Investigation of Metabolic Risk Factors in Asian Indians: A Report from the Diabetes among Indian Americans National Study

The burden of diabetes and heart disease among Asian Indians (AI) diaspora is well documented but not well understood. Conventional risk factors (e.g., elevated LDL levels and triglycerides, health behavior, knowledge) do not account for the high prevalence of Metabolic Syndrome (MetS; a clustering of risk factors for diabetes and heart diseae) and hence emerging risk factors such as subfractions of lipid profiles, lipoprotein(a), homocysteine, and C-reactive protein may improve current explanatory models. The sample comprised of 1038 nationally representative AI population from Houston, Phoenix, Washington DC, Boston, San Diego, and Edison/Parsippany NJ. The primary outcome measure was MetS, computed using the International Diabetes Federation criteria and AI specific waist circumference (WC) guidelines. Emerging risk and traditional risk factors were differentially studied by gender and obesity. Adjusting for known confounders (demographic, health behavior, lifestyle, acculturation, and access to healthcare), results showed one additional MetS risk factor (instead of two as per IDF criteria) beyond elevated WC may be sufficient to determine MetS in this high-risk population. High WC was associated with 13 of the 19 traditional/emerging risk factors and its predictive capability for identifying overweight and obesity (based on cut-offs for Asians) makes our results an important (and easily monitored) biometric for MetS in AIs. Older age, males, family history, C-reactive protein, and LDL density pattern independently predicted MetS in the regression model (R2 =0.15). Identification of emerging risk factors would be helpful for diagnosis of MetS and group-specific patient education can reduce its prevalence in this population.