Thursday, June 30, 2016
Association between increased childhood obesity and diabetes epidemic in India
The pandemic of non-communicable diseases has affected the developing countries in such a manner that they are grappling with problems of both overnutrition and undernutrition. India is experiencing an epidemic of obesity and metabolic syndrome, which has afflicted the populace irrespective of gender and age.
Children are affected by a variety of non-communicable diseases. Behavioural risk factors, such as an unhealthy diet or lack of physical activity, start during childhood and lead to obesity, hypertension, and dyslipidemia at a young age. India is fast becoming the hub for both adult obesity and childhood obesity, especially in urban populations.
Moreover, childhood obesity is a risk factor for the development of diabetes in adulthood. Studies indicate a socioeconomic gradient in the burden of childhood obesity in India, with a greater prevalence in urban areas and upper socioeconomic groups. The major causal factors that predispose Indians to obesity include body fat composition as well as distribution, presence of subclinical inflammation, insulin resistance, and metabolic syndrome
People of Asian ethnicity have a typical body fat distribution characterised by a higher accumulation of abdominal fat compared to other ethnic groups. Such body fat composition is known to increase the risk of insulin resistance at a lower body mass index. Moreover, one of the strong predictors of insulin resistance is excessive visceral fat, which leads to subclinical inflammation and diabetes.
The key determinant of the association between obesity and diabetes is inflammation. Obesity-associated chronic low-grade inflammation precedes diabetes. Studies have shown that high levels of C-reactive protein, along with low levels of adiponectin, are associated with insulin resistance and inflammation. Childhood obesity has demonstrated a strong association with insulin resistance, which eventually predisposes to diabetes.
Asian-Indians are vulnerable to developing insulin resistance from early infancy. Moreover, insulin resistance may be the source of pathogenesis that leads to glucose intolerance, hypertension, dyslipidaemia, and central obesity. Metabolic syndrome coupled with insulin resistance is more often seen in obese people.
The association between childhood obesity and diabetes is complex. There is an urgent need for comprehensive obesity-prevention strategies addressing the issues of nutrition and lifestyle.
News Source: Praveen PA, Tandon N. Childhood obesity and type 2 diabetes in India. WHO South-East Asia J Public Health. 2016;5(1):17-21.