Prevalence of dyslipidemia in urban and rural India: the ICMR-INDIAB study.

AIM: To study the pattern and prevalence of dyslipidemia in a large representative sample of four selected regions in India. METHODS: Phase I of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study was conducted in a representative population of three states of India [Tamil Nadu, Maharashtra and Jharkhand] and one Union Territory [Chandigarh], and covered a population of 213 million people using stratified multistage sampling design to recruit individuals ≥20 years of age. All the study subjects (n = 16,607) underwent anthropometric measurements and oral glucose tolerance tests were done using capillary blood (except in self-reported diabetes). In addition, in every 5th subject (n = 2042), a fasting venous sample was collected and assayed for lipids. Dyslipidemia was diagnosed using National Cholesterol Education Programme (NCEP) guidelines. RESULTS: Of the subjects studied, 13.9% had hypercholesterolemia, 29.5% had hypertriglyceridemia, 72.3% had low HDL-C, 11.8% had high LDL-C levels and 79% had abnormalities in one of the lipid parameters. Regional disparity exists with the highest rates of hypercholesterolemia observed in Tamilnadu (18.3%), highest rates of hypertriglyceridemia in Chandigarh (38.6%), highest rates of low HDL-C in Jharkhand (76.8%) and highest rates of high LDL-C in Tamilnadu (15.8%). Except for low HDL-C and in the state of Maharashtra, in all other states, urban residents had the highest prevalence of lipid abnormalities compared to rural residents. Low HDL-C was the most common lipid abnormality (72.3%) in all the four regions studied; in 44.9% of subjects, it was present as an isolated abnormality. Common significant risk factors for dyslipidemia included obesity, diabetes, and dysglycemia. CONCLUSION: The prevalence of dyslipidemia is very high in India, which calls for urgent lifestyle intervention strategies to prevent and manage this important cardiovascular risk factor

Prevalence of generalized & abdominal obesity in urban & rural India- the ICMR - INDIAB Study (Phase-I) [ICMR - INDIAB-3]

Background & objectives: Overweight and obesity are rapidly increasing in countries like India. This study was aimed at determining the prevalence of generalized, abdominal and combined obesity in urban and rural India. Methods: Phase I of the ICMR-INDIAB study was conducted in a representative population of three s0 tates [Tamil Nadu (TN), Maharashtra (MH) and Jharkhand (JH)] and one Union Territory (UT)[Chandigarh (CH)] of India. A stratified multi-stage sampling design was adopted and individuals ≥20 yr of age were included. WHO Asia Pacific guidelines were used to define overweight [body mass index (BMI) ≥23 kg/m [2] but <25 kg/m [2]], generalized obesity (GO, BMI≥25kg/m [2] , abdominal obesity (AO, waist circumference ≥90 cm for men and ≥80cm for women) and combined obesity (CO, GO plus AO). Of the 14,277 participants, 13,800 subjects (response rate, 96.7%) were included for the analysis (urban: n=4,063; rural: n=9737). Results: The prevalence of GO was 24.6, 16.6, 11.8 and 31.3 per cent among residents of TN, MH, JH and CH, while the prevalence of AO was 26.6, 18.7, 16.9 and 36.1 per cent, respectively. CO was present in 19.3, 13.0, 9.8 and 26.6 per cent of the TN, MH, JH and CH population. The prevalence of GO, AO and CO were significantly higher among urban residents compared to rural residents in all the four regions studied. The prevalence of overweight was 15.2, 11.3, 7.8 and 15.9 per cent among residents of TN, MH, JH and CH, respectively. Multiple logistic regression analysis showed that female gender, hypertension, diabetes, higher socio-economic status, physical inactivity and urban residence were significantly associated with GO, AO and CO in all the four regions studied. Age was significantly associated with AO and CO, but not with GO. Interpretation & conclusions: Prevalence of AO as well as of GO were high in India. Extrapolated to the whole country, 135, 153 and 107 million individuals will have GO, AO and CO, respectively. However, these figures have been estimated from three States and one UT of India and the results may be viewed in this light

Prevalence of dyslipidemia in all the four regions studied.

<p>*p<0.05 and **p<0.001 compared to urban participants; Dyslipidemia was diagnosed using NCEP guidelines – hypercholesterolemia: Total cholesterol (TC) ≥200 mg/dl; hypertriglyceridemia: triglycerides ≥150 mg/dl; low HDL cholesterol: HDL-C <40 (males) and <50 mg/dl (females); high LDL cholesterol: LDL-C ≥130 mg/dl; High total cholesterol: HDL-C ratio ≥4.5; Isolated hypercholesterolemia: TC ≥200 mg/dl and triglycerides <150 mg/dl; Isolated hypertriglyceridemia: serum triglycerides ≥150 mg/dl and TC <200 mg/dl; Isolated low HDL-C: HDL-C ≤40 mg/dl (male) and ≤50 mg/dl (female) without hypertriglyceridemia or hypercholesterolemia.</p

General characteristics of the study subjects based on the presence of dyslipidemia in all the four regions studied.

<p>*p<0.05 and **p<0.001 compared to subjects with no lipid abnormality.</p

Multivariable logistic regression showing factors independently associated with dyslipidemia in all the four regions studied.

<p>Values are presented as Odds ratio OR (95% Confidence Interval, CI), p value.</p

Venn diagram to show the overlap of the individual components of dyslipidemia [Hypercholesterolemia, hypertriglyceridemia and low HDL-cholesterol].

<p>Venn diagram to show the overlap of the individual components of dyslipidemia [Hypercholesterolemia, hypertriglyceridemia and low HDL-cholesterol].</p

a-d: Age- and sex-specific prevalence of dyslipidemia in the study population.

<p>Urban male, blue circles, solid line; urban female, blue circles, dotted line; rural male, red triangles, solid line; rural female, red triangles, dotted line; p denotes p for trend; *p<0.05, **p<0.001.</p

Mean values of lipids in all the four regions studied.

<p>*p<0.05 and **p<0.001 compared to urban participants; Values are presented as mean ± SD, except for serum triglycerides, where the values are presented as geometric mean.</p