Anamitra Barik1, Ravi V Shah2, Aferdita Spahillari3, Venkatesh L Murthy4, Bharath Ambale-Venkatesh5, Rajesh Kumar Rai6, Kaushik Das7, Amal Santra8, Jaba Ranjan Hembram9, Dilip Bhattacharya10, Jane E Freedman11, Joao Lima12, Ranendra Das13, Pinakpani Bhattacharyya14, Saumya Das15, Abhijit Chowdhury16. 1. Birbhum Population Project, Society for Health and Demographic Surveillance, Suri, West Bengal, India. Electronic address: anomitro2010@gmail.com. 2. Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United States. Electronic address: rvshah@partners.org. 3. Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States. Electronic address: aspahill@bidmc.harvard.edu. 4. Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor, MI, United States. Electronic address: vlmurthy@med.umich.edu. 5. Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, MD, United States. Electronic address: bambale1@jhmi.edu. 6. Birbhum Population Project, Society for Health and Demographic Surveillance, Suri, West Bengal, India. Electronic address: rajesh.iips28@gmail.com. 7. Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education and Research, Kolkata, India. Electronic address: kausikdasmail@gmail.com. 8. Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education and Research, Kolkata, India. Electronic address: asantra2000@yahoo.co.in. 9. Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education and Research, Kolkata, India. Electronic address: jhembram3@gmail.com. 10. Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education and Research, Kolkata, India. Electronic address: SHDS@rediffmail.com. 11. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States. Electronic address: jane.freedman@umassmed.edu. 12. Department of Cardiology, Johns Hopkins University, Baltimore, MD, United States. Electronic address: jlima@jhmi.edu. 13. Institute for Socioeconomic Research and Development, Delhi, India. Electronic address: das.ranen@gmail.com. 14. Quadra Medical Services, Kolkata, India. Electronic address: pinakpanidr@hotmail.com. 15. Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United States. Electronic address: sdas@partners.org. 16. Birbhum Population Project, Society for Health and Demographic Surveillance, Suri, West Bengal, India; Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education and Research, Kolkata, India. Electronic address: achowdhury2002@yahoo.co.in.
Abstract
BACKGROUND/ OBJECTIVES: While adiposity and hepatic steatosis are linked to cardiovascular risk in developed countries, their prevalence and impact in low-income countries are poorly understood. We investigated the association of anthropomorphic variables and hepatic steatosis with cardiometabolic risk profiles and subclinical cardiovascular disease (CVD) in a large rural Indian cohort. METHODS: In 4691 individuals in the Birbhum Population Project in West Bengal, India, we performed liver ultrasonography, carotid ultrasound and biochemical and clinical profiling. We assessed the association of hepatic steatosis and anthropomorphic indices (BMI, waist circumference) with CVD risk factors (dysglycemia, dyslipidemia, hypertension) and subclinical CVD (by carotid intimal-medial thickness). RESULTS: Rural Indians exhibited a higher visceral adiposity index and pro-atherogenic dyslipidemia at a lower BMI than Americans. Individuals with any degree of hepatic steatosis by ultrasound had a greater probability of dysglycemia (adjusted odds ratio, OR=1.67, 95% CI 1.31-2.12, P<0.0001) and pro-atherogenic dyslipidemia (OR=1.33, 95% CI 1.07-1.63, P=0.009). We observed a positive association between liver fat, adiposity and carotid intimal-medial thickness (CIMT) in an unadjusted model (β=0.02, P=0.0001); the former was extinguished after adjustment for cardiometabolic risk factors. CONCLUSIONS: In a large population of rural Indians, hepatic steatosis and waist circumference were associated with prevalent cardiometabolic risk and subclinical CVD at lower BMI relative to multi-ethnic Americans, though the association of the former with subclinical CVD was extinguished after adjustment. These results underscore the emerging relevance of hepatic steatosis and adiposity in the developing world, and suggest efforts to target these accessible phenotypes for cardiometabolic risk prevention.
BACKGROUND/ OBJECTIVES: While adiposity and hepatic steatosis are linked to cardiovascular risk in developed countries, their prevalence and impact in low-income countries are poorly understood. We investigated the association of anthropomorphic variables and hepatic steatosis with cardiometabolic risk profiles and subclinical cardiovascular disease (CVD) in a large rural Indian cohort. METHODS: In 4691 individuals in the Birbhum Population Project in West Bengal, India, we performed liver ultrasonography, carotid ultrasound and biochemical and clinical profiling. We assessed the association of hepatic steatosis and anthropomorphic indices (BMI, waist circumference) with CVD risk factors (dysglycemia, dyslipidemia, hypertension) and subclinical CVD (by carotid intimal-medial thickness). RESULTS: Rural Indians exhibited a higher visceral adiposity index and pro-atherogenic dyslipidemia at a lower BMI than Americans. Individuals with any degree of hepatic steatosis by ultrasound had a greater probability of dysglycemia (adjusted odds ratio, OR=1.67, 95% CI 1.31-2.12, P<0.0001) and pro-atherogenic dyslipidemia (OR=1.33, 95% CI 1.07-1.63, P=0.009). We observed a positive association between liver fat, adiposity and carotid intimal-medial thickness (CIMT) in an unadjusted model (β=0.02, P=0.0001); the former was extinguished after adjustment for cardiometabolic risk factors. CONCLUSIONS: In a large population of rural Indians, hepatic steatosis and waist circumference were associated with prevalent cardiometabolic risk and subclinical CVD at lower BMI relative to multi-ethnic Americans, though the association of the former with subclinical CVD was extinguished after adjustment. These results underscore the emerging relevance of hepatic steatosis and adiposity in the developing world, and suggest efforts to target these accessible phenotypes for cardiometabolic risk prevention.