CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 6, November/December 2011
AFRICA
303
Prevalence of the metabolic syndrome in people of
Asian Indian origin: outcomes by definitions
M DAS, S PAL, A GHOSH
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:
The three definitions showed differences in preva-
lence 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 modifiedATP III 2005, the prevalence
was 48.3%, and for southAsian-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
Submitted 16/7/09, accepted 31/8/10
Cardiovasc J Afr
2011;
22
: 303–305
DOI: 10.5830/CVJA-2010-070
People of Indian origin are ethnically a particularly vulner-
able 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 there-
fore 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 ethics 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 meas-
urement 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) choles-
terol 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.
