Body fat, metabolic syndrome and hyperglycemia in South Asians

[Eskander]

Source : https://www.sciencedirect.com/science/article/abs/pii/S1056872718303465



Abstract : The prevalence of overweight and obesity is escalating in South Asian countries. South Asians display higher total and abdominal obesity at a lower BMI when compared to Whites. Consequently, metabolic dysfunction leading to metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) will account for a majority of the health burden of these countries. In this review, we discuss those factors that contribute to MetS and T2DM in South Asians when compared to whites, focusing on adiposity. Abdominal obesity is the single-most important risk factor for MetS and its predisposition to T2DM. Excessive ectopic fat deposition in the liver (non-alcoholic fatty liver disease) has been linked to insulin resistance in Asian Indians, while the effects of ectopic fat accumulation in pancreas and skeletal muscle need more investigation. South Asians also have lower skeletal muscle mass than Whites, and this may contribute to their higher risk T2DM. Lifestyle factors contributing to MetS and T2DM in South Asians include inadequate physical activity and high intakes of refined carbohydrates and saturated fats. These are reflective of the recent but rapid economic transition and urbanization of the South Asian region. There is need to further the research into genetic determinants of dysmetabolism as well as gene x environment interactions. Collectively, MetS and T2DM have multi-factorial antecedents in South Asians and efforts to combat it through low-cost and socio-culturally appropriate lifestyle interventions need to be supported.

Relationships between body fat, ectopic fat and dysmetabolism (Table 1)​

Abdominal obesity is a pivotal risk factor for MetS, T2DM, atherosclerosis and CVD among all race/ethnic groups. In a large study spanning over 63 countries, the prevalence of abdominal obesity was specifically higher in South Asian as compared to White Caucasian and other ethnic groups.12 In Asian Indians, a higher prevalence of abdominal obesity is noted even at low levels of BMI.4,26 Obesity in south Asians is featured by high body fat percentage,4,26 increased total abdominal fat.

Low skeletal muscle mass, MetS and type 2 diabetes​

While relationship of adiposity with MetS continues to be intensely examined, the relationship of MetS with skeletal muscle mass has not received similar scrutiny. As age advances, there is a reduction in muscle mass, muscle force and its repair capacity. Among women, the ability of muscle to generate force declines sharply following menopause, which is linked to decline in estrogen levels, leading to increased intra-abdominal visceral fat mass and reduction of muscle mass and strength and bone

Early loss of beta cell function​

While increased insulin resistance among South Asians has been recognized,63 studies suggest that early loss of beta cell function could be yet another factor which predisposes South Asians to T2DM. It has been shown that beta cell function declines rapidly even at the stage of pre-diabetes, especially in those who have combined impaired glucose tolerance and impaired fasting glucose.64 Recent data show decreased beta cell function in Asian Indians even at the stage of ‘normal glucose

Cortisol and adipocytokines​

Several adipocytokines have been studied to understand the increased propensity for MetS, most prominently, adiponectin and leptin. Adiponectin increases with age and is generally higher among women than men, but lower among obese and those with T2DM. Similarly, leptin plays a causal role in diet-induced obesity. South Asians have lower circulating adiponectin, higher resistin and higher leptin levels compared to Europeans.66 Additionally, the relationship of adiponectin and insulin resistance

Metabolic syndrome and CVD in South Asians​

Presence of MetS is well accepted as a risk factor for CVD and CVD-related mortality. The South Asian ancestry may contribute the greatest proportion to the global burden of CVD. It was important to investigate whether MetS played a similar or greater role in development of CVD in South Asians. In a large cross-sectional survey in India, there was increased risk of ‘probable’ coronary artery disease (CAD) with increasing MetS, though the proportion of persons with ‘possible’ and ‘probable’ CAD

Nutrition​

Rapid strides in urbanization, globalization, growth of economy, emerging new technologies and evolving agricultural practices have led to increased availability, accessibility and affordability of more packaged and processed foods such as refined grains, added sugars, edible refined oils and fats in South Asia.46 This has resulted in rapid nutrition transition occurring in South Asian countries, leading to an escalation in obesity-related MetS and T2DM both among adults and children.17

Several

Physical activity​

Asian Indians/South Asians are more sedentary, than White Caucasians27 Importantly, nearly 90% of males and females in India are not involved in regular recreational exercise,81 while television viewing for long hours was common in all age groups. Physical inactivity is increasing in South Asia because of urbanization and mechanization. Further, as with the Europeans, lower physical activity in Asian Indians is inversely correlated with BMI, waist circumference, systolic blood pressure, and

Socio-cultural factors​

Socio-cultural and religious beliefs of South Asians impact on their diet and lifestyle, disease detection, prevention and management. South Asians are challenged by many interrelated factors that influence their food and lifestyle choices. These include their personal economic standing in society, level of education, religious beliefs, family background and traditional cultural expectations. For example, there is also tendency of south Asians to consume excess amount of sugars and

Genetics and epigenetics​

Studies among South Asians have also suggested the contribution of environment to an already obesogenic genotype.87 However, despite the large heritability component, search for precise genetic markers and mechanisms responsible for adiposity have identified genetic polymorphisms that explain only a small proportion of the adiposity variance. Some loci such as FTO and near-MC4R region are well known to be associated with obesity, and this has been replicated in numerous studies.

Conclusions​

This review systematically addresses the many etiopathological factors that contribute to MetS and T2DM in context of adiposity in South Asians. We highlight the role of adipose tissue distribution focusing on ectopic fat, diet, other lifestyle factors, an altered hormonal and systemic inflammatory milieu, potential genetic/epigenetic influences on the increased risk of MetS. Clearly, the problem has multi-factorial antecedents

 

[Azadkashmir]

need to start eating organic and more vegetables than meat.

