Association between body mass index (BMI) and hypertension in South Asian population: Evidence from Demographic and Health Survey

ABSTRACTAlthough there has been a well-established association between adiposity and hypertension, whether such associations are heterogeneous for South Asian populations or for different socioeconomic groups is not well-known. We analysed the recent Demographic and Health Survey (DHS) data from Bangladesh, India, and Nepal to estimate the age-specific prevalence of hypertension and the association of body mass index (BMI) with hypertension. We used multiple logistic regressions to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) of hypertension for overweight and obesity as well as for each 5-unit increase in BMI. The overall prevalence for hypertension among participants aged 35-44 years were 17.4%, 20%, and 22.5% for Bangladesh, India, and Nepal, respectively. For all age groups, men were more likely to be hypertensive than women in India and Nepal, but not in Bangladesh. Overweight and obesity were associated with higher odds of hypertension in all countries. For each 5 kg/m2 increase in BMI, the ORs for hypertension were 1.79 (95% CI: 1.65-1.93), 1.59 (95% CI: 1.58-1.61), and 2.03 (95% CI: 1.90-2.16) in Bangladesh, India, and Nepal, respectively. The associations between BMI and hypertension were consistent across various subgroups defined by sex, age, urbanicity, educational attainment and household’s wealth index. Our study shows that the association of BMI with hypertension is stronger for South Asian populations, and public health measures to reduce population-level reduction in BMI would also help in lowering the burden of hypertension.

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Association between body mass index (BMI) and hypertension in south Asian population: evidence from nationally-representative surveys

Clinical Hypertension ◽

10.1186/s40885-019-0134-8 ◽

2019 ◽

Vol 25 (1) ◽

Cited By ~ 3

Author(s):

Fariha Binte Hossain ◽

Gourab Adhikary ◽

Ariful Bari Chowdhury ◽

Md Shajedur Rahman Shawon

Keyword(s):

Body Mass Index ◽

Body Mass ◽

South Asian ◽

Asian Population ◽

Wealth Index ◽

Population Level ◽

Overweight And Obesity ◽

National Committee ◽

South Asian Population ◽

Asian Populations

Abstract Background Although there has been a well-established association between overweight-obesity and hypertension, whether such associations are heterogeneous for South Asian populations, or for different socioeconomic groups is not well-known. We explored the associations of overweight and obesity using South Asian cut-offs with hypertension, and also examined the relationships between body mass index (BMI) and hypertension in various socioeconomic subgroups. Methods We analysed the recent Demographic and Health Survey (DHS) data from Bangladesh, India, and Nepal, with a total of 821,040 men and women. Hypertension was defined by 2017 ACC/AHA cut-offs and by Joint National Committee 7 (JNC7) cut-offs for measured blood pressure and overweight and obesity were defined by measured height and weight. We used multiple logistic regressions to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) of hypertension for overweight and obesity as well as for each 5-unit increase in BMI. Results The prevalence of hypertension using JNC7 cut-offs among participants increased by age in all three countries. The prevalence ranged from 17.4% in 35–44 years to 34.9% in ≥55 years in Bangladesh, from 4.6% in 18–24 years to 28.6% in 45–54 years in India, and from 3.8% in 18–24 years to 39.2% in ≥55 years in Nepal. Men were more likely to be hypertensive than women in India and Nepal, but not in Bangladesh. Overweight and obesity using both WHO and South Asian cut-offs were associated with higher odds of hypertension in all countries. For each 5 kg/m2 increase in BMI, the ORs for hypertension were 1.79 (95% CI: 1.65–1.93), 1.59 (95% CI: 1.58–1.61), and 2.03 (95% CI: 1.90–2.16) in Bangladesh, India, and Nepal, respectively. The associations between BMI and hypertension were consistent across various subgroups defined by sex, age, urbanicity, educational attainment and household’s wealth index. Conclusions Our study shows that the association of BMI with hypertension is stronger for South Asian populations at even lower cut-offs points for overweight and obesity. Therefore, public health measures to reduce population-level reduction in BMI in all population groups would also help in lowering the burden of hypertension.

