Published online Aug 26, 2022. doi: 10.4330/wjc.v14.i8.462
Peer-review started: March 1, 2022
First decision: April 17, 2022
Revised: April 29, 2022
Accepted: July 20, 2022
Article in press: July 20, 2022
Published online: August 26, 2022
Processing time: 170 Days and 9.7 Hours
Existing data suggest significant beta cell dysfunction and insulin resistance (IR) in Asian Indians, even in the absence of diabetes. This dual pathophysiological defect, manifested at a lower body mass index (BMI) and younger age, explains the huge burden of dysglycaemia in South Asians. Importantly, most studies on this subject were performed in a relatively older population (mean age in 40s or 50s), in those at high risk for diabetes, screened and selected for clinical trials, or in individuals of this ethnicity residing outside South Asia. Thus, there is an unmet need to evaluate the burden of cardiometabolic risk factors in young South Asian adults, who are not preselected for glycaemia.
There is an unmet need to evaluate the burden of cardiometabolic risk factors in young South Asian adults, who are not preselected for glycaemia.
To evaluate young North Indian men (aged 20-50 years) for: (1) Burden of glycemic and cardiometabolic traits; and (2) Their relation to parameters of insulin action and beta-cell function.
Study participants were invited in a fasting state. Sociodemographic, anthropometric, and medical data were collected, and 75 g oral glucose tolerance test was performed with serum insulin and plasma glucose estimation at 0, 30, and 120 min. Participants were divided into quartiles for homeostatic model assessment for IR (HOMA-IR) and oDI (category 1: Best HOMA-IR/oDI quartile; category 3: Worst HOMA-IR/oDI quartile) and composite HOMA-IR/oDI phenotypes (phenotype 1: Best quartile for both HOMA-IR and oDI; phenotype 4: Worst quartile for both HOMA-IR and oDI) were derived.
We evaluated a total of 635 men at a mean (± SD) age of 33.9 ± 5.1 years and BMI of 26.0 ± 3.9 kg/m2. Diabetes and prediabetes were present in 34 (5.4%) and 297 (46.8%) participants, respectively. Overweight/obesity, metabolic syndrome, and hypertension were present in 388 (61.1%), 258 (40.6%), and 123 (19.4%) participants, respectively. The prevalence of dysglycaemia, metabolic syndrome, and hypertension was significantly higher in participants belonging to the worst HOMA-IR and oDI quartiles, either alone (category 3 vs 1) or in combination (phenotype 4 vs 1). The adjusted odds ratios for dysglycaemia (6.5 to 7.0-fold), hypertension (2.9 to 3.6-fold), and metabolic syndrome (4.0 to 12.2-fold) were significantly higher in individuals in the worst quartile of HOMA-IR and oDI (category 3), compared to those in the best quartile (category 1). The adjusted odds ratios further increased to 21.1, 5.6, and 13.7, respectively, in individuals with the worst, compared to the best composite HOMA-IR/oDI phenotypes (phenotype 4 vs 1).
The burden of cardiometabolic risk factors is high among young Asian Indian men. Our findings highlight the importance of using parameters of IR and beta-cell function in phenotyping individuals for cardiometabolic risk.
We evaluated a large cohort of young Asian India men for the burden of cardiometabolic risk factors in relation to parameters of IR and beta-cell function. Apart from the traditional risk factors such as age and BMI, across which abnormal cardiometabolic traits increased, we found that individuals in the most severely affected quartiles of IR (HOMA-IR), beta-cell function (oDI), and a combination of both had a significantly higher burden of dysglycaemia, hypertension, metabolic syndrome, and adverse lipid parameters. These findings highlight the importance of using parameters of IR and beta-cell function in phenotyping individuals for cardiometabolic risk.