Indian Journal of Public Health

: 2017  |  Volume : 61  |  Issue : 3  |  Page : 208--210

Correlates of cardiometabolic risk factors among women of an ethnic tribal community of Tripura

Purnajita Sen1, Sandeep Das1, Dipayan Choudhuri2,  
1 Research Scholar, Department of Human Physiology, Tripura University (A Central University), Agartala, Tripura, India
2 Associate Professor, Department of Human Physiology, Tripura University (A Central University), Agartala, Tripura, India

Correspondence Address:
Dipayan Choudhuri
Department of Human Physiology, Tripura University (A Central University), Suryamaninagar, Agartala - 799 022, Tripura


Cardiometabolic health status of 356 women (age 25–65 years) from Tripuri tribal community of Tripura, a Northeastern state of India was evaluated. The height, weight, waist, hip circumference and blood pressure, blood sugar, total cholesterol, triglyceride; high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol were recorded. Cardiometabolic risk was assessed according to the recent definition for Asian Indians. The overall prevalence of cardiometabolic risk was found to be 27.24%. Postmenopausal women showed a higher prevalence of risk than premenopausal women. Central obesity was the most prevalent risk component among all the subjects. The urban population with high income and higher education level with sedentary lifestyle were more prone to cardiometabolic risk. The study revealed that a substantial proportion of ethnic Tripuri women are having prevalence of different cardiometabolic risk factors. The fact needs to be taken into consideration while considering strategies to mitigate noncommunicable disease burden of the population.

How to cite this article:
Sen P, Das S, Choudhuri D. Correlates of cardiometabolic risk factors among women of an ethnic tribal community of Tripura.Indian J Public Health 2017;61:208-210

How to cite this URL:
Sen P, Das S, Choudhuri D. Correlates of cardiometabolic risk factors among women of an ethnic tribal community of Tripura. Indian J Public Health [serial online] 2017 [cited 2019 Jun 17 ];61:208-210
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An improved health-care delivery system combined with rapid urbanization, industrialization, and changing lifestyle pattern during the past few decades resulted in a global transition of disease pattern from communicable to noncommunicable diseases. Cardiovascular disorders once considered to affect only the affluent class have now been identified to effect people from all sections of the society and play an important determinant role for difference in life expectancy between indigenous and nonindigenous population across the world.[1]

Various epidemiological studies recorded adverse cardiometabolic health status among South Asians, including Indians, owing mainly to the high prevalence of central obesity in them. However, most of these observations were based on studies conducted in a conglomerate of population without taking ethnicity of the population into consideration. Available data indicated that the cluster of different modifiable cardiometabolic risk factors including central obesity, dyslipidemia, hyperglycemia, and hypertension vary across different ethnic groups and were dependent on extent of urbanization, lifestyle pattern, and socioeconomic and cultural factors.[2] Therefore, it seemed important to assess cardiometabolic risk profile of different population groups including the ethnic population of the country.

Traditionally, male was considered to be affected predominantly by cardiometabolic disorders. Recent evidence indicated that cardiometabolic disorders emerged as the major reason of death in women also worldwide, especially during their postmenopausal stage of life. Still, very few epidemiological studies were conducted so far on burden of cardiometabolic risk involving women from indigenous ethnic population of Northeast India and particularly from Tripura. Therefore, we undertook the present study to assess the burden of cardiometabolic risk and to evaluate the determinant role of several sociodemographic characteristics on various known cardiometabolic risk factors among women from the most dominant tribal community of Tripura, the Tripuries.

The study was conducted during the health camp organized by Prajapita Brahma Kumaris Ishwariya Vishwa Vidyalaya, Tripura, in February 2014 and February 2015. Three hundred and fifty-six women (25–65 years of age) were included in this study. One hundred and ninety of them were from premenopausal (25–45 years), and 166 were from postmenopausal (46–65 years) age groups. An informed consent was obtained from all the subjects before participating in the study. Ethical clearance was obtained from the Institutional Human Ethical Committee. The sample size for the study was calculated taking 30% prevalence with 95% of confidence interval (CI) and 5% absolute precision.

Socioeconomic status and dietary history of the subjects were evaluated through questionnaire. The marital status, history of menstrual cycle, and number of children of each subject were recorded. History of past and present illness and medication were recorded. Subjects having clinically confirmed pregnancy, diabetes, hypertension, polycystic ovary, any forms of cardiometabolic disorder or on the use of oral contraceptives were excluded from the study.

Anthropometric parameters such as height, weight, hip, and waist circumference of the subject were recorded following standard procedure. Body mass index and waist-to-hip ratio, and waist-to-height ratio (WHtR) were calculated. Blood pressure of the subject was recorded in the supine position. The blood glucose level was estimated using Digilab auto colorimeter. Serum total cholesterol, high-density lipoprotein (HDL) cholesterol, and triglyceride were estimated using commercially available kits in a full auto analyzer (ERBA-EM 200). The age of the subject was recorded as reported by the subject themselves.

Cardiometabolic risk of the subject was evaluated according to consensus statement for diagnosis of general obesity, abdominal obesity, and metabolic syndrome for Asian Indians according to the Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. The statistical analysis were performed using the PC version of SPSS statistical software (SPSS version 20, IBM, Armonk, New york, USA).