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The Need for Culturally Competent Care Within Gastroenterology Services: Evidence from Research with Adults of South Asian Origin Living with Inflammatory Bowel Disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa117 ◽

2020 ◽

Author(s):

Suzanne Mukherjee ◽

Bryony Beresford ◽

Karl Atkin ◽

Shaji Sebastian

Keyword(s):

Inflammatory Bowel Disease ◽

South Asian ◽

Bowel Disease ◽

Extended Family ◽

Religious Faith ◽

Asian Population ◽

Structured Interviews ◽

South Asian Population ◽

Asian Populations ◽

Inflammatory Bowel

Abstract Background and Aims It is widely acknowledged that the incidence of inflammatory bowel disease [IBD] is rising within South Asian populations, yet research into the experiences of this group of patients is rare. In this study the lived experiences of UK South Asian adults with IBD, including support from gastroenterology services, was investigated. Methods A sample of 33 patients representing the diversity of the UK South Asian population were recruited through five gastroenterology clinics in England. In-depth semi-structured interviews were conducted, audio-recorded, transcribed and analysed using the Framework approach. Results Although many experiences align with those of the general IBD population, participants believed that South Asian cultures and/or religions can lead to additional challenges. These are linked to: family and friends’ understanding of IBD; self and family attributions regarding IBD; stigma surrounding ill health; the taboo of bowel symptoms; managing ‘spicy food’; beliefs about food and ill health; roles within the family; living with extended family; the use of complementary and alternative therapies; and visits to family overseas. Religious faith helped many to cope with having IBD, but symptoms could hamper their ability to practise faith. Gastroenterology services were viewed positively, but unmet needs were identified, some of which were culturally specific. Conclusion Gastroenterology services have an important role to play in helping patients to overcome the challenges they encounter in their everyday life, both by providing individual patients with culturally appropriate care and advice, and via interventions to increase awareness and understanding of IBD within wider South Asian communities.

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SAT0058 AGE DEPENDENT EFFECTS OF BODY MASS INDEX AND SMOKING ON THE RISK OF RHEUMATOID ARTHRITIS IN MEN – RESULTS FROM A NESTED CASE CONTROL STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4846 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 961-961

Author(s):

C. Turesson ◽

U. Bergström ◽

M. Linnerud Keshavarz ◽

J. Å. Nilsson ◽

L. T. H. Jacobsson

Keyword(s):

