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Waistline: An index of lifeline

Indians are most susceptible to the triple menace of diabetes, heart disease and high blood pressure, says Dr KK Aggarwal.

india Updated: Mar 07, 2006 19:40 IST

Diabetes, heart disease and high blood pressure are the current epidemics of the world and no race or country is immune today. However, Indians are probably the most susceptible to this triple menace.

Being Indian is considered a risk factor for heart disease. An Indian doctor settled in US is 17 times more likely to get heart disease than an American doctor settled in the US. An Indian woman settled in UK, in one study, was found to be three times more likely to get diabetes than a British woman settled in the UK.

There are multiple risk factors for causation of heart disease and these involve active and passive smoking, uncontrolled blood pressure, persistently high blood sugar, raised levels of non-HDL bad cholesterol, lack of exercise, inability to manage stress and obesity.

Until recently, a weight (in kg) of more than 25 x height (in metres) x height (in metres) was considered overweight and a weight of more than 30 x height (in metres) x height (in metres) was considered obese. However, these criteria have been changed for the Asian population including Indians and now the classification of obesity as per the weight is a weight more than 23 x height (in metres) x height (in metres) is overweight and a weight more than 25 x height (in metres) x height (in metres) is obese.

This classification has limitations. More than 50% of the cases of proven coronary artery disease have a normal body mass index {weight (in kg)/[height (in mtr.) x height (in mtr.).

Hence, researchers all over the world have come out with an additional parameter for the classification of obesity. According to them, it is not the overall weight due to deposition of fat but the preferential of deposition of fat around the abdomen (apple or pot belly obesity) that makes people more prone to heart disease. This so-called abdominal obesity or adiposity is linked with higher level of insulin, insulin resistance, high blood sugar, thickened carotid arteries and early deposition of cholesterol in the heart vessels. These patients often have raised level of triglycerides and low levels of HDL cholesterol in the blood. For Asian, an abdominal circumference of more than 36 inches in men and 32 inches in women is considered a major risk factor for future heart disease.

In a scale of 10, this risk factor alone amount to 8 and the remaining two are shared by other eight risk factors of heart disease including smoking, high blood pressure and diabetes. These findings have come out and justified the slogan "longer the waist line, shorter the lifeline". Waistline is measured as the maximum circumference between the lower end of ribs and the upper end of the hip bones.

The major cause of potbelly obesity is consumption of refined (bad) carbohydrates and animal (bad) fats. The refined carbohydrates include any item, which is artificially whitened like white sugar, white maida, white bread and white rice. They have high a glycemic index and raised blood sugar levels immediately after consumption and, over a period of time, cause higher levels of insulin in the blood and resultant insulin resistance state. Once this situation has occurred, any bad fat that is consumed instead of getting converted into energy is converted into abdominal fat. This fat is deposited either in the ovaries leading to poly-cystic ovarian disease, in the liver leading to fatty liver and non alcoholic fatty liver disease; or in the heart leading to coronary blockages.

All those who have gained more than 10% of weight after the age of 18 or who are gaining weight after the age of 50 should check for their abdominal circumference and if more than 36 inches (in men) or 32 inches (in women) should consult their family physician or cardiologist for proper counseling.

The writer is a senior Physician, Head Department of Cardiology and Deputy Dean Board of Medical Education-Moolchand Hospital, President-Heart Care Foundation of India, President Delhi Medical Association and Member-Delhi Medical Council.