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BRITISH BIOMEDICAL BULLETIN

Original

Prevalence and Correlates of Hypertension & Diabetes among ≥ 18 Years Urban Population in India

Meshram II*1, Vishnu Vardhana Rao M2, Sudershan Rao V.3, Laxmaiah A.1 and Polasa K.3

1Division of Community Studies, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad-500007, India 2Division of Biostatistics, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad-500007, India 3Division of food & drug toxicology, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad-500007, India

A R T I C L E I N F O Received 24 Mar. 2015 Received in revised form 26 Mar. 2015 Accepted 03 Apr. 2015 Keywords: Diabetes, Hypertension, Dyslipidemia, Overweight/obesity, Socioeconomic groups. Corresponding author: Division of Community Studies, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad-500007, India. E-mail address: [email protected]

A B S T R A C T

Background: With epidemiological, demographic, lifestyle and nutrition transition, non-communicable diseases are increasing in India. The present study was carried out to assess prevalence of cardio-metabolic risk factors and correlates of hypertension and diabetes among urban population. Materials & Method: A community-based cross-sectional study was carried out in urban India, using multistage stratified random sampling Information on household’s socio-demographic particulars such as age, sex, education, occupation, income, etc was collected. Anthropometrics measurements such as height (cm), weight (kg), waist and hip circumference (cm), along with measurements of blood pressure, fasting blood sugar and lipid profile was carried out. Association was tested by using chi-square and logistic regression analysis was done. Results: The study showed that the prevalence of abdominal obesity, hypertension, diabetes and hyper triglyceridemia was 39%, 22%, 11.5% and 26% respectively among the urban population and was significantly higher among men as compared to women, although overweight/obesity was higher among women (48% Vs 29%). The prevalence was higher among high and middle income groups. The risk of hypertension and diabetes was significantly higher among men, middle aged & elderly (>59 years) and among overweight/obese. The risk of diabetes was significantly (p<0.01) lower among high and middle income groups as compared to slum dwellers. Conclusions: The prevalence of overweight/obesity and abdominal obesity was higher among high & middle income as compared to other socioeconomic groups. The risk of hypertension and diabetes was observed to be significantly associated with age, gender & overweight/obesity and also socioeconomic status. The information, education and communication (IEC) activities needs to be strengthened for control of these diseases.

Meshram et al___________________________________________________ ISSN-2347-5447

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© 2015 British Biomedical Bulletin. All rights reserved

Introduction

With Epidemiological, lifestyle and nutrition transition, non-communicable diseases such as hypertension, diabetes, cardiovascular diseases (CVDs) etc. are increasing in developing countries including India. Cardiovascular diseases caused about 9.1 million deaths in developing countries and 1.5 million deaths in India in the year 20001. It is estimated that by 2020, CVDs will be the largest cause of disability and appr. 2.6 million death among Indians2,3. Hypertension is important modifiable risk factors for cardiovascular disease and is the third major ‘killer’ disease accounting for one in every eight deaths worldwide4.

The World Health Organization (WHO) has estimated that globally about 62% of cerebrovascular diseases and 49% of ischemic heart diseases are attributable to suboptimal blood pressure (systolic > 115 mmHg), with little variation by sex4.

Hypertension is directly responsible for 57% deaths due to stroke and 24% deaths from coronary heart disease (CHD) in India.

As per Indian council of Medical research (ICMR) study, prevalence of hypertension was 16-24% among urban adults in different states in India5, while Midha et al reported 20-36% prevalence of hypertension6.

Diabetes mellitus (DM) is another important non-communicable disease. Globally, it is estimated that 382 million people are suffering from diabetes with a prevalence of 8.3%. North America and the Caribbean had the higher prevalence (11%), followed by the Middle East and North Africa (9.2%), Western Pacific regions (8.6%)7. Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in the more developed countries. However, it is predicted that the greatest increase will be in Asia and Africa by 2030.8 ICMR in 2009 reported 5-14%

prevalence of diabetes in urban Indian population in different states5.

