Transcript Obesity Trends in India and Consequences, Dr. Umesh file

Obesity Trends in India and Consequences
Dr. Umesh Kapil
MD, DNB, FAMS ,
Professor Public Health Nutrition
Department of Human Nutrition
All India Institute of Medical Sciences,
New Delhi 110 029, INDIA
Tel No: (Off) 91-11- 26593383 ; (R) 91-11-26195105
Mobile:. 9810609340
Fax : 91-11-26588641 , 91-11-26588663
[email protected]
India : Double Burden of Disease
Under nutrition due to Poverty 30 % below BPL
Over nutrition and Obesity
5-7% MIG and HIG Urban area
This is most productive workforce
of the country Academics/Planners/
Administrators/ Professionals
SHOULD BE GIVEN PRIORITY
Obesity Trends in India : Recent studies: Adults
Author
Year Country/ Criteria
of
used
State
Study
Prevalence
of overweight
(M/F)
BMI>25 21.3% (M)
33.4% (F)
Prevalence
of obesity
(M/F)
Gopinath et.al 1994
Delhi
INA
Singhal et al
1998
Jaipur
Asthana et al
1997
Varanasi BMI>25 30.2% (F) INA
Chadha et al
1997
Delhi
BMI>25 14.6% (M) INA
6.6% (F)
BMI>25 20.7 (M) INA
32.6% (F)
Obesity Trends in India : Recent studies
Author
Year Country/ Criteria Prevalence
of
used
of overState
Study
weight
(M/F)
Singh et.al
1999 5 Cities BMI>23 50.9% (F)
BMI>25
BMI>27
Vasanthanani 2000 Coimbatore BMI>30
Mohan et al
2000
Prevalence
of obesity
(M/F)
36.0% (M)
Chennai BMI>25 38.0% (M)
33.1% (F)
Easwaran et al 2001
Coimbatore
BMI>25 65.0% (M)
BMI>24 65.0% (F)
Gupta et al
2002
Jaipur
BMI>27
NFHS-II
1998- India
99
BMI>25 8.6% MIG
27.2 HIG
24.5% (M)
30.2% (F)
Trends in Body Mass Index of Adult Women
Survey
Normal (%) Obese (%)
BMI 18.5-25 BMI>25
NNMB (75-79)
48.8
3.4
NNMB (88-90)
46.6
4.1
NNMB (94)
46.3
6.6
NNMB Slum (93-94)
51.7
11.6
Body Mass Indix (BMI) is defined as weight (kg)/height² (m)
Obesity Trends in India : Recent studies
Children
S.No
Author Name
State/
country
Prevalence of
obesity
1.*
Umesh Kapil
etal, 2001
Delhi
(India)
8% boys
6% girls
2.**
Vedavati S etal,
1998
Chennai,
India
6% obese
1.* Indian Pediatrics, 2002 May, 17: 449-452
2.** Indian Pediatrics, 2003 Aug, 40: 775-779.
Obesity Trends in India : Recent studies
Children
S.No
Author Name
State/
country
Prevalence of
obesity
3.*
A.K.Gupta etal,
1985-86
India
7.94% boys
6.90% girls
4.**
Ramachandran A
etal, 2000
India
3.6% boys
2.7% girls
3.* Indian Pediatrics, 1990, Apr, 27 333-337
4.** Diabetes research and Clinical Practice 2002; 57 185-190.
Risk factor for Non Communicable Diseases
Obesity
 Oesteoprosis
 Mental Health
 Psychological
well being
 Accidents
 Muscloskeletal
injuries
 Cardiovascular diseases
CAD, CHF, Stroke
 Insulin Resistance and
 Type-2 Diabetes Mellitus
 Reproductive disorders
 Pulmonary diseases
 Gall stone disease
 Cancer- Colon, Rectum, Prostate-Male
 Gall stone–bile duct, breast, endometrium
cervix, ovary- Female
 Bone: Joint and skin diseases
Relative risk of health problems associated with
obesity in developed countries.
Greatly increased
(relative risk >>3)
Moderately increased
(relative risk
ca 2-3)
Diabetes
Coronary heart disease
Gall bladder disease
Osteoarthritis (knees)
Hypertension
Hyperuricaemia and
gout
Dyslipidaemia
Slightly increased
(relative risk
ca 1-2)
Cancer (breast cancer in
postmenopausal women,
endometrial cancer, colon
cancer)
Insulin resistance
Reproductive hormone
abnormalities
Breathlessness
Polycystic ovary syndrome
Sleep apnoea
Impaired fertility
Low back pain
Increased anaesthetic risk
Foetal defects arising from
maternal obesity
High Prevalence of Metabolic Syndrome
(Syndrome X)
Hypertension
Increased Insulin Resistance
Central Obesity
Dyslipidemia
Obesity and Mortality
Morbidly obese individuals (more than 200% ideal
body weight) have as much as a twelve fold
increase in mortality
Source: Bray GA. 1992. AJCN; 55; 488S-94S
Obesity and Diabetes
As many as 80% of patients with type-2 diabetes
mellitus are obese
Prevalence of Diabetes among U.S.
