Familial aggregation of central obesity in Southern Indians

Davey, Gail; Ramachandran, Ambady; Snehalatha, Chamukuttan; Hitman, GA; McKeigue, PM

doi:10.1038/sj.ijo.0801408

Cited by 36 publications

(31 citation statements)

References 19 publications

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“…Although fat distribution is to a large extent genetic [143,165] with a calculated heritability of 0.36-0.6, modifiable environmental factors play very a important role: education, alcohol consumption, physical activity, smoking and, in women, parity [166]. When BMI increases in a population, so does the WHR, especially in persons older than 45 years [167].…”

Section: Human Type Of Female Fat Distribution and Its Evolutionary Omentioning

confidence: 98%

Human obesity: an evolutionary approach to understanding our bulging waistline

Lev-Ran

2001

Diabetes Metabolism Res

131

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The unique worldwide spread of the human species and the remarkably long post-reproductive survival show that our genome permits excellent adaptation to vastly different environments. Moreover, the main scourges of later age, namely malignant growths and atherosclerosis, appear in humans later than in shorter-living animals. In recent years, excess weight and obesity have become mass phenomena with a pronounced upward trend in all developed countries. However, despite the detrimental effects of being overweight, these populations live longer than ever, which in part may be explained by the availability of better medical treatment. The prevalence and predicted further spread of obesity can be understood in the light of evolution. In all animal species energy metabolism is asymmetric with energy accumulation ('thrifty genotype') being the necessary condition of survival during hard times. For humans, which are no different to other animals in this respect, this genetic programming was necessary for survival because during the course of history, including the recorded history in the more developed Middle East, Europe or China, there was never a long period of uninterrupted food abundance, whereas famines were regular and frequent. Therefore fat accumulation, when food was available, meant survival at times of shortage, while the possible detrimental effects of overindulgence in food and being overweight expressed in unrealistically old age were irrelevant. It is the central, mostly intra-abdominal fat (in both humans and animals) that is more medically important than the subcutaneous truncal fat, and the accumulation of both types of fat is conditioned by high food consumption; therefore it is a historic novelty for human populations. In contrast, lower-body fat in human females is unique in the animal kingdom: it is much less metabolically active, it is of much lower pathologic significance than central fat, and it is programmed to be mobilized mostly during pregnancy and lactation. In view of all this, norms of desired weight should be based on hard mortality and morbidity statistics and not on theoretical, esthetic or fashion considerations. By this criterion, the upper limit of desirable weight is likely to be body mass index (BMI) 27 or 28, but specified for different populations (sex, race, ethnic origin); moreover, with aging, the detrimental effects of obesity diminish and finally disappear. Risks of other pathologies related to obesity (e.g. diabetes, hypertension and coronary disease) are also population-specific. However, total fatness, measured by BMI, is insufficiently sensitive as a risk factor, and fat distribution (upper-body versus low-body type, as reflected by waist circumference and waist:hip ratio) plays at least as prominent a role. Therefore the detailed norms, not yet available, should take into account both general obesity and fat distribution and be specific for different populations. Since long-term weight loss in adults is rarely achievable, public health measures should be aggressively d...

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Section: Human Type Of Female Fat Distribution and Its Evolutionary Omentioning

confidence: 98%

Human obesity: an evolutionary approach to understanding our bulging waistline

Lev-Ran

2001

Diabetes Metabolism Res

131

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“…In India nearly 75% of the Type 2 diabetics have first degree family history of diabetes indicating a strong familial aggregation [8]. Insulin resistance has been demonstrated to be a characteristic feature of Asian Indians.…”

Section: Risk Factorsmentioning

confidence: 99%

Diabetes Mellitus in India: The Modern Scourge

Mehta¹,

Kashyap

Das³

2009

Medical Journal Armed Forces India

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India has a high prevalence of diabetes mellitus and the numbers are increasing at an alarming rate. In India alone, diabetes is expected to increase from 40.6 million in 2006 to 79.4 million by 2030. Studies have shown that the prevalence of diabetes in urban Indian adults is about 12.1%, the onset of which is about a decade earlier than their western counterparts and the prevalence of Type 2 diabetes is 4-6 times higher in urban than in rural areas. The risk factors peculiar for developing diabetes among Indians include high familial aggregation, central obesity, insulin resistance and life style changes due to urbanization. Screening for gestational diabetes and impaired glucose tolerance among pregnant women provides a scope for primary prevention of the disease in mothers as well as in their children. The problems of obesity and impaired glucose tolerance (IGT) (important predisposing factors) are not confined to adults alone but children are also increasingly getting affected. Most long standing macro and micro vascular complications are also more common among Indian diabetics as compared to other races and ethnic groups. A strong familial clustering of diabetic nephropathy among Indian Type 2 diabetics has also been noted. Clustering of cardiovascular risk factor like Syndrome X is common among urban Indians. The rising incidence of diabetes and its complications are going to pose a grave health care burden on our country. Timely effective interventions/measures and screening tests for complications at the time of diagnosis becomes imperative not only for early detection, but also to prevent progression to end stage disease. Screening for gestational diabetes among pregnant women would also go a long way in primary prevention of the disease. Life style changes/interventions and drugs like rosiglitazone are the current strategies that can prevent and/or delay the onset of diabetes. Simple interventional strategies like "Eat less, Eat on time and Walk more" can go a long way in preventing these chronic disorders among present as well as in the future generations. MJAFI 2009; 65 : 50-54