This increase in prevalence of chronic non-communicable diseases in developing countries follows the trend of urbanization and lifestyle changes, most importantly a "Western-style" diet i.e. environmental (i.e., dietary) effect.

Overweight/obesity is important risk factor for chronic non-communicable diseases including type-2 diabetes, cardiovascular disease, hypertension and stroke, and certain forms of cancer9 and is an emerging problem in Asian countries including India. Globally, there are more than 1 billion overweight adults, at least 300 million of them obese.

The present study was carried out by National Institute of Nutrition (NIN), Hyderabad to assess consumption of processed and non-processed food along with the prevalence of overweight/obesity, hypertension and diabetes among urban population in 10 States of India during 2010-11. The information related to overweight/obesity, hypertension and diabetes among urban population ≥18 years is presented in this communication.

Materials and Methods

The study was approved by the Scientific Advisory Committee, and Institutional Ethical Review Board, National Institute of Nutrition (NIN), Hyderabad (IEC No. 05/2009). Written informed consent was obtained from each subjects involved in the study. Sampling design and frame

It was a community-based, cross-sectional study, carried out by adopting multistage stratified random sampling method.


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Sample size calculation

For hypertension Earlier studies have reported 20-36%

prevalence of hypertension among urban adults of ≥18 years6. Assuming the minimum level of prevalence of hypertension among urban adults (20%), with 95% confidence interval, 5% absolute precision, design effect of 1.5, the sample size required was 369~370 adults in each gender for each socio-economic group (i.e. 740 x 5=3700).

Diabetes mellitus

Fasting blood sugar level was estimated on alternate individual i.e. 2000 subjects.

Lipid profile estimation

Serum lipid level was estimated on sub sample of subjects.

Selection of States and cities

Two states were selected randomly from each region in India and state capital was selected for study. Study was carried out in five socio-economic strata viz., High Income Group (HIG), Middle Income Group (MIG), Low Income Group (LIG), Slum dwellers and Industrial Labours (IL). (See figure 4.) Selection of HHs

In order to get the required sample of 3700 subjects, considering 2.5 adults in each HHs, a total of 1500 HHs were covered. From each socio-economic group, 30 households were selected randomly. Thus a total of 150 HHs were covered from each city and thus 1500 HHs from 10 cities. Data collection

The data was collected by a 5 teams consisting of Nutritionist, Research Assistant and Laboratory technician, recruited from local areas and were trained

in survey methodology at National Institute of Nutrition, Hyderabad. The data was collected from the selected HHs on socio-demographic and economic particulars such as age, sex, community, education, income and occupation etc. of individuals. Anthropometric measurements were carried out using standard equipments and procedure.10 Weight (nearest of 0.1kg) was measured with SECA weighing scale, and height (nearest of 0.1cm) with anthropometer rod. Waist and hip circumference was measured on all the adults covered for anthropometry using fibre reinforced non-elastic tape.11 Waist circumference was measured at a point midway between lower rib margin and iliac crest. Three measurements of blood pressure (BP) at 5 minute interval in sitting position using OMRON digital BP Apparatus (HEM-7080 model) were taken on all the individual ≥18 years of age and average of three readings was used. Fasting blood glucose levels were estimated in a sub-sample by using one touch glucometers (Accu-Chek Active) and lipid levels were estimated using Cholestech LDX equipment.

Data analysis

The data was scrutinized, cleaned and entered into the computers at the National Institute of Nutrition, Hyderabad. The data was analyzed using SPSS version 17.0. Mean ±SD, Proportion test, bivariate and multiple regression analysis was carried out to know the important risk factors associated with hypertension and diabetes.

Individual with systolic blood pressure (SBP) 140 mmHg and/or diastolic blood pressure (DBP) 90 mmHg and/or currently on treatment for hypertension were categorized as hypertensive12.

Fasting blood sugar level of <110 mg/dl was considered as normal, 110-125 mg/dl as impaired fasting glucose and ≥126 mg/dl as diabetes13,14. Body mass index


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(BMI) was calculated as weight (kg)/[ht. (mt)2]. Individuals with BMI of <18.5 were classified as ‘chronic energy deficiency’ (CED), BMI between 18.5-22.99 as ‘normal’ and BMI≥ 23-27.49 as ‘overweight’ and ≥ 27.5 as ‘obese’15.