Analysis revealed that central obesity was the most prevalent cardiometabolic risk component in our study population. It was followed by elevated blood pressure, hyperglycemia, and altered lipid profile [Table 1]. The odds ratio and 95% CI of cardiometabolic risk and each component of the risk factors according to socioeconomic status showed that the prevalence of cardiometabolic risk was 2.48 times more likely (CI: 1.5365–4.0197) in postmenopausal women than premenopausal women (P = 0.0002). According to socioeconomic strata urbanity (CI: 1.33–3.54, P = 0.0018), sedentary working (CI: 2.0400–5.4589, P = 0.0001), high education (CI: 1.06–3.22, P = 0.02), and high-income groups (CI: 0.7205–2.0289, P = 0.4723) have been considered to be susceptible to cardiometabolic risk [Table 2]. The Chi-square values for all the variables were found to be significant. This indicated that the model was better fitted for predicting cardiometabolic risk in Tripuri tribal women.{Table 1}{Table 2}

The overall prevalence of cardiometabolic risk in Tripuri women was found to be 27.24%. This finding was in agreement with published reports on burden of cardiometabolic risk in women from various parts of the world including India. Sarkar et al. in their study with two tribal populations of India, Bhutia and Toto, observed 50% prevalence of metabolic syndrome among women from Bhutia community. The prevalence of metabolic syndrome was not that high among Toto women, but their lipid levels were found to be alarmingly adverse.[3] Prasad et al. observed a prevalence of 42.3% among females belonging to an underdeveloped Urban locality of Eastern India.[4] A multicenter nationwide study from India, including population from Dibrugarh, Assam of North East India, observed a high prevalence of several cardiovascular risk factors among subjects from both the sexes.[5] We observed substantially higher prevalence of risk factors among postmenopausal women than that of premenopausal Tripuri women. Earlier studies conducted in India documented a prevalence ranging from 13.8% in premenopausal to over 60% in postmenopausal women. The cardiometabolic risk in Tripuri women increased steadily with age with highest prevalence seen in women of 51–60 years of age. Similar to our findings, Kanjilal et al. in their study to among Asian Indians observed that number of subjects with metabolic syndrome was highest in 50–59 years age group.[6] In an earlier study, we observed 28.46% prevalence of cardio metabolic risk among premenopausal women belonging to a mixed Indian population from Agartala city, Tripura, using Adult Treatment Panel III National Cholesterol Education Program criteria.[7] It was assumed that the effect of endogenous estrogen against atherosclerosis in premenopausal women might protect them against cardiometabolic risk.

As in other studies, central obesity marked by increased waist circumference (≥80 cm) was found to be the most prevalent cardiometabolic risk factor in Tripuri women, followed by blood pressure, and hyperglycemia. Interestingly, both hypertriglyceridemia and reduced HDL cholesterol were found to be less prevalent risk factors compared to central obesity, hypertension, and hyperglycemia. Atherogenic dyslipidemia is common in South Asians with lower HDL and high level of low-density lipoprotein compared to Caucasians across all strata of society. The high rate of obesity is reported for the indigenous populations from studies conducted in different parts of the world including Australia, New Zealand, and the US. Obesity and related cardiometabolic risk have clearly emerged as a public health problem effecting almost all population including indigenous groups. Bordoloi and Kapoor observed a positive correlation of waist circumference and WHtR with blood pressure indicating regional obesity to be the risk factor for cardiovascular health in Kolita, a biologically isolated caste population of the state of Assam.[8] Lokanath et al. conducted a cross-sectional study on cardiometabolic risk among Kodava population of Mysore district of Karnataka and observed that female subjects and middle-aged subjects with increased waist circumference were more susceptible to metabolic syndrome and increased cardiovascular risk.[9]

Sociodemographic analysis of the study subjects revealed that urban subjects were having higher prevalence of cardiometabolic risk than the rural subjects. Sarkar et al. in their study, have not found any rural-urban difference in the prevalence of cardiometabolic syndrome among a population of Bhutia tribes, however, in case of Toto tribes, the prevalence in rural community was found to be low.[3] The prevalence, in our study, was also found to be high among educated group with higher monthly income and in people with sedentary lifestyle. These findings are in agreement with studies on different population across the worl d which indicates that sociodemographic characteristics play an important determinant role in the prevalence of cardiometabolic risk irrespective of origin or ethnicity of the population. Phipps et al. recently evaluated cardiometabolic risk factors for seven indigenous communities in Malaysia and reported variable prevalence of obesity, diabetes, cholesterol, and hypertension which might be linked to their socioeconomic status, lifestyle changes, and even genetic predispositions.[10]

In conclusion, our study revealed that women from indigenous Tripuri community from a small state of India are at the similar level of risk for cardiometabolic diseases such as other population of India owing to a rapid change in lifestyle pattern and narrowing of the urban and rural gap. Therefore, efforts taken by the policy makers to mitigate the increasing cardiometabolic risk in the population must be strengthen further.

Financial support and sponsorship

This study was financially supported by Tripura University (A Central University), Suryamaninagar, Agartala, Tripura, India.

Conflicts of interest

There are no conflicts of interest.


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