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OBESITY: AN EMERGING THREAT Dr. Nikhil Tandon Additional Professor Department of Endocrinology All India Institute of Medical Sciences New Delhi
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PREVALENCE OF OBESITY IN DELHI SCHOOL CHILDREN FROM DIFFERENT SOCIO -ECONOMIC GROUPS 0 200 400 600 800 1000 1200 1400 PrivateBoysGirlsGovt. Total Non-obese Obese /Overwt. 23.9 28.7 1.5 24.4 Tandon and colleagues, 2004
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Obesity in Children and Young Adults Obesity Abdominal Obesity Misra and colleagues, International Journal of Obesity, 2004
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Childhood Obesity is the Important Determinant for Diabetes in Children Snapshot Youth-onset Type 2 diabetes is a real concern in many countries Our data show that increase fat over chest and abdomen is a extremely important determinant of youth-onset diabetes
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Type 2 Diabetes Mellitus in Children, Adolescents and Young Adult Asian Indians (CAYA-2DM Trial): A Multicenter Collaborative study Objective To study the anthropometric, biochemical and immunological profiles of children, adolescents and young adults with type 2 diabetes mellitus and compare them with age-matched healthy controls
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Subjects: 31 patients; 59 age-matched healthy controls Anthropometric Profile: Body mass index, waist circumference, waist-hip ratio, skinfold thickness at 8 sites Percentage body fat by two-point bioelectrical impedance CAYA-2DM Trial Methods
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Variable(s)Cases (n=31)Controls (n=59) Pulse rate81.6±10.383.2±10.2 Systolic BP (mmHg) 121.5±12.3114.7±12.2*** Diastolic BP (mmHg) 76.6±11.175.1±11.0 BMI (kg/m 2 )24.7±5.320.8±5.3** Waist Circumference (cm) 83.0±15.470.9±15.2*** Waist Hip Ratio0.89±0.070.80±0.07*** *:p<0.05; **: p<0.01; ***: p<0.001 CAYA-2DM Trial Comparative Clinical Profile
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CAYA-2DM Trial Comparison of Cases and Controls Variable(s)Cases (n=31)Controls (n=59) Skinfold thickness (mm) Biceps13.8±6.38.7±6.3** Triceps21.2±8.815.6±8.7* Subscapular29.0±10.717.5±10.7*** Suprailiac29.7±12.418.9±12.3** Thigh31.7±13.225.5±13.0 Calf19.5±7.317.3±7.2 Percent body fat33.1±9.723.9±9.6*** *:p<0.05; **: p<0.01; ***: p<0.001
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CAYA-2DM Trial Comparison of Cases and Controls Variable(s)Cases (n=31)Controls (n=59) Overweight (BMI>25 kg/m 2 )42.98.5** High %BF (>25% M, >30% F)59.319.0** High WC (>102 cm M, > 88 F)21.45.1* High W-HR (>0.95 M,> 0.80 F)46.410.36** Hypercholesterolemia (>200 mg/dL)21.45.1* Hypertriglyceridemia (>150 mg/dL)39.35.1** Low HDL-C (< 40 M, < 50 F)46.423.7* High LDL-C (>130 mg/dL)7.15.1 *:p<0.05; **: p<0.01; ***: p<0.001
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Generalized (high BMI) as well as abdominal obesity (high W-HR) are the most important predictors for early onset of IGT and T2DM in Asian Indians. CAYA-2DM Trial Conclusions
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How to Predict Diabetes in Children ParameterRisk Abdominal obesity & family history of diabetes 68 times
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CAYA-2DM Trial Weight Percentiles of Cases: Birth and Current
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ISSUES Increasing obesity Contributory factors: - calorie dense food - consumption of processed foods - limited physical activity - sedentary interests: computers, TV, video games THE SEED FOR ADULT OBESITY IS SOWN EARLY - CHILDHOOD
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INTERVENTIONS Catch them young - school age children must be targeted Increase awareness: media; school teachers; governmental and NGO effort Minimise advertising pressure for “junk foods” School play grounds; “Games periods” Health food in school canteens
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