Individuals with waist circumference of ≥90 cm for men and ≥ 80 cm for women were considered cut off points for defining an abdominal obesity as per Asian cut off.

Individuals with waist to hip ratio (WHR) of ≥0.90 for men and ≥0.80 for women were considered as cut off points for central obesity16. Dyslipidemia

National Cholesterol Education Programme guidelines were used for definitions of dyslipidemia17.

Hypercholesterolemia

Serum cholesterol levels ≥200 mg/dl (≥5.2 mmol/liter).

Hypertriglyceridemia

Serum triglyceride levels ≥150 mg/dl (≥1.7 mmol/liter).

High-Density lipoprotein cholesterol

High-density lipoprotein cholesterol levels <40 mg/dl (<1.04 mmol/liter) for men and <50 mg/dl (<1.3 mmol/liter) for women.

Results

Coverage A total of 4295 individuals (Men:

2150; Women: 2147), with mean age: 38.9 ±15 years were covered. Blood pressure measurement was available for 3462, with mean systolic BP: 123.2 ± 16.9 mmHg; and mean diastolic: 80.5 ±15.1mmHg. Fasting blood sugar was available for 1840 individuals with mean blood sugar 104.5 ±40.1mg/dL. Mean waist circumference was 81.1± 12.2 and mean hip circumference was 91.6±10. Lipid profile such as serum

triglycerides, HDL cholesterol and cholesterol were available for 570, 319, and 323 subjects (Table 1).

Prevalence of cardio-metabolic risk factors-by gender

The overall prevalence of overweight/obesity, abdominal and central obesity was 52%, 39% and 70% respectively, while that of hypertension, and diabetes was 22%, and 11% respectively. The prevalence of hypercholesterolemia, Low HDL and hyper-triglyceridemia was 14%, 87% and 26% respectively. The prevalence of overweight/obesity, abdominal and central obesity and dyslipidemia was significantly higher among women as compared to men, while that of hypertension and diabetes was higher among men (Fig. 1 & Fig. 2).

Prevalence of cardio-metabolic risk factors by socio-economic groups

The prevalence of overweight/ obesity and abdominal obesity was higher among HIG (63.2% & 46.4% respectively) and MIG (57.3% & 43.3% respectively) and lowest among Slum dwellers (38% & 29.3% respectively).

Similarly, the prevalence of hypertension was significantly (p<0.01) higher among HIG and MIG group (25% each) and lower among slum dwellers (17.7%). The prevalence of diabetes was significantly (p<0.01) higher among slum dwellers (12.7%) and industrial labours (11.7%) and lower among LIG (10.2%). The prevalence of dyslipidemia i.e. hypercholesterolemia and triglyceridemia was higher among HIG (20% & 39%) and MIG (17% & 26%), as compared to LIG (16% & 21%) (Fig. 3, Table 2).


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Association of obesity, hypertension, and diabetes with socio-demographic variables

The prevalence of overweight/ obesity, and abdominal obesity was significantly (p<0.01) higher among middle aged and elderly, among women, among literate and those engaged in service and business. The prevalence was observed to be significantly (p<0.01) higher among elderly as compared to younger subjects. The prevalence of hypertension and diabetes was significantly (p<0.01) higher among elderly, among men, among those engaged in service and business (Table 3).

Logistic regression analysis for hypertension and diabetes

Multiple logistic regression analysis showed that the risk of hypertension was 1.6 times higher among men (CI=1.36-2.00) as compared to women and 7 times (OR 7.3, CI=5.51-9.67) higher among elderly as compared to 18-39 years subjects (Table 4).

Overweight/obesity (BMI≥23) had 2.4 times (2.35, CI= 1.48-3.72), abdominal obesity had 1.4 times (CI=1.04-1.73), while central obesity had 1.5 times higher risk of hypertension (CI=1.12-1.93).

