Meta-Analysis
Copyright ©The Author(s) 2018.
World J Diabetes. Jan 15, 2018; 9(1): 40-52
Published online Jan 15, 2018. doi: 10.4239/wjd.v9.i1.40
Table 1 Criteria for obesity, hypertension, and type 2 diabetes mellitus
Criteria for obesity, hypertension and T2DM
ObesityHypertension (JNC VII criteria)T2DM
BMI (≥ 30)SBP greater than or equal to 140 mmHg orWHO and ADA classification: Fasting plasma glucose ≥ 7.0 mmol/L (126 mg/dL) or 2 h plasma glucose ≥ 11.1 mmol/L (200 mg/dL)
Waist-hip ratio (> 0.80 for females and > 0.90 for males)DBP greater than or equal to 90 mmHg respectively
Waist circumference (≥ 90 cm, > 88 cm for female and > 102 cm for male)
DBP: Diastolic blood pressure; SBP: Systolic blood pressure; ADA: American Diabetes Association; JNC: Joint National Committee; WHO: World Health Organization; T2DM: Type 2 diabetes mellitus; BMI: Body mass index.
Table 2 Search terms used for literature review
Search terms for obesity and hypertensionSearch Terms for Obesity and type 2 diabetes
(((obesity[MeSH Terms]) AND hypertension[MeSH Terms]) AND prevalence[MeSH Terms]) AND India [MeSH Terms](((obesity[MeSH Terms]) AND type 2 diabetes[MeSH Terms]) AND incidence[MeSH Terms]) AND India[MeSH Terms]
(((obesity[MeSH Terms]) AND hypertension[MeSH Terms]) AND incidence[MeSH Terms]) AND India[MeSH Terms](((obesity[MeSH Terms]) AND type 2 diabetes[MeSH Terms]) AND prevalence[MeSH Terms]) AND India[MeSH Terms]
(((obesity[MeSH Terms]) AND hypertension[MeSH Terms]) AND relative risk[MeSH Terms]) AND India[MeSH Terms](((obesity[MeSH Terms]) AND type 2 diabetes [MeSH Terms]) AND risk ratio[MeSH Terms]) AND India[MeSH Terms]
(((obesity[MeSH Terms]) AND hypertension[MeSH Terms]) AND risk ratio[MeSH Terms]) AND India[MeSH Terms](((obesity[MeSH Terms]) AND type 2 diabetes[MeSH Terms]) AND relative risk[MeSH Terms]) AND India [MeSH Terms]
(((obesity[MeSH Terms]) AND hypertension[MeSH Terms]) AND attributable risk[MeSH Terms]) AND India[MeSH Terms](((obesity[MeSH Terms]) AND type 2 diabetes [MeSH Terms]) AND attributable risk[MeSH Terms]) AND India[MeSH Terms]
((((obesity[MeSH Terms]) AND hypertension[MeSH Terms]) AND prevalence[MeSH Terms]) OR incidence[MeSH Terms]) AND India [MeSH Terms]((((obesity[MeSH Terms]) AND type 2 diabetes [MeSH Terms]) AND prevalence[MeSH Terms]) OR incidence[MeSH Terms]) AND India [MeSH Terms]
Table 3 Characteristics of included obesity and hypertension studies
Ref.YearParticipants characteristics
Study characteristics
Measurements
Methodological quality of study
Age M (sd) in yrSettingStudy designSample sizeInclusion criteriaExposureOutcomeAdjusting confoundersSelection biasMeasurement errorResponse rate
Reddy et al[14]200320-30Urban slumsCross-sectional1000 (500 male and 500 female)Adults of 20-60 yr ageBMI > 25Mean blood pressure levelsImportant Confounders1Not mentionedMentioned100%
Mandal et al[15]200840-49Kolkata Municipal CorporationCross-sectional887Aged 20 yr or moreBMI ≥ 25JNC VII guidelineImportant confounders1 + religion, marital status, nature of work, family type, animal protein intakeNot mentionedMentioned and discussed98.30%
Bhadoria et al[16]201438-50Urban wardsCross-sectional939Individuals aged 20 yr and aboveBMI ≥ 27.5JNC VII guidelineImportant confounders1Not mentionedMentioned97.02%
Bhadoria et al[16]2014Males: 25-52 Female: 24-5348 villages and 15 urban wards of Jabalpur DistrictCross-sectional939Aged 20 yr and aboveW/H ratio > 0.85 for females and > 0.90 for malesJNC VII guidelineImportant confounders1Not mentionedMentioned97.02%
Bhadoria et al[16]2014Males: 25-52 Female: 24-53Villages of Jabalpur districtCross-sectional939Aged 20 yr and aboveBMI ≥ 27.5JNC VII guidelineImportant confounders1Not mentionedMentioned97.02%
Adhikari et al[17]201553.9 ± 12.7Semi-urban in Mangalore citycross-sectional800≥ 20 yrBMI ≥ 25JNC VII criteriaImportant confounders1 + serum cholesterol, serum triglyceridesMentioned and discussedMentioned and discussed68.80%
1Important confounder: Age, sex, family history, history of previous events, DM, diet, smoking, alcohol, no regular exercise, saturated fat intake, excess salt intake, sedentary physical activity. JNC VII criteria for diagnosis: Considering JNC 7 category guideline, normal blood pressure is defined as < 120/80 mmHg, prehypertension state is detected when systolic blood pressure (SBP) and diastolic blood pressure (DBP) is 120-139 mmHg and 80-89 mmHg respectively. If the blood pressure is > 140/90 mmHg it is diagnosed as hypertension with Stage 1 hypertension (when SBP and DBP are 140-159 mmHg and 90-99 mmHg respectively) and Stage 2 hypertension (when SBP and DBP are ≥ 160 mm Hg and ≥ 100 mmHg respectively). BMI: Body mass index; JNC: Joint National Committee.