 

[One_Nation]

need to start eating organic and more vegetables than meat.

No need to eat less meat. Meat with veggies is the best diet.
These health issues are a result of lack of meat in diet which leads to more urge to stuff up with unhealthy stuff and carbs.

 

[313ghazi]

When our people where poorer, they ate more balanced diets and worked hard physically.

Today for those of us with money, the food that was a treat, has become a staple, and physical exercise is limited to getting up to find the remote control.

 

[Azadkashmir]

No need to eat less meat. Meat with veggies is the best diet.
These health issues are a result of lack of meat in diet which leads to more urge to stuff up with unhealthy stuff and carbs.

i have tried 1 month vegetarian diet although had eggs i dont know if eggs considered meat or not but it made a difference to my health i went really slim plus headaches and body pains went away i could breath better and my blood pressure improved.

 

[SoulSpokesman]

@Eskander

Our problem is we eat too much carbs. Carbs with carbs (think aaloo with parathey) and unhealthy fats on top.

Regards

 

[Paitoo]

i have tried 1 month vegetarian diet although had eggs i dont know if eggs considered meat or not but it made a difference to my health i went really slim plus headaches and body pains went away i could breath better and my blood pressure improved.

A vegetarian diet is definitely better as you age. I am realising this now after decades of being a heavy red meat eater. I have switched mainly to a veggie diet and I feel far better than I have felt at any point in the last 10 years.

Also one must note that we don't really need to eat as much as we normally do. Even 60% of it is ok once you get used to it. Body is remarkably adaptive to lower food intake.

 

[One_Nation]

i have tried 1 month vegetarian diet although had eggs i dont know if eggs considered meat or not but it made a difference to my health i went really slim plus headaches and body pains went away i could breath better and my blood pressure improved.

That diet is good for losing weight and so is staying hungry but that is not a diet.
Continuing meat free will eventually make you weak and sick and force you to resort to carb heavy and starchy food to make up the difference.
Reasonable amount of carbs, meat and veggies with physical activity is the best diet.

 

[hembo]

A vegetarian diet is definitely better as you age. I am realising this now after decades of being a heavy red meat eater. I have switched mainly to a veggie diet and I feel far better than I have felt at any point in the last 10 years.

Also one must note that we don't really need to eat as much as we normally do. Even 60% of it is ok once you get used to it. Body is remarkably adaptive to lower food intake.

I am close to 50 with a BMI of almost 30. I switched to lots of veg/ salads + cheese/ butter/ olive oil + lots of meat/ fish/ egg (complete avoidance of carbs & sugar apart from the very few grams in the carefully selected vegetables) with intermittent fasting (2 meals a day with 6-7 hours) few days back and managed to loose about 4 kgs in 10 days. I feel better apart from initial couple of days, when my body was switching its dependance from carbs+sugar to fats for the required energy. I'm gonna continue for couple of months to see if I can bring my BMI below 24. I have been high on BMI since last 25 years inspite of many lackluster efforts to reduce it.

 

[Paitoo]

I am close to 50 with a BMI of almost 30. I switched to lots of veg/ salads + cheese/ butter/ olive oil + lots of meat/ fish/ egg (complete avoidance of carbs & sugar apart from the very few grams in the carefully selected vegetables) with intermittent fasting (2 meals a day with 6-7 hours) few days back and managed to loose about 4 kgs in 10 days. I feel better apart from initial couple of days, when my body was switching its dependance from carbs+sugar to fats for the required energy. I'm gonna continue for couple of months to see if I can bring my BMI below 24. I have been high on BMI since last 25 years inspite of many lackluster efforts to reduce it.

Same here, my BMI is 29 and I am planning to get into IF. Many friends are already into it and are saying it works well. I have tried everything else, and exercise is not helping beyond a point, just tiring out my limbs.

 

[hembo]

Same here, my BMI is 29 and I am planning to get into IF. Many friends are already into it and are saying it works well. I have tried everything else, and exercise is not helping beyond a point, just tiring out my limbs.

I tried IF for last 2 months, but it didn't help too much apart from arresting any more increase in weight. So I added ketogenic diet along with IF and seeing some good results. I was always too lazy to seriously work out and always had a sedentary work & lifestyle. Lets see if I can reduce BMI & increase energy / repair damaged cells at the same time as they claim for ketosis.

 

[fitpOsitive]

Cut the sugar.

 

[Mentee]

No need to eat less meat. Meat with veggies is the best diet.
These health issues are a result of lack of meat in diet which leads to more urge to stuff up with unhealthy stuff and carbs.

And excessively drinking the coffee and citrus juices in breakfast mindlessly .

 

[SoulSpokesman]

@One_Nation @hembo

I did Keto + IF once for a three month period- lost 12 kg and never felt healthier.

To diet and exercise, add the third pillar- often ignored- at least 7 hours of sleep.

Regards

 

[PakAlp]

@Eskander

Our problem is we eat too much carbs. Carbs with carbs (think aaloo with parathey) and unhealthy fats on top.

Regards

Nice

Dieting is generally considered as eating less food or starving yourself. What people need is to eat healthy diet, some meat, veggies, fruits, carbs and fats. Even if your calories are abit higher than usual, its ok.

We should get rid of sugar, fastfood, friedfood, chocolates, biscuits, crisps, fizzy drinks from our diet.

Walk 10,000 steps a day. I used to eat loads, including fast food but still lost weight due to walking 10,000 steps a day. Its a must.

You will become fitter, healthier, happier. Guaranteed.