Similarly, the risk of diabetes was 1.8 times higher among men (CI=1.28-2.48) as compared to women and 12 times (OR 12.2, 7.19-20.67) higher among elderly as compared to 18-39 years subjects. The risk of diabetes was significantly lower among HIG (OR: 0.43, 0.25-0.72) and MIG (OR: 0.50, 0.31-0.82) as compared to slum dwellers.

Abdominal obesity had 2.4 times (CI=1.67-3.45) higher risk of diabetes as compared to normal subjects (Table 4).

Discussions

This is the first study carried out by NIN from 10 major cities of India in different socioeconomic groups. The study revealed that the prevalence of obesity

(abdominal and central) as well as hypertension was higher among subjects from HIG and MIG as compared to slum dwellers. Also the prevalence of hypertension, diabetes and dyslipidemia was higher among men, although prevalence of obesity was higher among women. The study also showed that the risk of hypertension was higher among middle aged and elderly, among men and among obese, while the risk of diabetes was higher among elderly, among men and with abdominal obesity.

Study carried out by ICMR in 7 different states in India showed that the prevalence of overweight and obesity in urban areas ranged from 11.5% in Mizoram to 30-32% in Andhra Pradesh, Tamil Nadu and Kerala.5 Sen et al reported 33% and 50% prevalence of overweight/obesity among men & women respectively in urban areas of Jalpaiguri, West Bengal.18. Mungrephy and Kapoor reported 27% prevalence of overweight and obesity among Tangkhul Naga women from North Eastern state19.

ICMR task force study carried out in 7 states observed 16% prevalence of hypertension in Andhra Pradesh, 18% in Maharashtra, 19% in Mizoram & Kerala, 20% in Tamil Nadu, 23% in Uttarakhand and 24% Madhya Pradesh5.

Gupta et al reported the highest prevalence of hypertension (48.2%) in a recent multi-centric study, conducted in the urban population of India20.

Prabhakaran et al in their study among urban population of Nellore, Andhra Pradesh reported 29.3% prevalence of hypertension21. Chakraborty et al. observed lower prevalence of hypertension (17.6%) among 18-60 years slum dwellers in Bengalee slum population22.

A study by ICMR conducted in 3 states and 1 union territory (UT) in urban and rural areas, showed that the prevalence


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of diabetes in adults ≥20 years was 10.4% in Tamil Nadu, 8.4% in Maharashtra, 5.3% in Jharkhand and 13.6% in Chandigarh23. Gupta et al reported that the prevalence of diabetes varies from 5.4% in a northern state to a high of 12.3–15.5% in Chennai, South India, and 12.3–16.8% in Jaipur, Central India24.

Higher risk of hypertension and diabetes among men, although overweight/ obesity is more among women, is mostly due to greater exposure of other risk factors such as environmental and behavioural risk factors among men. This is attributed to high prevalence of overweight/obesity among HIG and MIG due to sedentary lifestyle, consumption of fatty food and less of physical activity.

High prevalence of diabetes among industrial workers and slum dwellers, despite of low prevalence of overweight/ obesity and low fat intake may be attributed to other behavioural risk factors such as smoking and alcohol consumption.

Joshi et al in their study among urban population reported 19% hypercholes-terolemia, 37% hypertriglyceridemia, 73% low HDL-C, and 16% high LDL-C in India25. Similar findings are also reported by others26. A study among Asian Indian immigrants in the United States (n = 1038), reported a prevalence of hypercholes-terolemia of 43.5%, hypertriglyceridemia of 42.3%, low HDL-C of 26.4% and high LDL-C of 41.4%27.

