Comparison of dyslipidemia among the normal-BMI and high-BMI group of people of rural Tamil Nadu
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Background: Overweight and obesity are considered major epidemic health problems in both developed and underdeveloped countries, as many studies showed a remarkable rise. One of the causes of dyslipidemia is obesity. Body mass index (BMI) correlates reasonably well with laboratory-based measures of adiposity for population studies, and is extremely practical in most clinical settings. Aim: The aim of the study is to evaluate the lipid profile of patients with normal BMI and high BMI. Materials and Methods: A cross-sectional study of 400 subjects attended the medical outpatient department (OPD) of a private medical college hospital at Salem from March 2010 to August 2011. The subjects were divided into two groups (200 in each group): (1) high BMI (BMI 25 and above) and (2) normal BMI (BMI less than 25). The laboratory parameters; cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride (TG) were determined directly by using an automated chemistry analyzer. Statistical Analysis: The Student's t-test was used for comparison between categorical variables, i.e. lipid profile, high-BMI and normal-BMI subjects at P ≤0.05. Results: The total cholesterol, LDL and very LDL cholesterol and the TGs are found to be relatively high among the subjects with high BMI when compared with normal BMI persons, and this difference was found to be statistically significant (P < 0.05), whereas HDL cholesterol had not shown any significant difference between the two groups (P > 0.05). Conclusion: By analyzing the results of the study conducted, it was concluded that there was an increased risk of dyslipidemia among the high-BMI group compared with the normal-BMI people. Hence, a community-based education in this regard is of utmost importance. Keywords: Dyslipidemia, high BMI, normal BMI
[TAG:2]Introduction [/TAG:2] The prevalence of obesity is rising to epidemic proportions at an alarming rate in both developed and less-developed countries around the world, [1] and many Indian studies have shown that the prevalence of overweight and obesity ranged between 30% and 65% among the urban population. [2] Body mass index (BMI; in kg/m 2 ) is widely used for the classification of overweight (BMI = 25 kg/m 2 ) and obesity (BMI = 30 kg/m 2 ) in men and women. [3] BMI correlates reasonably well with laboratory-based measures of adiposity for population studies, [4] and is extremely practical in most clinical settings. Obesity is a chronic health problem affecting an increasing number of people worldwide, and is now recognized as a global epidemic. In India, obesity is emerging as an important health problem, particularly in urban areas, paradoxically co-existing with under nutrition. The rising prevalence of overweight and obesity in India has a direct correlation with the increasing prevalence of obesity-related co-morbidities such as hypertension, the metabolic syndrome, dyslipidemia, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). [5],[6] A recent study by ICMR on the prevalence of dyslipidemia among the rural population of India had shown that 13.9% had hypercholesterolemia, 29.5% had hypertriglyceridemia, 72.3% had low high-density lipoprotein-cholesterol (HDL-C), 11.8% had high low-density lipoprotein-cholesterol (LDL-C) levels and 79% had abnormalities in one of the lipid parameters. Regional disparity exists, with the highest rates of hypercholesterolemia observed in Tamil Nadu (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 Tamil Nadu (15.8%) [7] Several recent studies conducted in the United States showed that the prevalence of overweight and obesity is increasing dramatically, suggesting that 86.3% of adults will be overweight or obese, with the prevalence of obesity increasing to 51.1% by 2030. [8],[9] Even as the causes of increased cardiovascular risk in type 2 diabetes are multifactorial, an atherogenic lipid profile characterized by elevated triglycerides and low levels of HDL-C are few major modifiable factors contributing progressively to cardiovascular risk. [10],[11] There is enough evidence indicating that a high-fat diet is the major cause of obesity and insulin resistance. Obesity is always associated with increases in plasma triglycerides. Obesity is considered to be the link between insulin resistance and metabolic abnormalities, inclusive of diabetes, hypertension and dyslipidemia, all of which are risk factors for coronary artery disease. [12] The present study was therefore performed to assess the association between high BMI and dyslipidemia.
The aim of the study was to evaluate the lipid profile of patients with normal BMI and high BMI. [TAG:2]Materials and Methods [/TAG:2] This was a cross-sectional study of 400 subjects attending the medical outpatient department (OPD) of a private medical college hospital at Salem from March 2010 to August 2011. All the subjects were ≥20 years of age, and of either sex. Subjects with chronic illness, smoking, alcoholism and diabetes mellitus, and patients who were already on lipid-lowering drugs, were excluded from the study. More than 95% of the study population was from rural area, belonging to grade IV socioeconomic status based on the modified BG Prasad classification. The subjects were divided into two groups (200 in each group):
The subjects were counseled regarding the survey-based study and, after an overnight fast of 12-14 h, weight was measured by a machine that was calibrated daily using a weight of 5 kg, and height was measured in the standing position without shoes, at the level of the vertex by using the wall scale. The measurement tools used were BMI = weight in kg/height in meters (square), i.e. mass (kg)/height 2 (m 2 ). The blood sample (5 mL) was drawn from the antecubital veins in the sitting position for lipid profile. Laboratory parameters: Cholesterol (TC), LDL, HDL and triglyceride (TG) were determined directly by using an automated chemistry analyzer. The presence of dyslipidemia was considered according to the updated National Cholesterol Education Programme (NCEP) Adult Treatment Panel III (ATP III) recommendations. All the data were recorded and analyzed through computer package SPSS (Statistical Package for Social Science) version 16.00. The results were given in text as mean and standard deviation (SD) for continuous variables (age, lab investigations, etc.) and frequency/percentages for categorical variables (gender, symptoms, etc.). The Student's t-test was used for comparison between categorical variables, i.e. lipid profile, high-BMI and normal-BMI subjects at P ≤ 0.05. [Table 1] shows the age- and gender-wise distribution of the entire study population (N = 400) - 200 in each group (high BMI and normal BMI). Among the high-BMI group, there were 119 males and 81 females and in the normal BMI group, there were 106 males and 94 females. The male:female ratio in the high BMI and normal BMI groups was 1.49 and 1.12, respectively. The majority of the study subjects in the high BMI group were in the age group of 30-60 years and that of the normal BMI group were in the age group of 20-50 years.
