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Abstract Background Reference data for plasma lipids and blood pressure are not available for Asian Indian adolescents. This study aimed to develop representative age- and sex- specific percentile reference data for serum lipids [total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-HDL cholesterol] and blood pressure for urban Asian Indian adolescents aged 14–18 years. The sample consisted of 680 boys and 521 girls aged 14–18 years from the cross-sectional population survey, Epidemiological Study of Adolescents and Young Adults (ESAY) for whom the data for serum lipid levels and blood pressure were recorded. Smoothed age- and sex- specific 5th, 10th, 25th, 50th, 75th, 85th, 90th and 95th percentiles where derived using LMS regression. Results Percentile-based reference data for serum lipids and blood pressure are presented for adolescent Asian Indian boys and girls for the first time. Asian Indian adolescents had lower levels of serum TC, LDL-C and HDL-C and higher TG than their counterparts in the USA. Interesting trends in TC and HDL-C levels where observed, which might reflect changes in dietary pattern and physical activity in this age group in India. Conclusion These reference data could be used to identify adolescents with an elevated risk of developing dyslipidemia, hypertension and cardiovascular disorders, to plan and implement preventive policies, and to study temporal trends.

The aim of the present study was to evaluate the impact of a high-protein meal replacement (HPMR) on weight and metabolic, lipid and inflammatory parameters in overweight/obese Asian Indians. In this 12-week open-label, parallel-arm randomised controlled trial, 122 overweight/obese men and women were administered either a HPMR or a control diet after 2 weeks of diet and exercise run-in. Body weight, waist circumference (WC), percentage body fat (%BF), fasting blood glucose, post-oral glucose tolerance test (post-OGTT) blood glucose, fasting and post-OGTT serum insulin, lipid profile, high-sensitivity C-reactive protein (hs-CRP), kidney function and hepatic aminotransferases were assessed before and after the intervention. Additional improvement in mean values for the following parameters in the HPMR group compared with the control group was observed: body weight, 4·9 % (95 % CI 3·8, 6·1; P<0·001); WC, 3·8 % (95 % CI 2·5, 5·1; P<0·001); %BF, 6·3 % (95 % CI 4·3, 8·2; P<0·001); systolic blood pressure, 2·8 % (95 % CI 0·4, 5·1; P=0·002); diastolic blood pressure, 3·5 % (95 % CI 0·7, 6·3; P= 0·01); post-OGTT blood glucose, 7·3 % (95 % CI 1·4, 13·1; P=0·02); total cholesterol, 2·5 % (95 % CI 1·6, 3·5; P<0·001); LDL-cholesterol, 7·3 % (95 % CI 1·7, 12·9; P<0·01); alanine aminotransferase, 22·0 % (95 % CI 2·1, 42; P=0·03) and aspartate aminotransferase, 15·2 % (95 % CI 0·9, 29·5; P=0·04). The absolute reduction in BMI was 0·9 units in the intervention arm compared with the control arm (–0·9 %, 95 % CI –1·4, –0·5; P<0·001) and in serum TAG was 11·9 mg/dl (–11·9 mg/dl, 95 % CI –21·1, –2·7; P<0·01). The reduction in fasting serum insulin in the intervention v. the control arm was 3·8 v. 0 % (P=0·002); post-OGTT serum insulin was 50·3 v. 77·3 mU/l (P=0·005); and hs-CRP, 16·7 % v. 0 % (P=0·002). These findings show that intervention with HPMR may lead to significant weight loss and improvement in obesity measures, metabolic, lipid and inflammatory parameters and hepatic transaminases in overweight/obese Asian Indians. [ABSTRACT FROM AUTHOR]

The article compares the nutrient profiles of urban Indian teenagers with their rural counterparts and with American teenagers. The authors report that urban Indian teenagers have high intake of total fat compared with rural Indian teenagers. They also speculate that high total fat and saturated fatty acids intake and low intake of monosaturated fatty acids could be the reason for the increased prevalence of obesity and insulin resistance among urban Indian teenagers.