It is concluded that the prevalence of overweight/obesity and abdominal obesity was higher among HIG & MIG as compared to other socioeconomic groups. The risk of hypertension was higher among men, among overweight/obese and with abdominal & central obesity, while diabetes was higher among elderly, men, among slum dwellers and with abdominal obesity. There is a urgent need to initiate programmes focussing on lifestyle, and dietary

modification to control increasing burden on non-communicable diseases. Limitation

We have not assessed the family history of hypertension and diabetes mellitus. Also use of tobacco in any form and alcohol consumption was not assessed. Industrial labour and slum dwellers were not covered in North eastern region as it may not be available. Contribution

All the authors were involved in study design, concept and methods. Author 1 prepare manuscript, author 2 carried out statistical analyses, All other critically reviewed the article before final submission. Acknowledgement

The authors are grateful to Shri P.I. Suvrathan, Chairperson and Shri VN Gaur, CEO, the Food Safety and Standards Authority of India, Ministry of Health and Family Welfare, Government of India, for commissioning and financial support. We are also thankful to Dr. VM Katoch, Director General and Secretary, Department of Health Research, Ministry of Health and Family Welfare, Government of India, for his support and encouragement. We are also thankful to our Ex-Director, Dr Sesikeran, for his valuable support and guidance during the survey. We are thankful to all Regional Coordinators, Project and Technical, Administrative, Secretarial, Supportive staff of FDTRC and Division of Community Studies, National Institute of Nutrition, ICMR, Hyderabad. We are also thankful to the entire field staff involved in data collection and also the participants involved in this study.


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References 1. World Health Organization. Obesity:

preventing and managing the global epidemic. Report of a WHO Consultation. World Health Organ 2000, Tech Rep Ser. 894:i-xii, 1-253.

2. Goenka S, Prabhakaran D, Ajay VS, Reddy KS. Preventing cardiovascular disease in India-translating evidence to action. Current Science. 2009; 97:367–77.

3. Reddy KS, Prabhakaran D, Chaturvedi V, Jeemon P, Thankappan KR, Ramakrishnan L et al. Methods for establishing a surveillance system for cardiovascular diseases in Indian industrial populations. Bull World Health Organ. 2006; 84:461–9.

4. World Health Organization. World Health Report. Reducing Risks, Promoting Healthy Life. World Health Organ, Geneva, Switzerland, 2002. Chapter 4, p-12. Available from: http://www.who.int/whr/ 2002/en/whr02_ch4.pdf. Last accessed April 24, 2013.

5. National Institute of Medical Statistics, Indian Council of Medical Research (ICMR). IDSP Non-Communicable Disease Risk Factors Survey, Phase-I States of India, 2007-08. National Institute of Medical Statistics and Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India, 2009.

6. Midha T, Bhola N, Kumari R, Rao YK, Pandey U. Prevalence of hypertension in India: A meta-analysis. World J Meta-Anal. 2013; 26: 83-89.

7. International Diabetes Federation Diabetes Atlas Sixth edition, 2013.

8. Wild S, Roglic G, Green A, Sicree R, King H. "Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030". Diabetes Care. 2004; 27 (5): 1047–53.

9. Rodgers A, Lawes C, MacMahon S. Reducing the global burden of blood pressure- related cardiovascular disease. J Hypertens Suppl. 2000; 18:S3–6.

10. Jelliffee DB, Jelliffee EP. Community nutritional assessment. Oxford, Oxford University Press, 1989.

11. World Health Organization. Measuring obesity: classification and description of anthropometric data. Copenhagen: WHO. 1989. (Nutr UD, EUR/ICP/NUT 125).

12. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003; 289:2560-72.

13. World Health Organization; International Diabetes Federation. Geneva: World Health Organization; Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation, 2006.

14. Indian Council of Medical Research (ICMR) - WHO Guidelines for measurement of Type 2 diabetes, ICMR, 2003.

15. WHO Expert Consultation. Appropriate body - mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363: 157-63

16. World Health Organization, International Association for the Study of Obesity, International Obesity Task Force. The Asia-Pacific Perspective: Redefining obesity and its treatment. Sydney: Health Communications, 2000.

17. National Institute of Health; National Heart, Lung and Blood Institute; 2002. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in adults (Adult Treatment Panel III) Final Report. Publication No. 02-5215. September 2002.

18. Sen J, Mondal N, Dutta S. Factors affecting overweight and obesity among urban adults: a cross-sectional study. Epidem Bioststat Public Health. 2013; 10:8741-11.

