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VOLUME 13 NUMBER 1 • JULY 2016
37
SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
Prevalence of the metabolic syndrome in people of Asian
Indian origin: outcomes by definitions
M DAS, S PAL, A GHOSH
Correspondence to: Dr A Ghosh
Biomedical Research Laboratory, Department of Anthropology, Visva Bharati
University, Santiniketan, West Bengal, India
e-mail:
arnab_cu@rediffmail.comM Das
Department of Anthropology, Sree Chaitanya College, Habra, West Bengal,
India
S Pal
Human Genetic Engineering Research Centre, Calcutta, India
Previously published in
Cardiovasc J Afr
2011;
22
(6): 303–305
S Afr J Diabetes Vasc Dis
2016;
13
: 37–39
Abstract
Background:
The prevalence of the metabolic syndrome
(MS) is high among south Asian Indians. In order to better
comprehend the MS, its definition and modifications require
region-specific cut-off values and common minimum criteria
for people of Indian origin.
Methods:
To define the MS, the criteria as defined in the
National Cholesterol Education Program (NCEP): expert
panel on detection, evaluation, and treatment of high blood
cholesterol in adults (Adult Treatment Panel III) (ATP III 2001),
followed by the modified ATP III of 2005 were used, along
with a modified version specific to the people of south Asian
origin (ATP III SAS, 2009).
Results:
Thethreedefinitionsshoweddifferencesinprevalence
of the MS among the adult Asian Indians. According to the
criteria of NCEP ATP III 2001, the prevalence was found to
be 32.3%. Using the modified ATP III 2005, the prevalence
was 48.3%, and for south Asian-specific (SAS) ATP III, it was
31.4%. For all three definitions, females had a considerably
higher prevalence of the MS than males. It was also observed
that that a large number of individuals were misclassified
due to lack of common minimum criteria.
Conclusion:
In order to curb the growing threat of the MS,
and to aid clinical management among people of Indian
origin, a more comprehensive definition of the MS is urgently
required.
Keywords:
obesity, metabolic syndrome, CVD, diabetes, Asian
Indians
Introduction
People of Indian origin are ethnically a particularly vulnerable group
from the standpoint of metabolic abnormalities. Throughout the
Asia–Pacific region, there are differences in the prevalence of
obesity and metabolic disturbances. South Asians (e.g. Indians)
have a more centralised distribution of body fat and a markedly
higher mean waist–hip ratio (WHR) for a given level of body mass
index (BMI) compared to Europeans. In Asian populations, morbidity
and mortality is occurring in people with lower BMI and smaller
waist circumference (WC). Therefore they tend to accumulate intra-
abdominal fat without developing generalised obesity.
1,2
The metabolic syndrome (MS), which can be defined as the
constellation of cardiovascular disease (CVD) risk factors, is one
of the growing public health burdens in the Asia–Pacific region,
although the populations are no more overweight than Europeans
and Americans.
1
The MS is a phenotype and therefore is used
to identify subjects with a high risk, based on easily measurable
biological variables. However, it lacks some critical variables, which
are population specific, in order to better predict the population’s
risk. It therefore needs further validation among Asian Indians.
3,4
The present work was an attempt to study the prevalence of the
MS using different definitions of the MS in people of Indian origin.
Methods
The cross-sectional study comprised 350 adult Asian Indians (≥ 30
years) (184 males and 166 females) living in and around Calcutta,
India. Written consent was obtained from all participants. The
institutional ethical committee of the Human Genetic Engineering
Research Center (HGERC), Calcutta, India approved the study.
Written consent from participants was also obtained prior to actual
commencement of the study.
Anthropometric measures, namely height, weight and waist
circumference were obtained using standard techniques.
5
BMI (kg/
m
2
) was computed accordingly.
Left arm systolic (SBP) and diastolic (DBP) blood pressure
measurements were taken twice using a sphygmomanometer
and stethoscope and were averaged for the analyses. A third
measurement was taken only when the difference between the
two measurements was ≥ 5 mmHg. Prior medical records for blood
pressure were also taken into consideration.
A fasting blood sample (~7 ml) was collected from each subject
for the determination of metabolic profiles. All subjects maintained
an overnight fast of approximately 12 hours prior to blood collection.
The serum was separated by centrifugation within two hours of
collection. Determination of total cholesterol (TC), triglyceride
(TG), high-density lipoprotein (HDL) cholesterol and fasting blood
glucose (FBG) levels was carried out on the separated serum using
a semi-autoanalyser. Low-density lipoprotein (LDL) cholesterol was
then calculated using the standard formula:
LDL = TC – (HDL + TG/5).
All biochemical parameters were analysed at the HGERC and were
measured in mmol/l.
Definition of the metabolic syndrome
To define the metabolic syndrome, the criteria as set out in the
National Cholesterol Education Program (NCEP): expert panel on