolescents may be helpful for detection of and application of primary prevention strategies for fasting hyperinsulinemia and the metabolic syndrome in this population.

Comparison of definitions of the metabolic syndrome in adult Asian Indians.

OBJECTIVE: The optimum definition of the metabolic syndrome (MS) is not known. We compared international definitions of MS [recently proposed modified definition of National Cholesterol Education Programme, Adult Treatment Panel III (NCEP, ATP III) and International Diabetes Federation (IDF)] with two proposed candidate definitions in adult Asian Indians. DESIGN: Data from three previous cross-sectional studies carried out in North India were analyzed. SUBJECTS: The study included 2050 adult (mean age: 40 +/- 18 years) Asian Indian subjects residing two metropolitan cities. MEASUREMENTS: Candidate definitions of MS were proposed by modifying the NCEP, ATP III and IDF definitions by including the following modified variables into two combinations (MS-ATP1 and MS-IDF1); waist circumference cut-off points as >90 cm in males and >80 cm in females, body mass index (BMI) cut-off point as >23 kg/m2, impaired fasting glucose (IFG) cut-off point >100 mg/dl and waist circumference as an obligatory criterion. RESULTS: Maximum overall and gender-specific prevalence of the MS (49.2% overall; 41.4% in males; 55.3% in females) was observed using the definition which included modified cut-off points of WC (non-obligatory), BMI, and IFG (>100 mg/dl) in addition to other defining parameters. Compared to other definitions this proposed candidate definition maximally detected presence of MS in subjects with IFG and T2DM [Percentage prevalence: 78.1% (73.0-82.7) and 91.1% (84.2-95.6)]. Even in subjects without abdominal obesity, a high prevalence of other abnormal defining parameters of the metabolic syndrome; hypertension (> or = 130 or > or = 85 mmHg), 35.7%; BMI >23 kg/m2, 15.3%; hypertriglyceridemia (>150 mg/dl), 20.2% and low levels of HDL-C (<40 in males; <50 mg/dl in females), 55% were seen. Further, 10.5% of subjects who did not have abdominal obesity had presence of at least 3 risk variables of the metabolic syndrome. These data indicate that by making abdominal obesity a mandatory criterion would lead to missing of some cases of the metabolic syndrome. CONCLUSION: By including BMI and making waist circumference as a non-obligatory criterion, more cases of the metabolic syndrome is detected. For Asian Indians, making waist circumference as mandatory variable in the definition of the metabolic syndrome would lead to non-inclusion of nearly 11% cases who would otherwise be diagnosed as metabolic syndrome according to modified NCEP, ATP III definition.

Association between subclinical inflammation & fasting insulin in urban young adult north Indian males.

BACKGROUND & OBJECTIVES: Elevated levels of c-reactive protein (CRP) are known to be associated with insulin resistance and metabolic syndrome in adults. A substantial prevalence of hyperinsulinaemia and elevated CRP levels have been shown in Indian young adults. We therefore studied the association of serum high-sensitivity C-reactive protein (hs-CRP) with fasting insulin and insulin resistance in urban adolescent and young adult males in north India. METHODS: In this cross-sectional study 324 healthy males, 14-25 yr of age were selected randomly and their clinical and anthropometric profile [body mass index (BMI), waist and hip circumferences, waist-to-hip circumference ratio (W-HR), and skinfold thickness at four sites], percentage of body fat (%BF) and biochemical (fasting blood glucose, lipoprotein profile, fasting insulin and hs-CRP) parameters were recorded. Insulin resistance was assessed by the homeostasis model of assessment (HOMA-IR). RESULTS: Fasting insulin and hs-CRP levels correlated significantly with BMI, waist circumference, and triceps and subscapular skinfold thickness. Fasting insulin also correlated with %BF, and hs- CRP correlated with W-HR. No correlation was observed between hs-CRP and fasting insulin levels or insulin resistance. In multiple logistic regression analysis different independent risk factors for hyperinsulinaemia and elevated hs-CRP levels were observed; hypercholesterolaemia, overweight and high subscapular skinfold thickness for the former, and high triceps skinfold thickness for the latter. INTERPRETATION & CONCLUSION: Lack of correlation between hs-CRP and surrogate markers of insulin resistance and different risk factors for each, in young Indian males are unique observations of our study. Further studies on a larger sample of both genders need to be done to confirm these findings.

Dyslipidemia in Asian Indians: determinants and significance.

Data suggest that lipid fractions other than total cholesterol, i.e. serum triglycerides (TG) and high-density lipoprotein (HDL) cholesterol are important for the pathogenesis of atherosclerosis. A combination of hypertriglyceridemia, low levels of HDL-cholesterol and high levels of small dense low-density lipoprotein, termed as "atherogenic dyslipidemia', is particularly seen in Asian Indians. Although precise reason for such dyslipidemia is unknown, genetic predisposition and characteristic body composition (excess truncal subcutaneous fat and intraabdominal fat) may be important contributors. A common interface between such body composition and dyslipidemia in Asian Indians is high tendency to develop insulin resistance, more than the other ethnic groups. The general guidelines for the management of dyslipidemia in Asian Indians should be according to National Cholesterol Education Program, Adult Treatment Panel III. However, optimal management requires consideration of ethnic-specific dietary, lifestyle and management factors to formulate individual treatment guidelines.