19. Mungreiphy NK, Kapoor S. Socioeconomic changes as covariates of overweight and obesity among Tangkhul Naga tribal women of Manipur, north-east India. J Biosoc Sci. 2010. 42:289-305

20. Gupta R, Pandey RM, Misra A, Agrawal A, Misra P, Dey S, et al. High prevalence and low awareness, treatment and control of


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hypertension in Asian Indian women. J Hum Hypertens. 2012; 26:585-93.

21. Prabakaran J, Vijayalakshmi N, Ananthaiah Chetty N. Risk Factors of Non-Communicable Diseases in an Urban Locality of Andhra Pradesh. Nat J Res Com Med. 2013; 2:28–32.

22. Chakraborty R, Bose K, Kozieł S. Waist circumference in determining obesity and hypertension among 18-60 years old Bengalee Hindu male slum dwellers in Eastern India. Ann Hum Biol. 2011; 38: 669-675.

23. Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study. Diabetologia. 2011; 54:3022–7.

24. Gupta R, Mishra A. Type 2 diabetes in India: regional disparities. Br J Diabetes Vasc Dis. 2007; 7:12–16.

25. Joshi SR, Anjana RM, Deepa M, Pradeepa R, Bhansali A, et al. Prevalence of Dyslipidemia in Urban and Rural India: The ICMR–INDIAB Study. PLoS ONE. 2014; 9(5): e96808.

26. Sharma U, Kishore J, Garg A, Anand T, Chakraborty M, et al. Dyslipidemia and associated risk factors in a resettlement colony of Delhi. J Clin Lipidol. 2013; 7: 653–60

27. Misra R, Patel T, Kotha P, Raji A, Ganda O, et al. Prevalence of diabetes, metabolic syndrome, and cardiovascular risk factors in US Asian Indians: results from a national study. J Diabetes Complications. 2010; 24: 145–153.

Table 1. Mean± standard deviation (SD) of anthropometric & blood pressure measurements,

fasting blood sugar and lipid profile

Particulars N Mean (SD)

Height 3563 157.6 (9.3)

Weight 3571 59.0 (12.9)

BMI 3558 23.6 (4.5)

Waist circumference 3503 81.4 (18.5)

Hip circumference 3491 92.0 (21.9)

BP -Systolic 3469 123.2 (16.9)

BP-Diastolic 3466 80.5 (15.1)

Fasting blood sugar 1849 104.7 (40.1)

Lipid profile

Ser. cholesterol 323 165.2 (34.4)

Ser. Triglycerides 570 129.8 (69.2)

Ser. HDL 319 33.2 (15.3)

Ser. VLDL 282 111.1 (55.0)

BMI-body mass index, BP-blood pressure, HDL-high density lipoproteins, VLDL- very low density lipoproteins.


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Table 2. Prevalence (%) of overweight/obesity, abdominal and central obesity in urban population in different SES groups-gender wise

SES groups HIG MIG LIG IL Slum

dwellers Pooled P value

Gender Overweight/obesity (BMI ≥23)

n 759 788 738 582 691 3558

Men 63.1 57.3 46.6 44.3 30.4 49.2 0.001

Women 63.1 57.4 53.0 56.0 44.1 54.8 0.001

Pooled 63.1 57.4 50.1 50.5 38.1 52.2

Gender Abdominal obesity

n 750 773 723 574 676 3496

Men 39.2 33.2 23.4 27.9 17.5 28.7 0.001

Women 52.9 52.3 47.3 47.4 38.9 47.9 0.001

Pooled 46.4 43.3 36.1 38.2 29.3 38.9

Central obesity

n 747 776 722 570 670 3485

Men 68.0 65.9 60.0 55.2 51.0 60.7 0.001

Women 82.0 80.7 77.9 75.7 75.0 78.4 0.08

Pooled 76.4 74.5 70.5 65.9 64.5 70.1

Hypertension

n 743 768 715 569 667 3462 0.02

Men 28.4 26.6 24.1 23.5 18.4 24.5

Women 22.6 24.1 19.4 15.9 17.2 20.1 0.02

Pooled 25.3 25.3 21.5 19.5 17.7 22.1

Diabetes

n 373 422 384 308 361 1848

Men 14.9 13.9 12.0 11.0 13.9 13.2 0.83 0.43

Women 7.0 9.5 9.6 12.3 11.9 10.0

Pooled 10.7 11.6 10.7 11.7 12.7 11.5

n Ser cholesterol (mg/dL)