Rheumatoid Arthritis ◽

Body Mass Index ◽

Body Mass ◽

Health Survey ◽

Conditional Logistic Regression ◽

Statistical Significance ◽

Overweight And Obesity ◽

Acr Criteria ◽

The Impact ◽

Reduced Risk

Background:As rheumatoid arthritis (RA) is more common in women compared to men, most studies of disease predictors have mainly included women, and data on risk factors in men are limited. Smoking is an established predictor of RA. A negative association between body mass index (BMI) and the risk of RA in men has been reported from several studies of Scandinavian populations.Objectives:To investigate whether the impact of smoking and BMI on the risk of subsequent development of RA in men differs by age.Methods:A total of 22 444 men from a defined catchment area were included in a Preventive Medicine Program (PMP). Height and weight were measured as part of the health survey, and BMI was calculated as weight (in kg)/height (in m2). Information on smoking was obtained using a structured self-administered questionnaire. Normal BMI, overweight and obesity was defined according to the WHO criteria. From this population, we identified individuals who developed RA after inclusion by linking the PMP register to the local community based RA register and to local and national patient administrative databases. In a structured review of the medical records, patients were classified according to the 1987 ACR criteria for RA. Four controls for each validated case, matched for sex, year of birth and year of screening, who were alive and free of RA when the index person was diagnosed with RA, were selected from the PMP register. The impact of BMI category and smoking on the risk of RA was examined in multivariable conditional logistic regression models, stratified by age at inclusion in the health survey (above vs below the median).Results:A total of 151 men were diagnosed with RA and fulfilled the ACR criteria after inclusion in the PMP (median time to diagnosis 13 years, interquartile range 9-19; 76 % rheumatoid factor positive at diagnosis). These pre-RA cases were compared to 604 matched controls. Among men aged >46 years, overweight/obesity was associated with a significantly reduced risk of subsequent RA (odds ratio (OR) 0.40; 95 % confidence interval (CI) 0.21-0.76, adjusted for smoking), whereas there was no such association in younger men (adjusted OR 0.75 (95% CI 0.42-1.36). Smoking was a significant predictor of RA in men aged >46 years (Table 1). There was a similar trend in those aged ≤46 years, but it did not reach statistical significance (Table 1).Conclusion:Overweight/obesity was associated with a reduced risk of subsequent RA in men aged >46 years. The relative importance of life style factors for the risk of RA may be greater in older men compared to younger.Disclosure of Interests:Carl Turesson Grant/research support from: Unrestricted grant from Bristol-Myers Squibb, Consultant of: Roche, Speakers bureau: Abbvie, Bristol Myers-Squibb, Pfizer, Roche, Ulf Bergström: None declared, Mitra Linnerud Keshavarz: None declared, Jan-Åke Nilsson: None declared, Lennart T.H. Jacobsson Consultant of: AbbVie, Eli Lilly, Janssen, Novartis and Pfizer

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Signatures of natural selection and ethnic-specific prevalence of NPC1 pathogenic mutations contributing to obesity and Niemann–Pick disease type C1

Scientific Reports ◽

10.1038/s41598-020-75919-4 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Andreea Chiorean ◽

William S. Garver ◽

David Meyre

Keyword(s):

Natural Selection ◽

South Asian ◽

Asian Population ◽

Loss Of Function ◽

The South ◽

South Asian Population ◽

Asian Populations ◽

Pathogenic Mutations ◽

Z Scores ◽

Niemann Pick

Abstract While homozygous pathogenic mutations in the NPC1 gene cause Niemann-Pick type C1 disease, heterozygous mutations cause highly-penetrant obesity. We aimed to investigate the prevalence of NPC1 mutations and their signatures of natural selection in 122,678 exome sequenced participants from six ethnic groups in the Genome Aggregation Database. Pathogenic missense coding mutations were identified by in silico tools and the ClinVar database. Signatures of natural selection were assessed by the probability of NPC1 being loss-of-function mutation intolerant and Z-scores of observed/expected synonymous and non-synonymous mutation ratios. There was no evidence of negative selection observed for synonymous, non-synonymous and loss-of-function mutations. However, there were significant ethnic differences in the prevalence of heterozygous pathogenic NPC1 mutations ranging from 0.56% in Ashkenazi Jewish to 3.26% in African/African Americans (5.8-fold difference). Four homozygous carriers of pathogenic NPC1 mutations were also identified, belonging to the South Asian population. In conclusion, NPC1 mutations are consistent with a model of balanced selection, where heterozygotes and homozygotes have higher and lower reproductive fitness, respectively. Therefore, NPC1 heterozygous mutations may account for a substantial and ethnic-dependent percentage of obesity in the general population, while NPC1 homozygous mutations may be frequent in the South Asian populations and warrants more investigation.

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Elhízó Magyarország. A túlsúly és az elhízás trendje és prevalenciája Magyarországon, 2015

Orvosi Hetilap ◽

10.1556/650.2016.30389 ◽

2016 ◽

Vol 157 (31) ◽

pp. 1248-1255 ◽

Cited By ~ 7

Author(s):

Imre Rurik ◽

Tímea Ungvári ◽

Judit Szidor ◽

Péter Torzsa ◽

Csaba Móczár ◽

...