Table 4 Characteristics of included obesity and type 2 diabetes mellitus studies
Ref.YearParticipants characteristics
Study characteristics
Measurements
Methodological quality of study
Age M (sd) in yrSettingStudy designSample sizeInclusion criteriaExposureOutcomeAdjusting confoundersSelection biasMeasure-ment errorResponse rate
Mohan et al[19]199655.5 ± 11.9TamilnaduCross-sectional1399Individuals aged ≥ 20 yrBMI ≥ 30 kg/m2Diabetes (WHO criteria)Important confounders1 +, SBP, DBPNot mentionedMentioned and discussed90.20%
Mohan et al[19]199655.5 ± 11.9TamilnaduCross-sectional1399individuals aged ≥ 20 yrWC ≥ 90 cmDiabetes (WHO criteria)Important confounders1 +, SBP, DBPNot mentionedMentioned and discussed90.20%
Kumar et al[20]Pub-lished year 200836.4KolkataCross-sectional2200Policemen with (monthly income: Rs.6000-15000), age (20 and 60 yr)BMIT2DMImportant confounders1 +, SBP, DBP,Not mentionedMentioned and discussed98.18%
Kumar et al[20]Pub-lished year 200836.4KolkataCross-sectional2200policemen with (monthly income: Rs.6000-15000), age (20 and 60 yr)WHRT2DMImportant confounders1 + SBP, DBPNot mentionedMentioned and discussed98.18%
Kumar et al[20]Pub-lished year 200836.4KolkataCross-sectional2200Policemen with (monthly income: Rs.6000-15000), age: 20 and 60 yrWCT2DMImportant confounders1 SBP, DBPNot mentionedMentioned and discussed98.18%
Bharati et al[21]200720-49Rural and urban field practice area.Cross-sectional1370Adults: ≥ 20 yrBMI > 30T2DM (ADA classif-ication)Important confounders1 + blood cholesterol, hypertensionNot mentionedNot mentioned100%
Bharati et al[21]200720-49Rural and urban field practice areaCross-sectional1370Adults: ≥ 20 yrWHRT2DM (ADA classifi-cation)Important confounders1 + blood cholesterol, hypertensionNot mentionedNot mentioned100%
Ravindra Singh et al[24]2012-1330-39Agra CityCross-sectional633Adults: ≥ 30 yr residing in Agra CityBMIT2DM (WHO criteria)Important confounders1Not mentionedNot mentioned100%
Ravindra Singh et al[24]2012-1330-39Agra CityCross-sectional633Adults: ≥ 30 yr residing in Agra CityWHRT2DM (WHO criteria)Important confounders1Not mentionedNot mentioned100%
Ravindra Singh et al[24]2012-1330-39Agra CityCross-sectional633Adults: ≥ 30 yr residing in Agra CityWC (> 88 cm for female and > 102 cm for male)T2DM (WHO criteria)Important confounders1Not mentionedNot mentioned100%
Ghor-pade et al[22]200735-50Rural TamilnaduCohort1403Adults > 25 yr of age from selected populationBMI ≥ 23T2DMImportant confounders1 + n work status, Alcohol intakeMentionedMentioned and discussed85%
Vijaya-kumar et al[23]200730-44Urban KeralaCross-sectional1990≥ 18 yr, residing since t 6 moWHR (< 0.80 in women, 0.90 in men)T2DM (Those with diabetes, and ADA classi-fication)Important confounders1 + hyperchol-esterolemia, elevated BPNot mentionedNot mentioned82.70%
1Important confounders: Age, family history, sex, dietary habit, social economic status. As per WHO and ADA classification, diagnosis of diabetes is confirmed when fasting plasma glucose is ≥ 7 mmol/L (126 mg/dL) or 2 h plasma glucose is ≥ 11.1 mmol/L (200 mg/dL). Impaired glucose tolerance (IGT) test and impaired fasting glucose (IFG) test is considered as positive when the fasting plasma glucose is < 7 mmol/L (126 mg/dL) and 6.1 to 6.9 mmol/L (110 mg/dL to 125 mg/dL) respectively, 2 h plasma glucose is ≥ 7.8 and < 11.1 mmol/L (140 mg/dL and 200 mg/dL) and < 7.8 mmol/L (140 mg/dL) respectively. Both: Males and females; NA: Not available; ADA classification of diabetes: Fasting: ≥ 126 mg/dL; DBP: Diastolic blood pressure; SBP: Systolic blood pressure; ADA: American Diabetes Association; JNC: Joint National Committee; WHO: World Health Organization; T2DM: Type 2 diabetes mellitus; WC: Waist circumference; WHR: Waist to hip ratio; BMI: Body mass index.