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“…However, as both visceral and subcutaneous fat are linked to insulin resistance (43)(44)(45), it is relevant that SAD is also a valid measure of total abdominal fat (23). Because abdominal obesity seems to be an early sign of insulin resistance (46) that is more genetically determined than generalized obesity (47), high SAD values might, to a larger extent than increments in other measures, reflect such a genetic component (48) as well as reflect a sedentary lifestyle (48).…”

Section: Statisticsmentioning

confidence: 99%

Sagittal Abdominal Diameter Is a Strong Anthropometric Marker of Insulin Resistance and Hyperproinsulinemia in Obese Men

et al. 2004

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OBJECTIVE -It is clinically important to find noninvasive markers of insulin resistance and hyperproinsulinemia because they both predict cardiovascular and diabetes risk. Sagittal abdominal diameter (SAD) or "supine abdominal height" is a simple anthropometric measure previously shown to predict mortality in men, but its association with insulin resistance and hyperproinsulinemia is unknown. RESEARCH DESIGN AND METHODS-In a common high-risk group of 59 moderately obese men (aged 35-65 years, BMI 32.6 Ϯ 2.3 kg/m 2 ), we determined anthropometry (SAD, BMI, waist girth, and waist-to-hip ratio [WHR]); insulin sensitivity (euglycemichyperinsulinemic clamp); and plasma concentrations of intact proinsulin, specific insulin, Cpeptide, glucose, and serum IGF binding protein-1 (IGFBP-1). To compare SAD with other anthropometric measures, univariate and multiple regression analyses were used to determine correlations between anthropometric and metabolic variables.RESULTS -SAD showed stronger correlations to all measured metabolic variables, including insulin sensitivity, than BMI, waist girth, and WHR. SAD explained the largest degree of variation in insulin sensitivity (R 2 ϭ 0.38, P Ͻ 0.0001) compared with other anthropometric measures. In multiple regression analyses, including all anthropometric measures, SAD was the only independent anthropometric predictor of insulin resistance (P Ͻ 0.001) and hyperproinsulinemia (P Ͻ 0.001).CONCLUSIONS -In obese men, SAD seems to be a better correlate of insulin resistance and hyperproinsulinemia (i.e., cardiovascular risk) than other anthropometric measures. In overweight and obese individuals, SAD could represent a simple, cheap, and noninvasive tool that could identify the most insulin resistant in both the clinic and clinical trials evaluating insulin sensitizers. These results need confirmation in larger studies that also include women and lean subjects. Diabetes Care 27:2041-2046, 2004M ore than half of adult Americans are overweight or obese (1). Many, but far from all of those subjects, will suffer from obesity-related diseases. Insulin resistance may be the key factor in obesity that contributes to increased health risk, as the more insulin resistant an individual, the more likely they are to develop diabetes and cardiovascular disease (2-4). Therefore, identification of insulin resistance also is important in moderately obese subjects.Recently, elevated intact proinsulin, reflecting both insulin resistance and ␤-cell dysfunction (5), has emerged as an independent predictor of type 2 diabetes (5-7) and cardiovascular mortality (8,9). However, a simple clinical surrogate marker for hyperproinsulinemia is still to be found.McLaughlin and Reaven (10) recently highlighted the need for a useful tool to identify insulin resistance, as direct measures of insulin resistance are unfeasible for clinical use. While fasting insulin has shown to be a useful estimate of insulin resistance, it is invasive and the lack of standardized assays limits its use (11). Alternatively, triglycerid...

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Familial aggregation of central obesity in Southern Indians

Cited by 36 publications

References 19 publications

Human obesity: an evolutionary approach to understanding our bulging waistline

Human obesity: an evolutionary approach to understanding our bulging waistline

Diabetes Mellitus in India: The Modern Scourge

Sagittal Abdominal Diameter Is a Strong Anthropometric Marker of Insulin Resistance and Hyperproinsulinemia in Obese Men

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