The prevalence of obesity,sleep apnea, and the metabolic syndrome is rapidly increasing in India and other south Asian countries, leading to increased morbidity and mortality due to type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). 

The literature search has been carried out using the key words “insulin resistance, the metabolic syndrome, cardiovascular risk, diabetes, obesity, Asian Indians, and South Asians” in the medical search engine Pubmed (National Library of Medicine, Bethesda, MD) from 1966 to September 2009. Obstructive Sleep Apnea 

Obstructive sleep apnea (OSA) has been reported to be present in 7.5% of Asian Indians in western India.Growing evidence indicates OSA to be independently associated with obesity, hypertension, and excess cardiovascular risk and mortality.Patients with OSA have a high prevalence of insulin resistance and the metabolic syndrome. OSA is also associated with increased amounts of inflammatory cytokines, including tumor necrosis factor-? (TNF-?) and hs-CRP levels.Obese Asian Indians with OSA had higher abdominal obesity and fasting blood glucose and a higher prevalence of the metabolic syndrome (82.0% vs. 56.6%; P < 0.01) as compared with obese subjects without OSA.In addition, after adjusting for obesity, we have recently reported significant association of OSA with proinflammatory state (high levels of hs-CRP and TNF-?; P < 0.05) as compared with those without OSA. These data also indicate that the presence of OSA may increase the risk of atherosclerosis and CHD independent of obesity in Asian Indians.However, more studies are needed to validate these findings.

 Metabolic Syndrome and Associated Cardiovascular Risks 

A high prevalence of the metabolic syndrome and associated cardiovascular risk factors has been observed not only in urban South Asian/Asian Indian adults and children but also in economically disadvantaged people residing in urban slums and rural areas.

The main drivers are rapid nutrition, lifestyle, and socioeconomic transitions, consequent to increasing affluence, urbanization, mechanization, and rural-to-urban migration. Less investigated determinants of the metabolic syndrome include psychological stress in urban setting, genetic predisposition, adverse perinatal environment, and childhood “catch up” obesity.

Data show atherogenic dyslipidemia, glucose intolerance, thrombotic tendency, subclinical inflammation, and endothelial dysfunction are higher in South Asians than Caucasians. Many of these manifestations are more severe and are seen at an early age (childhood) in South Asians than Caucasians.

Metabolic syndrome and cardiovascular risk in South Asians is also heightened by their higher body fat, truncal subcutaneous fat, intra-abdominal fat, and ectopic fat deposition (liver fat, etc.).

Further, cardiovascular risk cluster manifests at a lower level of adiposity and abdominal obesity. The cutoffs of body mass index and waist circumference for defining obesity and abdominal obesity, respectively, have been lowered and the definition of the metabolic syndrome has been revised for Asian Indians in a recent consensus statement, so that physicians could intervene early with lifestyle management.

Data from a major intervention program conducted by us on urban adolescent schoolchildren in north India for prevention of obesity (the MARG project) has shown encouraging results, making it a model for any future intervention program in South Asians.

 Obesity and Lifestyle 

Urbanization and mechanization in South Asia have led to a sedentary lifestyle and changing dietary patterns, with increased fat and carbohydrate intake and less fiber intake. This has led to increasing prevalence of the metabolic syndrome not only in adults but also in children.

The prevalence of obesity and the metabolic syndrome is increasing in urban and even rural populations. Migrant Indians also show a high prevalence, and women are more affected than men. Increasing prevalence of the metabolic syndrome is related to a distinctive obesity phenotype in South Asians, which includes excess body fat, abdominal obesity, thick truncal subcutaneous fat, and fat deposition at ectopic sites in the body, most importantly in the liver.

Prevention is important, and community-based programs aimed at creating awareness about various aspects of lifestyle modifications are needed on countrywide basis, especially focusing on school health.

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Filed under: Cardiovascular Disease • Diabetes • Heart Problems • Hypertension • Obesity • Obstructive Sleep Apnea • Sleep Apnea • Sleep Apnea Effects • Sleep Apnea Research • Sleep Apnea Study

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