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Misra A.,Center for Nutrition and Metabolic Research | Bhardwaj S.,National Diabetes | Bhardwaj S.,Center for Nutrition and Metabolic Research
Nestle Nutrition Institute Workshop Series | Year: 2015

There is an increased prevalence of obesity and the metabolic syndrome (MS) among South Asians. The phenotypes of obesity and body fat distribution are different in South Asians; they have high body fat, intra-abdominal and subcutaneous fat and fatty liver at a lower body mass index compared to white Caucasians; this has led to the frequent occurrence of morbidities related to a higher magnitude of adiposity [e.g. type 2 diabetes mellitus (T2DM), hypertension (HTN) and dyslipidemia]. The increasing prevalence of obesity and related diseases in the South Asian population requires aggressive lifestyle management including diet, physical activity and, sometimes, drugs. For therapeutic interventions, several drugs can be used either as mono- or combination therapy. Drugs like orlistat, which is used for the management of obesity, also reduce the risk of T2DM. Similarly, HMG CoA reductase inhibitors decrease low-density-lipoprotein cholesterol levels and reduce the risk of cardiovascular diseases. However, some drugs used for the treatment of HTN (e.g. β-blockers) may increase the risk of hyperglycemia and therefore need to be used with caution. Finally, to prevent obesity, MS and T2DM among South Asians, it is particularly important to effectively implement and strengthen population-based primary prevention strategies. © 2015 Nestec Ltd., Vevey/S. Karger AG, Basel. Source


Chopra S.M.,National Diabetes Obesity and Cholesterol Foundation N DOC | Chopra S.M.,Center for Nutrition and Metabolic Research | Misra A.,National Diabetes Obesity and Cholesterol Foundation N DOC | Misra A.,Center for Nutrition and Metabolic Research | And 3 more authors.
European Journal of Clinical Nutrition | Year: 2013

The prevalence of obesity is rising globally and in India. Overweight, obesity and related diseases need to be delineated in Asian Indian women. A literature search was done using key words like 'obesity', 'Asian Indian women', 'body fat distribution', 'type 2 diabetes', 'fertility', 'polycystic ovarian disease', metabolic syndrome', 'cardiovascular disease', 'non-alcoholic fatty liver disease', 'gender', 'sex' and 'prevalence' up to September 2012 in Pubmed and Google Scholar search engines. This review highlights the Asian Indian body composition with regards to obesity and provides a collated perspective of gender-specific prevalence of the co-morbidities. Recent data show that women (range of prevalence of overweight and obesity from different studies 15-61%) have higher prevalence of overweight and obesity as compared with men (range of prevalence of overweight and obesity from different studies 12-54%) in India and that obesity is increasing in the youth. The prevalence of overweight and obesity in both men and women steeply rose in a Punjabi community from Jaipur. Importantly, prevalence of abdominal obesity has been consistently higher in women than in men. The lowest prevalence (6.0%) of type 2 diabetes mellitus in women is reported from South India (rural Andhra Pradesh; 2006) and the highest (14.0%) by the National Urban Diabetes Survey (2001). Although the clustering of cardiovascular disease risk factors was generally high, it increased further in post-menopausal women. There are a number of factors that predispose Indian women to obesity; sedentary behaviour, imbalanced diets, sequential and additive postpartum weight gain and further decrease in physical activity during this period and cultural issues. In view of these data, preventive measures should be specifically targeted to Indian women. © 2013 Macmillan Publishers Limited All rights reserved. Source


Misra A.,Center for Nutrition and Metabolic Research | Bhardwaj S.,National Diabetes | Bhardwaj S.,Center for Nutrition and Metabolic Research
Nestle Nutrition Institute Workshop Series | Year: 2014

With improvement in the economic situation, an increasing prevalence of obesity and the metabolic syndrome is seen in developing countries in South Asia. Particularly vulnerable population groups include women and children, and intra-country and inter-country migrants. The main causes are increasing urbanization, nutrition transition, reduced physical activity, and genetic predisposition. Some evidence suggests that widely prevalent perinatal undernutrition and childhood 'catch-up' obesity may play a role in adult-onset metabolic syndrome and type 2 diabetes. Data show that atherogenic dyslipidemia, glucose intolerance, thrombotic tendency, subclinical inflammation, and endothelial dysfunction are higher in South Asians than white Caucasians. Many of these manifestations are more severe even at an early age in South Asians than white Caucasians. Metabolic and cardiovascular risks in South Asians are also heightened by their higher body fat, truncal subcutaneous fat, intra-abdominal fat, and ectopic fat deposition (liver fat, muscle fat, etc.). Further, cardiovascular risk cluster manifests at a lower level of adiposity and abdominal obesity. The cutoffs of body mass index and waist circumference for defining obesity and abdominal obesity, respectively, have been lowered for Asians, and same has been endorsed for South Asians in the UK. The economic cost of obesity and related diseases in developing countries, having meager health budget, is enormous. Increasing awareness of these noncommunicable diseases and how to prevent them should be focus of population-wide prevention strategies in South Asian developing countries. Community intervention programs focusing on increased physical activity and healthier food options for schoolchildren are urgently required. Data from such a major intervention program conducted by us on adolescent urban schoolchildren in north India (project MARG) have shown encouraging results and could serve as a model for initiating such programs in other South Asian developing countries. © 2014 Nestec Ltd., Vevey/S. Karger AG, Basel. Source


Gulati S.,National Diabetes | Gulati S.,Center for Nutrition and Metabolic Research | Misra A.,National Diabetes | Kondal D.,Public Health Foundation of India | And 8 more authors.
Annals of Nutrition and Metabolism | Year: 2013

Background: The prevalence of overweight and obesity among children is increasing in India. However, knowledge of, attitude towards and practice of health and nutrition in mothers and children have not been researched. Objective: To assess knowledge of, attitude towards and practice of nutrition, physical activity and other lifestyle practices in a nationally representative sample of urban children and mothers in India. Methods: A cross-sectional observational study of 1,800 children aged 9-18 years and their mothers, using qualitative (focus group) and quantitative (semi-structured survey) data. Results: The overall prevalence of overweight/obesity among the children was 19.2% in males and 18.1% in females; 64.8% of mothers were either overweight [body mass index (BMI) 23.0-24.9; 23.3%] or obese (BMI >25.0; 41.5%). Household family income, related socioeconomic factors, and overweight in mothers were most significantly associated with obesity in children (all p ≤ 0.001). Dietary consumption patterns (snacking, fast food etc.) showed a marked association between mothers and children (all p ≤ 0.000). Focus group discussion revealed several interesting attitudes and misconceptions among children ('home-cooked food is old fashioned') and mothers ('a child with chubby cheeks is healthy, not fat'). Importantly, only a few mothers understood that excess weight or diets are contributory factors of morbidities in children or themselves. Conclusions: This study highlights the poor knowledge, faulty attitudes and practices of urban Asian Indian mothers and their children in a highly correlated manner. These knowledge gaps must be addressed to formulate effective strategies for the prevention of obesity and related metabolic disorders. Copyright © 2013 S. Karger AG, Basel. Source

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