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      Prevalence of dyslipidemia, hypertension and diabetes among tribal and rural population in a south Indian forested region

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          Abstract

          While NCDs are in rise globally, tribal and rural populations residing near to reserve forests with limited exposure to modern lifestyles may bear a unique burden. This study investigates the prevalence and risk factors of hypertension, diabetes, and dyslipidemia among these communities. We conducted a cross-sectional study between 2018 and 2020 in the forest-dwelling population of Chamarajanagar, India. Using multistage stratified sampling based on caste and remoteness, we enrolled 608 participants aged over 18 years, including 259 non-tribal and 349 tribal individuals. Data collection includes the administration of STEPS questionnaire and measurement of fasting blood sugar, lipid levels, and blood pressure. The prevalence of diabetes, hypertension, and dyslipidemia were 4.6%, 28.8%, and 85.7%, respectively, among the study population. We also found abnormal levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL), Triglycerides (TGA), Total cholesterol (TC), and very low-density lipoprotein (VLDL)in 4.9%, 82.4%, 22.7%, 5.8%, and 7.4% of participants, respectively. Significant differences were observed in diabetes, LDL abnormality, TGA abnormality, VLDL abnormality, and TC abnormality, but not in hypertension, dyslipidemia, or HDL abnormality, across the Socio Geographic Discrimination Index. We found a significant difference in diabetes and HDL abnormality, but not in hypertension, dyslipidemia, LDL abnormality, TGA abnormality, TC abnormality, or VLDL abnormality, between tribal and non-tribal populations living in the forest-dwelling area. Waist circumference was a significant independent predictor of diabetes among tribal participants, while wealth index, age, and waist circumference were significant predictors of hypertension. There were no significant predictors for dyslipidemia among tribal participants. Our study suggests that tribal population living in a remote area are at a lower risk of developing diabetes compared to non-tribal populations living in the same geographic area. However, the prevalence of hypertension and dyslipidemia among tribal populations remains high and comparable to that of the general population.

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          Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.

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          A WHO expert consultation addressed the debate about interpretation of recommended body-mass index (BMI) cut-off points for determining overweight and obesity in Asian populations, and considered whether population-specific cut-off points for BMI are necessary. They reviewed scientific evidence that suggests that Asian populations have different associations between BMI, percentage of body fat, and health risks than do European populations. The consultation concluded that the proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMIs lower than the existing WHO cut-off point for overweight (> or =25 kg/m2). However, available data do not necessarily indicate a clear BMI cut-off point for all Asians for overweight or obesity. The cut-off point for observed risk varies from 22 kg/m2 to 25 kg/m2 in different Asian populations; for high risk it varies from 26 kg/m2 to 31 kg/m2. No attempt was made, therefore, to redefine cut-off points for each population separately. The consultation also agreed that the WHO BMI cut-off points should be retained as international classifications. The consultation identified further potential public health action points (23.0, 27.5, 32.5, and 37.5 kg/m2) along the continuum of BMI, and proposed methods by which countries could make decisions about the definitions of increased risk for their population.
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            2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).

            Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.
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              Global burden of hypertension: analysis of worldwide data.