The vital characteristics of the study subjects are shown in [Table 2]. The mean (SD) BMI among the high BMI group was found to be 29.6 (2.12) in males and 31.6 (2.32) in females when compared with the normal BMI group of 22.4 (1.86) among males and 23.2 (2.1) among females. In both the groups [Table 3], the BMI was slightly higher among females than that among males, but had not shown any statistical significant difference.
The NCEP has laid down cut-off values for the presence of dyslipidemia. These values are very important in classifying the patients and making therapeutic decisions. The majority of subjects from both (obese as well as non-obese) groups belonged to the urban population. Among the high BMI group, 59 (59%) had hypercholesterolemia, 42% had HDL-C of <30 mg/dl, 41% had LDL-C of >130 mg/dL, 56% had very low-density lipoprotein (VLDL)-C of >40 mg/dL and 55% had TG >150 mg/dL. Whereas in the normal BMI group 21% had total cholesterol >200 mg/dL, 22% had HDL-C of <30 mg/dL, 18% had LDL-C of >130 mg/dL, 12% had VLDL cholesterol of >40 mg/dL and 16% had TG >150 mg/dL. The total cholesterol, LDL-C and VLDL-C and the TGs were found to be relatively high among the subjects with high BMI when compared with normal BMI persons, and this difference was found to be statistically significant (P < 0.05), whereas the HDL-C had not shown any significant difference between the two groups (P > 0.05).
Dyslipidemia, a group of biochemical disorders, is frequently encountered in obese individuals. The dyslipidemia associated with obesity no doubt plays a major role in the development of atherosclerosis and CVD in obese individuals. [3] All the components of the dyslipidemia, including higher TGs, decreased HDL levels and increased LDL particles, have been shown to be atherogenic. It has been suggested that BMI should be routinely assessed in primary care clinics for both adults and children in order to facilitate early identification, evaluation and treatment of obesity and its related disorders. [7] A study that was conducted to estimate the prevalence of dyslipidemia in Turkey [13] found that dyslipidemia was higher in high BMI men than that in women. A study by Antal et al. [14] on a group of Hungarian university students in Budapest showed the higher occurrence of increased LDL-C and decreased HDL-C levels in the male group with high BMI than that in female patients of similar BMI. In our study, there was a significant difference for LDL-C between males and females, whereas the other lipid parameters did not show a statistical significant difference between these two groups. An Indian study performed by Pandya et al. [15] among the Gujarati population inferred that diabetic obese patients are more prone to develop dyslipidemias than the non-obese patients. The present study showed that cholesterol was significantly higher in high BMI people compared with people with normal BMI. These findings correlate well with the findings of Philip et al. [16] From this study, it can be inferred that LDL-C was significantly higher in people with high BMI compared with people with normal BMI, while the values of HDL-C did not show any significant association between the two groups (high BMI and normal BMI); these findings correlate well with the studies of Grundy and Barnett. [17] In our study, the TG levels were significantly higher among the high BMI group when compared with the normal BMI group, and the findings are in par with the study performed by Lemieux et al. [18] There is a paucity of studies on dyslipidemia in South Asians. The overall prevalence of dyslipidemia in India in various studies ranges from 10% to 73%, [12] depending on the area of residence (rural vs. urban), socio-economic stratum (high vs. middle or low), diet and physical activity patterns and age. The prevalence of hypertriglyceridemia varied from 73% in obese to 61% in non-obese Asian Indians in urban areas and migrant Asians, whereas it was 43% and 21% among the rural population. In rural areas, the recent data show an increasing prevalence. [19],[20] In our study, most of the population was from rural areas, and the prevalence of hypertriglyceridemia in this population was 55% among high BMI and 16% among the normal BMI group. Besides giving health education on lifestyle modifications through various media, the prevalence of obesity and its complications is increasing worldwide, and this is being considered as one of the major public health problems, also proven by the present study.
By analyzing the results of the study conducted, it was concluded that there was an increased risk of dyslipidemia among the high BMI group compared with the people with normal BMI. The prevalence of dyslipidemia in asymptomatic subjects emphasizes the need for routine health screening for early preventive measures. The influence of BMI on metabolic and CVDs is multiplicative. Therefore, weight loss should be urged for all those with a high BMI. Hence, a community-based education in this regard is of utmost importance.
The authors wish to acknowledge the guidance and support extended by the Head of the Institution, Professor, Dr. K. Jayapal, for conducting this study and for his valuable advices for completing the manuscript.
[Table 1], [Table 2], [Table 3]
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