Keyword(s):

Body Mass Index ◽

Waist Circumference ◽

Body Mass ◽

Educational Level ◽

Public Awareness ◽

Age Groups ◽

Overweight And Obesity ◽

Political Support ◽

Geographical Regions ◽

Wide Range

Introduction: The prevalence of obesity is growing continuously worldwide, even in Hungary. Since 1988, when the first professional wide-range evaluation was performed, only limited data are available. Aim: Authors present the results of the ever largest Hungarian obesity-prevalence surveys, performed by family and occupational physicians. Method: Data from 0.55% of the population above 18 year were registered in all geographical regions of Hungary (43,287 persons; 17,901 males and 25,386 females), close to the proper national representativeness. Age, body mass index, waist circumference, educational level, presence of hypertension and/or diabetes were analyzed statistically and compared with previous data. Results: The overall prevalence rate of overweight and obesity among men was 40% and 32%, respectively, while overweight and obesity occurred in 32% of women. In the different age groups of men, the prevalence of overweight and obesity was: 32.7% and 18.2% in 18–34 years; 40.1% and 34.4% in 35–59 years; 43.5% and 38.8% in over 60 years, respectively. In the same age groups of women, overweight and obesity occurred in 19.6% and 15.7%, 36.8% and 38.7%, and 36.5% and 39.7%, respectively. Body mass index and waist-circumference were presented according to age, by decades and by type of residency as well. The highest ratio of overweight was registered among men with the highest educational level, while highest ratio of obesity among women having the lowest education. Obesity according to Body mass index and abdominal obesity was the highest in the villages, especially among females. Registered metabolic morbidities were strongly correlated with body mass index and both were inversely related to the level of urbanization. Conclusions: Over the previous decades, the ratio of the overweight and even the number of obese persons increased significantly, and it was most prominent among males, mainly in younger generation. Obesity means a serious medical, public health and economic problem, and it requires higher public awareness and political support. Orv. Hetil., 2016, 157(31), 1248–1255.

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Socioeconomic Differentials in Hypertension based on JNC7 and ACC/AHA 2017 Guidelines Mediated by Body Mass Index: Evidence from Nepal Demographic and Health Survey

10.1101/667899 ◽

2019 ◽

Author(s):

Juwel Rana ◽

Zobayer Ahmmad ◽

Kanchan Kumar Sen ◽

Sanjeev Bista ◽

Rakibul M Islam

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Health Survey ◽

Sampling Technique ◽

Developed Countries ◽

The Body ◽

Demographic And Health Survey ◽

Secondary Outcome ◽

National Committee ◽

Socioeconomic Differentials

AbstractBackgroundUnlike developed countries; higher socioeconomic status (SES, education, and wealth) is associated with hypertension in low and middle-income countries (LMICs) with limited evidence. We examined the associations between SES and hypertension in Nepal and the extent to which these associations vary by sex and urbanity. The body mass index (BMI) was examined as a secondary outcome and assessed as a potential mediator.Materials and methodsWe analyzed the latest Nepal Demographic and Health Survey data (N=13,436) collected between June 2016 and January 2017, using a multistage stratified sampling technique. Participants aged 15 years or older from selected households were interviewed with an overall response rate of 97%. Main outcomes were hypertension and normal blood pressure defined by the widely used Seventh Report of the Joint National Committee (JNC 7), and the American College of Cardiology/American Heart Association (ACC/AHA) 2017.ResultsThe prevalence of hypertension was higher in Nepalese men than women. The likelihood of having hypertension was more than double for individuals in the highest versus lowest wealth quintiles [men: OR 2.13, 95% CI 1.60-2.85); women: OR 2.54, 95% CI 2.00- 3.24] and for individuals with the higher education versus no education [men: OR 2.38, 95% CI 1.75-3.23; women: OR 1.63, 95% CI 1.18-2.25]. The associations between SES and hypertension were different by sex and urbanity. These associations were mediated by BMI.ConclusionsHigher SES was positively associated with the higher likelihood of having hypertension in Nepal according to both JNC 7 and ACC/AHA 2017 guidelines. These associations were mediated by BMI, which may help to explain broader socioeconomic differentials in CVD and related risk factors, particularly in terms of education and wealth. Our study suggests that the mediating factor of BMI should be tackled to diminish the risk of CVD in people with higher SES in LMICs.

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