              Reliable information about the prevalence of hypertension in different world regions is essential to the development of national and international health policies for prevention and control of this condition. We aimed to pool data from different regions of the world to estimate the overall prevalence and absolute burden of hypertension in 2000, and to estimate the global burden in 2025. We searched the published literature from Jan 1, 1980, to Dec 31, 2002, using MEDLINE, supplemented by a manual search of bibliographies of retrieved articles. We included studies that reported sex-specific and age-specific prevalence of hypertension in representative population samples. All data were obtained independently by two investigators with a standardised protocol and data-collection form. Overall, 26.4% (95% CI 26.0-26.8%) of the adult population in 2000 had hypertension (26.6% of men [26.0-27.2%] and 26.1% of women [25.5-26.6%]), and 29.2% (28.8-29.7%) were projected to have this condition by 2025 (29.0% of men [28.6-29.4%] and 29.5% of women [29.1-29.9%]). The estimated total number of adults with hypertension in 2000 was 972 million (957-987 million); 333 million (329-336 million) in economically developed countries and 639 million (625-654 million) in economically developing countries. The number of adults with hypertension in 2025 was predicted to increase by about 60% to a total of 1.56 billion (1.54-1.58 billion). Hypertension is an important public-health challenge worldwide. Prevention, detection, treatment, and control of this condition should receive high priority.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Project administrationRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: InvestigationRole: ResourcesRole: ValidationRole: Writing – review & editing
                Role: InvestigationRole: ResourcesRole: ValidationRole: Writing – review & editing
                Role: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLOS Glob Public Health
                PLOS Glob Public Health
                plos
                PLOS Global Public Health
                Public Library of Science (San Francisco, CA USA )
                2767-3375
                20 May 2024
                2024
                : 4
                : 5
                : e0002807
                Affiliations
                [1 ] Department of Community Medicine, Mysore Medical College and Research Institute, Mysore, India
                [2 ] Health Equity Cluster, Institute Public Health, Bengaluru, India
                [3 ] Research Scientist II, Multi-Disciplinary Research Unit, Mysore Medical College and Research, Mysore, India
                [4 ] Research Scientist-I, Multi-Disciplinary Research Unit, Mysore Medical College and Research, Mysore, India
                [5 ] Research Fellow, SingHealth Duke-NUS Global Health Institute, Singapore, Singapore
                [6 ] Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
                Sciensano, BELGIUM
                Author notes

                The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-4254-7093
                https://orcid.org/0000-0002-5045-5121
                https://orcid.org/0000-0003-4694-1423
                https://orcid.org/0000-0003-0607-5647
                https://orcid.org/0000-0003-4370-8933
                https://orcid.org/0000-0003-0968-0826
                Article
                PGPH-D-23-01277
                10.1371/journal.pgph.0002807
                11104681
                38768141
                a5e69e18-e6a0-4f79-834e-ef73933d5c03
                © 2024 Mallikarjuna Majgi et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 9 July 2023
                : 3 April 2024
                Page count
                Figures: 3, Tables: 5, Pages: 23
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100001411, Indian Council of Medical Research;
                Award ID: MRU/35/2018-19
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100009053, The Wellcome Trust DBT India Alliance;
                Award ID: IA/CPHI/16/1/502648 and IA/CRC/20/1/600007
                Award Recipient :
                This study was partially funded by Multi-disciplinary Research Unit part of ICMR, India (unique ID- MRU/35/2018-19) and partially by DBT/Wellcome Trust India Alliance fellowship to Dr. Prashanth N Srinivas [IA/CPHI/16/1/502648] (Supports to PNS and YCB) and Clinical & Public Health Research Centres grant Centre for Training, Research, and Innovation in Tribal Health (CTRITH) IA/CRC/20/1/600007 awarded to Prashanth NS, Suresh Shapeti, Deepa Bhat and Upendra Bhojani (Supports to PNS and YCB). Multi-disciplinary Research Unit part of ICMR, India has given funding for the testing kits awarded to Sumanth Mallikarjuna Majgi. Transportation, manpower and other logistics were provided by DBT/Wellcome Trust India Alliance grant awarded to Prashanth N Srinivas. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Medical Conditions
                Metabolic Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Hypertension
                Medicine and Health Sciences
                Medical Conditions
                Metabolic Disorders
                Dyslipidemia
                Medicine and Health Sciences
                Medical Conditions
                Noncommunicable Diseases
                Biology and Life Sciences
                Nutrition
                Diet
                Alcohol Consumption
                Medicine and Health Sciences
                Nutrition
                Diet
                Alcohol Consumption
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Obesity
                Medicine and Health Sciences
                Public and Occupational Health
                Physical Activity
                Biology and Life Sciences
                Biochemistry
                Lipids
                Cholesterol
                Custom metadata
                Data is available in Figshare. Figshare: Prevalence of Dyslipidemia, Hypertension, and Diabetes among Adivasi and rural population in a South Indian forested region data set https://figshare.com/articles/dataset/Prevalence_of_Dyslipidemia_Hypertension_and_Diabetes_among_Adivasi_and_rural_population_in_a_South_Indian_forested_region_data_set/23561328.

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