Association of central obesity and insulin resistance with high prevalenceof diabetes and cardiovascular disease in an elderly population with low fat intake and lower than normal prevalence of obesity: the Indian paradox

Objective To test the hypothesis that high prevalences of cardiovascular di sease and diabetes in urban population of India are manifestations of insul in-resistance syndrome. Design and setting Cross-sectional surveys were conducted in 20 streets in the city of Moradabad and in two villages. Subjects and methods There were 566 subjects (255 rural and 311 urban) aged 60-84 years. All subjects were divided on the basis of their insensitivity to insulin into groups with mild, moderate and high insensitivity to insul in and data from both sexes were pooled for analysis. Results Overall increases in the prevalences of coronary disease, diabetes, hypertension, central obesity and associated disturbances were observed wi th increasing insensitivity to insulin and the trend was more significant a mong urban than it was among rural subjects. Multivariate logistic regressi on analysis revealed a significant positive association of level of insulin insensitivity with the age-adjusted prevalences of coronary disease, hyper tension, diabetes, hypertriglyceridaemia, intolerance of glucose and centra l obesity among urban subjects. We observed a significant inverse associati on between insensitivity to insulin and physical activity both for rural an d for urban subjects and between insensitivity to insulin and high-density lipoprotein cholesterol level for urban subjects. For rural subjects, we fo und significant associations of sensitivity to insulin with coronary artery disease and intolerance of glucose without significant associations with o ther risk factors. Conclusion Insensitivity to insulin was significantly associated with risks of cardiovascular disease and diabetes, despite there being a low prevalen ce of obesity (9.0%) among urban subjects. Hypertension, diabetes, hypertri glyceridaemia, intolerance of glucose and central obesity were significantl y associated with insensitivity to insulin and coronary disease for urban b ut not for rural people. Coronary Artery Dis 9:559-565 (C) 1998 Lippincott Williams & Wilkins.