1. Dr Chandra Mohan Kumar, MD,PGDAP Associate Professor, HIMSR

2. Problem Cardiovascular Diseases CVD has become most important group of preventable diseases for the human race As they begin in childhood and manifest due to interactions & accumulation of various risk factors, throughout the life cycle. Risk reduction delays progression

3. Cardiometabolic Risks Obesity and Overweight Sedentary Lifestyle Smoking High Triglycerides Low HDL Cholesterol Impaired Fasting Glucose/Impaired GTT Family history of Cardiac Death

4. VariablePercentage (%) Obesity (BMI)50.1 Diabetes24 Impaired fasting glucose8.5 Hypercholesterolemia26.6 Hypertriglyceridemia42.7 LDL-C > 100 mg/dl51.6 HDL-C < 40 mg/dl (Males) <50 mg/dl (Females) 37 Prevalence of cardio-metabolic risk factors in urban adult population of New Delhi, India (n = 459) PLoS One 2011, 6, e24362

5. Adolescent Obesity The worldwide prevalence of childhood overweight and obesity increased from 4.2% (95% CI: 3.2%, 5.2%) in 1990 to 6.7% (95% CI: 5.6%, 7.7%) in 2010 The situation has worsened faster in developed nations In US, prevalence of adolescent obesity has trebled in last three decades with current estimates indicating that 1/3 rd of adolescents being obese/overweight

7. Childhood Obesity- Indian Scenario Percentage of overweight children in various studies in last 10 years -Delhi 32%, Pune 25%, Chennai 22% Many of the studies have used IOTF cut offs rather than WHO hence it may underestimate the actual burden. Indian children have a higher fat distribution in trunk region Urban area HIG children are more likely to develop central obesity BMC Pediatrics 2011, 11:105, Indian Pediatr. 2011; 48:105-10

8. Obesity leads to Insulin Resistence Obesity, dyslipidemia, hyperglycaemia and hypertension are positively associated with insulin resistance and it leads to increased risk of type 2 diabetes and/ or cardiovascular disease Diab Care, 26 (2003), pp. 861–867

9. Sedentary Lifestyle Reduced physical activity Academic Pressure- Long School Hours and Tuitions 70% of adolescent school children in Delhi were physically inactive in the 10th and 12th classes, in which important academics are held  vehicles, reduced play areas  Screen Time on TV, Computer, Mobiles, Videogames At least 1 h per day of physical activity of at least moderate intensity to prevent clustering of cardiovascular disease risk factors Lancet 2006 Jul 22;368(9532):299-304

10. Dyslipidemia Main risk factor for CVD LDL and TGs above 90 th percentile HDL below 10 th percentile Dyslipidemia in Indians has been attributed to a multitude of factors, including physical inactivity, carbohydrate rich diet, abnormal body composition in particular excess truncal fat and increased intra abdominal fat and genetic predisposition

11. Does this make a teen COOL ??

12. But this definitely makes them HOT

13. Diabetes Prevalence T2DM increased in urban Indian adults from 12% in the year 2000 By the year 2025 it is predicted that India will have a rise of 59% of diabetics in the population... Which is the highest number of diabetic patients in the world We woke to this problem about a decade back when we realized that 10% of newly diagnosed DM are adolescents and most were asymptomatic picked up on screening for obesity or strong family history

14. Smoking Thirty per cent of the population 15 years or older (47% men and 14% of women) either smoked or chewed tobacco* The Global Youth Tobacco Survey (GYTS) 2006- - national prevalence of current tobacco use among school-going adolescents (between 13 to 15 years of age) 14.1% Tob Control 2003;12:e4 doi:10.1136/tc.12.4.e4

15. Family History A family history of CVD- the net effect of shared genetic, biochemical, behavioural and environmental components. Presence of a positive parental history doubled baseline risk for CVD. Am J Cardiol 1991;67(11): 933-938.. JAMA 2004;291(18):2204-2211.

16. Hypertension Prevalence of hypertension in children in India 6% in Delhi, 9.8% Ahmedabad and....................................................................................................................................................17.4 % Chennai!!!! In studies done in 80s and 90s it was between 0.5% to 2% Times of India April 7 th 2013

17. Likelihood of Premature Cardiac Death Current smokers were at 86% greater risk for early death than those classified as never smokers; Those with a waist-to-height ratio >0.65 were at 139% greater risk than those with a WHR <0.5; and Those with an HbA1c level >6.5% were at 281% greater risk than those with an HbA1c level <5.7% Cardiometabolic risk factors among US adolescents and young adults and risk of early mortality. Pediatrics. 2013 Mar;131(3):e679-86. doi: 10.1542/peds.2012-2583

18. Is the picture so gloomy? Government schools study shows only 3% were overweight Distribution by economic category presents another picture. In LIG category 3.3% and in MIG category 7% school children were obese Overall figures are estimated to be between 6-7% Studies from rural India( BHARAT) can present a more soothing picture Indian Pediatrics 2008; 45:330-331

19. Rays of Hope Globalization, IT use and Real-time Information Sharing Recent studies of nationally representative samples suggest that the prevalence of obesity is stabilizing in USA There is improvement in lipid chemistry indicators in form of increase in HDL and decrease in triglyceride levels. Physical Activity and TV Viewing indicators also have shown improvement

20. Trends of Physical Activity and TV Viewing in US Pediatrics 2013;132:606–614

21. Trends in consumption of fruits, vegetables, sweets, and soft drinks

23. What to do first Adolescent Care and Counselling for preventive and promotive health care Weight loss leads to improvement in cardiometabolic profile In a Prevention Program, a modest weight loss was associated with a 34% reduction of diabetes incidence during a 10-year follow-up N Engl J Med 2002;346:393–403

24. IAP’s Efforts AHA President’s Action Plans IAP Task forces

25. Further Research Percentile scores for Lipids TG,LDL,HDL Prevalence of Obesity/Hypertension Changing Trends and Trendlines

26. Thank you