There is paucity of data on the association of various risk factors of the metabolic syndrome in urban Asian Indian adolescents. This cross-sectional study included 948 subjects (527 males; 421 females) aged 14-19 y, selected randomly from New Delhi, India. Principal component factor analysis included variables such as: body mass index (BMI), waist circumference (WC), triceps (TR) and subscapular (SS) skinfold thickness, systolic and diastolic blood pressures, fasting blood glucose, serum triglycerides, high-density lipoprotein cholesterol and fasting insulin. Factor scores were used to generate a cumulative risk scale and identify independent correlates of high cumulative risk. Three factors namely: obesity/insulin factor (BMI, WC, TR, SS and fasting insulin) explained 40.9% and 35.5%, 'blood pressure' factor explained 14.1% and 14.2%, and the 'metabolic' factor (glucose/triglycerides) explained 10.4% and 10.8% of the variance data in males and females, respectively. Overweight and hyperinsulinemia in both genders and high SS in males were independently associated with high cumulative risk. More than one factor is associated with the metabolic syndrome in Asian Indian adolescents. Obesity (generalized, abdominal and truncal sub-cutaneous) accounts for the maximum variance in clustering and appears to be the stronger correlate of high cumulative risk rather than hyperinsulinemia. [ABSTRACT FROM AUTHOR]

To determine the prevalence of different psychiatric comorbidities in patients with obesity and study their relationship with the degrees of obesity. This cross-sectional study included 151 patients with a BMI≥25 kg/m2. Subjects with diagnosed psychiatric illness, type 2 diabetes mellitus, coronary artery disease or any neurological illness were excluded. Prevalence of psychiatric comorbidities was assessed by MINI screening tool for all major axis 1 disorders including anxiety, eating and mood disorders. The WHOQOL-BREF was used for assessment of well-being, in the four domains, physical, psychological, social and environmental. Females constituted 68.6% of the study population. Lifetime diagnosis of any psychiatric illness was present in 24%, higher in females than males [31% vs 9%, p = 0.003]. The WHOQOL-BREF average scores of psychological, physical and environmental domains were significantly lower (p < 0.001) in patients diagnosed with depression as compared to those without. The WHOQOL-BREF average score of only the physical domain were significantly lower in individuals with BMI ≥30 kg/m2 as compared to those with BMI <30 kg/m2. The burden of undiagnosed psychiatric comorbidity in patients with obesity decreases the quality of life. There is need to screen for psychiatric comorbidities for effective management of obesity. • Undiagnosed psychiatric comorbidity is present in up to one-fourth of patients with obesity. • Psychiatric comorbidity is associated with decreased quality of life in all domains. • Majority of the patients were found to have deranged awareness levels and perceptions regarding their obesity. • Conveying a diagnosis, screening for psychiatric comorbidities and counselling are essential for effective management. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess the phenotypic correlations of insulin resistance with obesity and its relationship with the metabolic syndrome in Asian Indian adolescents. Design and subjects: We analyzed clinical, anthropometric (body mass index [BMI], waist circumference [WC]) and laboratory (fasting blood glucose [FBG], lipids and fasting serum insulin) data from 793 subjects (401 males and 392 females) aged 14–19 years randomly selected from Epidemiological Study of Adolescents and Young (ESAY) adults (n =1447). The percentile cut-offs for 14–19 years age from ESAY cohort were used for defining abnormal values of variables. We devised three sets of definitions of metabolic syndrome by including BMI and fasting insulin levels with other defining variables. Results: Nearly 28.9% of adolescents had fasting hyperinsulinemia despite normal values of BMI, WC, FBG, lipids, and blood pressure. Remarkably, NCEP criteria with appropriate percentile cut-off points for Asian Indian adolescents identified metabolic syndrome in only six (0.8%) subjects. Inclusion of both BMI and WC in the definition resulted in increase in the prevalence of metabolic syndrome to 4.3%. With inclusion of hyperinsulinemia, the prevalence of metabolic syndrome increased to 4.2% (from 0.8%) in the modified NCEP definition, 5.2% (from 0.9%) when BMI was substituted for WC, and 10.2 (from 4.3%) when both BMI and WC were included. Conclusions: Our data show marked heterogeneity of phenotypes of insulin resistance and poor value of NCEP definition to identify metabolic syndrome. We propose that BMI and fasting insulin should be evaluated in candidate definitions of metabolic syndrome in Asian Indian adolescents. [Copyright &y& Elsevier]