<200 277 79.8 83.1 89.8 95.3 83.6 85.8 0.07

≥200 46 20.2 16.9 10.2 4.7 16.4 14.2

Ser Triglycerides (mg/dL)

<150 425 61.1 74.0 78.1 82.8 79.1 74.4 0.001

≥150 147 38.9 26.0 21.9 17.2 20.9 25.6

Ser HDL (mg/dL)

≥40/≥50 40 9.6 12.7 13.0 14.1 14.3 12.5 0.91

<40/<50 279 90.4 87.3 87.0 85.9 85.7 87.5

HIG-high income group, MIG- middle income group, LIG-low income group, IL-industrial labour, SES-socioeconomic status.


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Table 3. Association of cardio-metabolic risk factor with socio-demographic variables among urban population

Age groups n BMI≥23 WC≥90/80 WHR≥0.9/0.8 HTN DM

18-39 1942 42.6 27.2 60.7 11.6 3.0

40-59 1223 64.8 52.8 80.9 29.0 17.3

>=60 393 60.6 53.3 88.0 49.9 30.6

Pooled 3558 52.2 39.0 70.8 22.1 11.5

P value 0.001 0.001 0.001 0.001 0.001

Gender

Men 1644 49.3 28.7 61.0 24.5 13.2

Women 1914 54.8 48.0 79.2 20.1 10.0

P value 0.01 0.001 0.001 0.01 0.03

Education

Illiterate 477 39.4 31.1 69.9 23.4 12.9

1-8th class 638 46.4 40.5 69.9 22.4 14.5

9th & above 2443 56.2 40.0 71.2 21.8 10.3

P value 0.001 0.001 NS NS 0.08

Occupation

Labour 440 30.9 22.7 57.6 16.4 9.0

Housewife 1351 56.4 47.7 77.0 19.9 12.2

Service+ others 1767 54.3 36.4 69.3 25.2 11.5

P value 0.001 0.001 0.001 0.001 NS

SES-socioeconomic groups HIG-high income group, MIG- middle income group, LIG-low income group, IL-industrial labour.


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Table 4. Logistic regression analysis between hypertension & diabetes among study population with socio-demographic factors, BMI and obesity

Particulars HTN Diabetes

OR 95% CI OR 95% CI

Gender Men 1.65*** 1.37 2.01 1.79*** 1.29 2.49

Women 1.0 1.0

Age groups (yrs)

20-39 1.0 10

40-59 2.99*** 2.41 3.70 5.14*** 3.28 8.05

≥60 7.36*** 5.55 9.75 11.38*** 6.80 19.03

SES HIG - - - 0.45*** 0.27 0.76

MIG - - - 0.54** 0.33 0.87

LIG - - - 0.61* 0.37 1.02

Ind Lab - - - 0.66 0.39 1.09

Slum - - - 1.0

BMI

CED 1.0 - - -

Normal 1.66* 1.06 2.62 - - -

Overweight 2.43*** 1.53 3.87 - - -

WC Normal 1.0 1.0

Obese 1.35* 1.04 1.73 2.30*** 1.61 3.29

WHR Normal 1.0

Obese 1.46** 1.11 1.91 - - -

BMI-body mass index, WC-waist circumference, WHR-waist hip ratio, CED-chronic energy deficiency, OR: odds ratio, CI: confidence interval, Variables included: Age groups, gender, education, occupation, regions, social group, BMI, WC, WHR, *p<0.05, **P<0.01, ***p<0.001.


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Figure 1. Prevalence (%) of cardio-metabolic risk factors among urban population-Gender wise


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Figure 2. Prevalence (%) of dyslilidemia among urban population-Gender wise


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Figure 3. Prevalence (%) of cardio-metabolic risk factors among different socio-economic groups in urban population

Figure 4. Selected regions, States and cities

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