Cardiometabolic Risk Factors in Adolescents- Are we leading

to an obese unfit nation

Dr Chandra Mohan Kumar,MD,PGDAP

Associate Professor, HIMSR

ProblemCardiovascular Diseases CVD has become

most important group of preventable diseases for the human race

As they begin in childhood and manifest due to interactions & accumulation of various risk factors, throughout the life cycle.

Risk reduction delays progression

Cardiometabolic RisksObesity and OverweightSedentary LifestyleSmokingHigh TriglyceridesLow HDL CholesterolImpaired Fasting Glucose/Impaired GTTFamily history of Cardiac Death

Variable Percentage (%)Obesity (BMI) 50.1

Diabetes 24

Impaired fasting glucose 8.5

Hypercholesterolemia 26.6

Hypertriglyceridemia 42.7

LDL-C > 100 mg/dl 51.6

HDL-C < 40 mg/dl (Males)

<50 mg/dl (Females)

37

Prevalence of cardio-metabolic risk factors in urban adult population of

New Delhi, India (n = 459)

PLoS One 2011, 6, e24362

Adolescent ObesityThe worldwide prevalence of childhood

overweight and obesity increased from 4.2% (95% CI: 3.2%, 5.2%) in 1990 to 6.7% (95% CI: 5.6%, 7.7%) in 2010

The situation has worsened faster in developed nations

In US, prevalence of adolescent obesity has trebled in last three decades with current estimates indicating that 1/3rd of adolescents being obese/overweight

Childhood Obesity- Indian ScenarioPercentage of overweight children in various

studies in last 10 years -Delhi 32% , Pune 25%, Chennai 22%

Many of the studies have used IOTF cut offs rather than WHO hence it may underestimate the actual burden.

Indian children have a higher fat distribution in trunk region

Urban area HIG children are more likely to develop central obesity

BMC Pediatrics 2011, 11:105, Indian Pediatr. 2011; 48:105-10

Obesity leads to Insulin Resistence

Obesity, dyslipidemia, hyperglycaemia and hypertension are positively associated with insulin resistance and it leads to  increased risk of type 2 diabetes and/ or cardiovascular disease

Diab Care, 26 (2003), pp. 861–867

Sedentary LifestyleReduced physical activity

Academic Pressure- Long School Hours and Tuitions

 70% of adolescent school children in Delhi were physically inactive in the 10th and 12th classes, in which important academics are held

vehicles, reduced play areas

Screen Time on TV, Computer, Mobiles, Videogames

At least 1 h per day of physical activity of at least moderate intensity to prevent clustering of cardiovascular disease risk factors

Lancet 2006 Jul 22;368(9532):299-304

DyslipidemiaMain risk factor for CVDLDL and TGs above 90th percentileHDL below 10th percentileDyslipidemia in Indians has been

attributed to a multitude of factors, including physical inactivity, carbohydrate rich diet, abnormal body composition in particular excess truncal fat and increased intra abdominal fat and genetic predisposition

Does this make a teen COOL ??

But this definitely makes them HOT

DiabetesPrevalence T2DM increased in urban

Indian adults from < 3% in 1975 to > 12% in the year 2000

By the year 2025 it is predicted that India will have a rise of 59% of diabetics in the population... Which is the highest number of diabetic patients in the world

We woke to this problem about a decade back when we realized that 10% of newly diagnosed DM are adolescents and most were asymptomatic picked up on screening for obesity or strong family history

Smoking

Thirty per cent of the population 15 years or older (47% men and 14% of women) either smoked or chewed tobacco*

The Global Youth Tobacco Survey (GYTS) 2006-- national prevalence of current tobacco use among school-going adolescents (between 13 to 15 years of age) 14.1%

• Tob Control 2003;12:e4 doi:10.1136/tc.12.4.e4

Family HistoryA family history of CVD- the net effect of

shared genetic, biochemical, behavioural and environmental components.

Presence of a positive parental history doubled baseline risk for CVD.

Am J Cardiol 1991;67(11): 933-938. . JAMA 2004;291(18):2204-2211.

HypertensionPrevalence of hypertension in children in

India 6% in Delhi, 9.8% Ahmedabad and ....................................................................................................................................................17.4 % Chennai!!!!

In studies done in 80s and 90s it was between 0.5% to 2%

Times of India April 7th 2013

Likelihood of Premature Cardiac Death

Current smokers were at 86% greater risk for early

death than those classified as never smokers;

Those with a waist-to-height ratio >0.65 were at

139% greater risk than those with a WHR <0.5; and

Those with an HbA1c level >6.5% were at 281%

greater risk than those with an HbA1c level <5.7%

Cardiometabolic risk factors among US adolescents and young adults and risk of early mortality. Pediatrics. 2013 Mar;131(3):e679-86. doi: 10.1542/peds.2012-

2583

Is the picture so gloomy?Government schools study shows only 3%

were overweightDistribution by economic category

presents another picture. In LIG category 3.3% and in MIG category 7% school children were obese

Overall figures are estimated to be between 6-7%

Studies from rural India( BHARAT) can present a more soothing picture

Indian Pediatrics 2008; 45:330-331

Rays of HopeGlobalization, IT use and Real-time

Information SharingRecent studies of nationally

representative samples suggest that the prevalence of obesity is stabilizing in USA

There is improvement in lipid chemistry indicators in form of increase in HDL and decrease in triglyceride levels.

Physical Activity and TV Viewing indicators also have shown improvement

Trends of Physical Activity and TV Viewing in US Pediatrics 2013;132:606–614

Trends in consumption of fruits, vegetables, sweets, and soft drinks

What to do firstAdolescent Care and Counselling for preventive and

promotive health care

Weight loss leads to improvement in cardiometabolic profile

In a Prevention Program, a modest weight loss was associated with a 34% reduction of diabetes incidence during a 10-year follow-up

N Engl J Med 2002;346:393–403

IAP’s EffortsAHAPresident’s Action PlansIAP Task forces

Further Research Percentile scores for Lipids TG,LDL,HDL Prevalence of Obesity/HypertensionChanging Trends and Trendlines

Thank you