Metabolic Syndrome and Obesity
- For the same level of Body Mass Index (BMI), Asian Indians have significantly high body fat percentage which is mainly distributed in the abdomen area (best measured clinically by waist circumference), compared to whites.
- As a result, they develop insulin resistance (resistance to insulin-stimulated glucose uptake and to insulin suppression of free fatty acid levels); at much lower level of BMI and waist circumference than whites. The clinical expression of insulin resistance is metabolic syndrome (MS) and is commonly observed in South Asian patients with coronary artery disease (CAD) or diabetes.1-3
- The prevalence of MS increases from 10% at age 20 to 29 years to 53% by age 60 years among Indians, which may be related to increase in bodyweight and fat mass.4
- MS develops even among Indians with healthy weight and increases exponentially with the increase in BMI. In CURES, the prevalence of MS was 18% among those with a healthy BMI (18.5-22.9); 40% among overweight participants (BMI 23–24.9); and 53% among those who were obese (BMI 25–29.9).5
- Although the waist circumference (WC) is the classical component of MS, several studies have substituted appropriate BMI cut points, especially when the WC is not available. Among Asian Indians, the prevalence of MS increased with increasing BMI.6 Thus, the prevalence of metabolic syndrome is double that of whites at every BMI category as shown in Figure 012.
1. Enas EA, Mohan V, Deepa M, Farooq S, Pazhoor S, Chennikkara H. The metabolic syndrome and dyslipidemia among Asian Indians: a population with high rates of diabetes and premature coronary artery disease. Journal of the cardiometabolic syndrome. Fall 2007;2(4):267-275.
2. Gholap N, Davies M, Patel K, Sattar N, Khunti K. Type 2 diabetes and cardiovascular disease in South Asians. Prim Care Diabetes. Sep 23 2010.
3. Deepa R, Sandeep S, Mohan V. Abdominal obesity, viceral fat, and type 2 diabetes- “Asian Indian Phenotype”. In: Mohan V, Gundu Rao, eds. Type 2 diabetes in South Asians; Epidemiology , Risk factors and Prevention. New Delhi: Jaypee Medical Publishers; 2006:138-152.
4. Misra R, Patel T, Kotha P, et al. Prevalence of diabetes, metabolic syndrome, and cardiovascular risk factors in US Asian Indians: results from a national study. Journal of diabetes and its complications. Mar 18 2009.
5. Deepa M, Farooq S, Datta M, Deepa R, Mohan V. Prevalence of metabolic syndrome using WHO, ATPIII and IDF definitions in Asian Indians: the Chennai Urban Rural Epidemiology Study (CURES-34). Diabetes/metabolism research and reviews. Feb 2007;23(2):127-134.
6. Palaniappan L P, Wong EC, Shin JJ, Fortmann SP, Lauderdale DS. Asian Americans have greater prevalence of metabolic syndrome despite lower body mass index. International journal of obesity (2005). Aug 3 2010.