Prevalence and risks of hypertension among Indian tribes and its status among the lean and underweight individuals.

OBJECTIVE: With the increased worldwide prevalence of hypertension among the underprivileged populations, fewerstudies have reported such risks among Indian tribes. In the context of high prevalence of undernutrition, no such study has examined hypertension among lean and underweight Indian tribal individuals separately. METHODS: We selected total samples of 1066 adult males and 1090 adult females in 20-60 years age-group cross-sectionally to examine the status of hypertension and its risks among nine major tribes in three Indian states; separate analyses for lean and underweight tribal individuals were done. RESULTS: Increased prevalence of hypertension (females, 14.2%; males, 9.3%) was observed among the tribes with the overall percentage of individuals at adversity (hypertensive + isolated hypertensive) at more than 20% (males 20.1%; females 26.5%). Age-group-wise prevalence showed a sharp rise in the prevalence of hypertension in the 40 + year individuals; additionally, this rise was alarming among females. Undernutrition was observed to be a potential risk factor as a remarkable prevalence of hypertension was observed among the undernourished (approximately 9%) and lean tribal participants (12%). Underweight females were observed to be at higher risk. Tribal statuses were observed to be alarming than the national trends due to their very low average BMI along with high average SBP. A curvilinear prevalence of hypertension was observed while comparing through both the nutritional extremes. CONCLUSION: The increased prevalence and risks of hypertension in the background of lean and underweight status of Indian tribes indicates their epidemiological transition burdened with alarming cardio-metabolic health risks that warrant an early and consistent surveillance.

Comparing the ability of anthropometric indicators in determining the prevalence of hypertension among Indian tribes.

OBJECTIVE: We compared the ability of the selected anthropometric indicators to best predict the prevalence of hypertension among the Indian tribes. METHODS: A cross-sectional study was undertaken among 1431 adult participants (705 males and 726 females) between the ages of 20 and 60 years from six major tribes in India. Selected anthropometric indicators such as body mass index (BMI), waist-hip-ratio (WHR), waist-height-ratio (WHtR), percentage body fat (PBF), visceral fat (VF), minimum-waist-circumference (MWC) and sum-of-the-four skinfold thickness (SF4), along with the physiological parameters such as blood pressure were recorded. Discriminant analysis (DA) was performed to examine and compare the ability of the selected anthropometric indicators towards classifying hypertension among males, females and the total population. RESULTS: Significant independent association was observed for hypertension and similar conditions within gender and selected age-group categories. The overall hypertension prevalence among the studied tribes was observed at 12.6%. Standardized function coefficients (SFCs) in discriminant analysis revealed PBF(0.89, 0.36, and 0.76 for overall, males, and females respectively) as the most powerful discriminator of hypertension. In addition, visceral fat (0.74, 1.46, and 0.58 for overall, males and females respectively) was observed to be the other significant indicator of hypertensive blood pressure. These exploratory findings for the first time indicate fat deposition, rather than body density alone, as an emerging physiological and metabolic risk among Indian tribes. CONCLUSION: In the context of the highly prevalent chronic undernutrition, internal fat deposition is a major classifying factor of physiological and metabolic intolerance. It also indicates the increasing trend in lifestyle changes and the associated adversities among the Indian tribes.

Gender Disparities in the Prevalence of Undernutrition and the Higher Risk among the Young Women of Indian Tribes.

BACKGROUND: High undernutrition is a grave concern in India. Marginalized populations like Indian tribes have been under the serious stress of such nutritional extreme. Women, in particular, are the worst sufferers. Gender-related comprehensive studies regarding the prevalence and risks of undernutrition among the tribes have not been properly pursued in India; the vulnerability of the young females has least been examined. METHODS AND FINDINGS: We conducted a cross-sectional study during January 2011 to December 2013 among 1066 males and 1090 females (n = 2156) in the 20-60 years age group belonging to the nine major tribes; Santals, Oraons and Koras (West Bengal): Santals, Bhumijs and Bathudis (Odisha): Dhodias, Kuknas and Chaudharis (Gujarat). The undernutrition burden was estimated and such risks were analyzed for the women in comparison to the men. The overall undernutrition among the females was found to be 47.4% (95% CI 44.4-50.4) against 32.1% (95% CI 29.3-34.9) among males, indicating about a half of the female population undernourished. The odds of risks for underweight status among females were observed to be high in comparison to males with an odds of 1.9 (95% CI, 1.6-2.2; p≤0.001) for the overall undernutrition category, 1.7 (95% CI, 1.3-2.3; p≤0.001) for the mild undernutrition category, 1.3 (95% CI, 1.1-1.6; p≤0.01) for combined moderate and mild undernutrition category and 3.3 (95% CI at 2.3-4.6; p≤0.001) for severe undernutrition category. The young females were observed with a high prevalence of undernutrition along with increased risk. The 30-year mean BMI trend of the Indian population in comparison to the males, females, and overall tribal population places the tribal females at the highest risk. CONCLUSION: Indian tribes are suffering from the higher prevalence of undernutrition by further highlighting a high gender bias. The health and empowerment of adolescent and young tribal girls needs additional focus. Overall, no remarkable control on undernutrition has been achieved among Indian tribes despite various efforts.

Triple Burden of Obesity, Undernutrition, and Cardiovascular Disease Risk among Indian Tribes.

BACKGROUND: Socio-cultural transitions among individuals from vulnerable groups introduce epidemiological transition, with a concomitant increase in the prevalence of undernutrition, obesity, and cardiovascular disease risks. An accepted conventional wisdom exists for Indian tribes that they are undernourished and away from lifestyle-related diseases. However, the extent of this triple burden affecting them is unknown. In this study, we assessed this triple burden among the 9 major tribes of India. METHODS AND FINDINGS: During January 2011 to December 2013, we conducted a cross-sectional study among 1066 men and 1090 women constituting a total of 2156 adults belonging to the 9 major tribal groups: Santals, Oraons, and Koras (West Bengal); Santals, Bhumijs, and Bathudis (Odisha); and Dhodias, Kuknas, and Chaudharis (Gujarat) to estimate the prevalence of the triple burden (undernutrition, overweight or obesity, and hypertension). A high prevalence of undernutrition and hypertension was observed among the Koras (51.9%and 10.6%, respectively), Bathudis (51.3% and 12.1%, respectively), and Oraons (49.6% and 16.5%, respectively). However, the prevalence of overweight and hypertension among the Bhumijs (17.7% and 14.7%, respectively), Dhodias (23.8% and 12.9%, respectively), Kuknas (15.8% and 11.3%, respectively), and Santals of West Bengal (12.2% and 11.8%, respectively) and Odisha (15% and 9.6%, respectively) was most alarming. The prevalence of overweight or obesity among the women was 10.9% and 1.5%, respectively, with 14.0% hypertensive women. The prevalence of overweight and obesity among the men was 14.8% and 1.7%, respectively, with 9.2% hypertensive men. Undernutrition was highly prevalent among men and women. However, data from the past 30 years on systolic blood pressure (SBP) and body mass index (BMI) revealed that the studied tribes were at a higher risk than the general Indian population. In addition, a vast gender disparity with relation to the disease and risk prevalence was observed. CONCLUSION: The alarming trend of an increasing prevalence of overweight/obesity, undernutrition, and hypertension is observed among indigenous populations of India, emphasizing the incorporation of a specific health management policy.