Abstract: Objective: We examined the association of subclinical atherosclerosis and endothelial dysfunction with nonalcoholic fatty liver disease (NAFLD) in Asian Indians. Methods: This study included 40 non-diabetic subjects with NAFLD and 40 apparently healthy controls without NAFLD with similar age, gender and body mass index. Measurements included anthropometric parameters, oral glucose tolerance test, fasting and 2 h insulin, lipid profile, C-reactive protein, sICAM-1, VCAM-1, carotid intima-media thickness (CIMT) and brachial artery flow mediated dilatation (FMD). Results: Subjects with NAFLD had higher average and maximum CIMT (0.6 ± 0.12 and 0.684 ± 0.16 mm, respectively, vs 0.489 ± 0.1 and 0.523 ± 0.1 mm, respectively; p < 0.05), and had higher prevalence of atherosclerotic plaques (20% vs 5%, p < 0.05) than controls. Significantly greater degree of impairment in FMD and higher levels of hs-CRP and sICAM-1 were observed in NAFLD patients than controls. The presence of NAFLD was observed to be the independent predictor of having high average CIMT (OR 4.8; 95% CI: 1.8–12.8), high maximum CIMT (OR 5.4; 95% CI: 2.0–14.4) and impaired FMD (OR 11.7; 95% CI: 1.4–96.5) even after adjusting for obesity, metabolic syndrome, insulin resistance and lipid parameters. Conclusion: In Asian Indians NAFLD is significantly associated with subclinical atherosclerosis and endothelial dysfunction independent of obesity and metabolic syndrome. Elevated levels of hs-CRP and sICAM-1 may be useful as indicators of liver injury in NAFLD. [Copyright &y& Elsevier]

Abstract: Objective: The relationship between C-reactive protein (CRP), a surrogate marker of cardiovascular risk, and dietary nutrients is not known. We investigated the relationship between serum CRP levels and dietary nutrients in young Asian Indians residing in a major metropolitan city in north India. Methods: Dietary nutrient intake values (24-h dietary recall and monthly consumption data) and serum CRP levels were studied in 359 healthy adolescents and young adults (312 male and 47 female) (mean age, 18.0 ± 2.3 y; range, 14–25 y), after carefully excluding those with history of infections and smoking. Bivariate and multivariate logistic regression analysis was performed with CRP [raised (>3.0 mg/L)/normal] as the outcome variable and various dietary nutrients and anthropometric variables as covariates. Results: Mean CRP level was 1.3 ± 2.3 mg/L (range, 0.02–17.5 mg/L). Raised CRP levels (>3 mg/L) were noted in 9% study subjects (8.6% males and 12.8% females). After adjustment for other covariates, saturated fat emerged as the single most important nutrient contributing to increase in serum CRP levels. The odds of having a raised CRP level in subjects consuming more than 10% energy as saturated dietary fat were twice as compared to subjects having a normal saturated fat intake [Adjusted odds ratio (OR) (95% CI) = 2.0 (0.94–4.1)]. For every one percent decrease in energy intake by saturated fat, CRP level was calculated to decrease by 0.14 mg/L. For decreasing CRP levels to <1.0 mg/L (low risk for cardiovascular disease), Asian Indian adolescents and young adults should ensure saturated fat intake <7% of caloric intake. Conclusion: We suggest that daily saturated fat intake should be limited to <7% of caloric intake in urban adolescents and young adult Asian Indians to decrease their future cardiovascular risk. [Copyright &y& Elsevier]