Adults, BRFSS, 1993-94
4%
4-6%
6%
n/a
Source: Mokdad et al., Diabetes Care 2000;23:1278-83
Prevalence of Diabetes among U.S.
Adults, BRFSS, 1997-98
4%
4-6%
6%
n/a
Source: Mokdad et al., Diabetes Care 2000;23:1278-83
Obesity and Diabetes
Mild obesity Two fold risk of Diabetes
Moderate obesity Five fold risk of Diabetes
Severe obesity Ten fold risk of Diabetes
Indian Scenario : Diabetes
Between 1988 and 2000, there was a 70%
increase in the prevalence of Diabetes
in the city of Chennai
The recent study document a prevalence of
13% in adults
Possible Reasons:
Average per capita energy ( Kcals ) intake
as per expenditure classes , India
Expenditure
Classes
Urban
(1972-73)
Urban
(1993-94)
Lower 30%
1579
1682
Middle 40%
2154
2111
Top 30%
2572
2405
Source: NSSO, 1997
Average daily per capita dietary intake of
Fats in India
Year
Fat (g)
Rural
24
Fat(g)
Urban
36
27
37
1993-94
31.4
42
1999-2000
36.1
49.6
1972-73
1983
Source: NSSO 2001
Life style changes between 1972-2000
Increase in Sedentary Life style
Decrease Physical activities
Intake of calories remaining same
Increase in Fat intake
Most manual jobs have been replaced by mechanized
jobs
Transportation to school /work place universally by
use of motor car/Bus/Bicycles
Increase in hours for activities :TV viewing/ Computer
Studies on prevalence of hypertension on
obese children
S.No
Author Name
1*.
M.Verma etal
1994
2**.
A.K. Gupta etal
1993
State/
country
Punjab
(India)
India
1* Indian Pediatrics1994Sept; 31: 1065-1069
2** Indian Pediatrics 1990 Apr;27(4)333-7.
Prevalence of
hypertension
Obese children:
13.7%
Non-obese:
children: 0.4%
Obese children:
34%
Non-obese
children: 0.16%
Study on prevalence of IGT(Impaired
Glucose Tolerance) and diabetes mellitus in
obese children
S.No
Author Name
1.*
Ranjana Sinha
etal, 1999-2000
2.**
Ripamonti G
etal, 1990
State/
country
Yale
Italy
Prevalence of IGT
& DM
IGT: 25% (4-10yrs
: 21%(11- 18yrs)
DM: 4%( 11-18yrs)
IGT: 11%
1.* New England Journal of Medicine;2002 March;346(11);802-810
2.** Minerva Med; 1991 Jun; 82(6):345-8
Study on the prevalence of Dyslipediamas in
obese children
S.No
Author Name
State/
country
Prevalence of
Dyslipediamas
1.*
Zwiauer K etal,
1990
Australia
46% girls
41% boys
2,**
Valverde MA
etal, 1998
Portugal
67.6% elevated
triglyceride levels
1.* Wien Klin Wochenschr. 1990 May 11; 102(10): 299-303
2.** Arch Latinoam Nutr. 1999 Dec; 49(4): 338-43
Study on the prevalence of Dyslipediamas
in obese children (Cont..)
S.No
Author Name
State/
country
3.*
Fredland O etal, Texas
2002
(USA)
Prevalence of
Dyslipediamas
52% elevated
serum cholesterol
levels
3.*J Pediatr Endocrinology Met’ 15’ 1011-1016 (2002)
Role of Physical Activity
According to WHO at least 30 minutes of cumulative
moderate exercise (equivalent to walking briskly) for all
ages plus for children , an additional 20 minutes of
vigorous exercise ( equivalent to running) three times a
week .
(These recommendations are basically for prevention of
CHD).
The prevention of obesity may require combination
of both : more Physical Activity and Dietary
interventions.
BMI in relation to morbidity over 18 years
Type 2 diabetes
Cholelithiasis
Coronary Heart Disease
Hypertension
6
Women
Relative Risk
5
4
3
2
1
0
<21
22
23
24
25
26
27
28
29
30
Body Mass Index
Willett, Dietz & Colditz, N.E.J.M. 1999. 341, 426-434
Aged 30-55 at start.
Obesity:
cardiovascular risk
60
6.6
Total cholesterol
6.2
50
SBP
5.8
mmol/l
2.8
2.6
30
2.4
Triglycerides
2.2
2.0
20
1.8
1.6
10
1.4
1.2
Data from British
Regional Heart Survey
1.0
18
HDL cholesterol
20
22
24
26
28
30
32
Body Mass Index (kg/m²)
34
0
% with high SBP
40
WE MUST LEARN LESSON FROM THE
DVELOPED COUNTRIES
RDA for the Affluent Urban Sedentary Population
life Styles Should be developed
All India Institute of Medical Sciences ,
New Delhi
Thank you