|Year : 2022 | Volume
| Issue : 1 | Page : 3-8
Prevalence of obesity and hypertension and its associated risk factors among chiru females of Manipur
Hosea Thanglen1, Lorho Mary Maheo2
1 Research Scholar, Department of Anthropology, Manipur University, Imphal, Manipur, India
2 Associate Professor, Department of Anthropology, D. M. College of Science, Imphal, Manipur, India
|Date of Submission||05-Jul-2021|
|Date of Decision||12-Nov-2021|
|Date of Acceptance||19-Dec-2021|
|Date of Web Publication||5-Apr-2022|
Research Scholar, Department of Anthropology, Manipur University, Canchipur, Imphal - 795 003, Manipur
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Obesity and hypertension are two well-known public health issues associated with a very high risk of cardiovascular diseases worldwide. It has become increasingly prevalent with the advancing chronological age and developing of noncommunicable diseases such as hypertension, diabetes, cancer, and respiratory diseases. Objectives: The paper aims to determine the prevalence of obesity and hypertension and their associated risk factors among the Chiru females of Manipur. Methods: A cross-sectional study was conducted among 207 Chiru females of Manipur, whose ages ranged from 20 to 79 years. Anthropometric and blood pressure were measured using standard procedures. Statistical methods such as Chi-square, Pearson correlation, and odds ratio (OR) were employed. Results: The nutritional status of the overweight and the obese are 33.3% and 11.6%. The overall prevalence of high blood pressure was 22.2%. This study observed a significant Pearson correlation between blood pressure and body mass index (BMI), age, physical activity, salt intake, smoking, and alcohol. The binary logistic regression, in terms of OR and coefficient of correlation, shows enough shreds of evidence that BMI and lifestyle factors are strongly associated and correlated with hypertension. Conclusion: The present study found a high prevalence of overweight and obesity among Chiru females, which might have contributed to the overall moderate prevalence of hypertension. Smoking, physical inactivity, and salt intake involve a significant risk of hypertension. Therefore, lifestyle has dramatically influenced the Chiru females of Manipur in terms of hypertension and obesity.
Keywords: Body mass index, Chiru, diastolic blood pressure, hypertension, lifestyle, risk factors, systolic blood pressure
|How to cite this article:|
Thanglen H, Maheo LM. Prevalence of obesity and hypertension and its associated risk factors among chiru females of Manipur. Indian J Public Health 2022;66:3-8
|How to cite this URL:|
Thanglen H, Maheo LM. Prevalence of obesity and hypertension and its associated risk factors among chiru females of Manipur. Indian J Public Health [serial online] 2022 [cited 2022 May 27];66:3-8. Available from: https://www.ijph.in/text.asp?2022/66/1/3/342591
| Introduction|| |
Globally, obesity is considered to be a well-known public health issue with rising prevalence in both developed and developing countries as almost two-third of adult populations are overweight. According to a World Health Organization report, increased cases of obesity from 1975 to 2016 have almost tripled; more than 1.9 billion and over 650 million people worldwide were overweight and obese in 2016. Thirty-nine percent of adults (39% men and 40% women) were overweight, and 13% adult population (11% men and 15% women) were obese in 2016. A recent report also estimated that about 60%–70% of high blood pressure in adults is accountable to obesity. The prevalence of overweight and obesity among Indian women has increased considerably in the past one and a half-decade. Chandigarh, Lakshadweep, Andhra Pradesh, Puducherry, Delhi, Gao, Punjab, Telangana, Tamil Nadu, and Daman and Diu are the ten states and union territories having the highest prevalence of obesity in order of ranking as per the National Family Health Survey (NFHS-4), 2015–2016. The reports also estimated that obesity among Indian women is higher and double than that of the male population in Indian states and union territories. Body mass index (BMI) is considered the most acceptable and widely used standard measurement of obesity to predict and screen hypertension. Hypertension is regarded as one of the most common cardiovascular disorders, posing a major public health challenge to the individual and population in epidemiological transition. According to the World Health Organization report 2015, the overall prevalence of high blood pressure among adults aged 18 years and above was assessed to be 25.9% among males and 24.8% among females. One in four adult men and one in every five adult women (i.e., 22% of the adults aged 18 years and over) had hypertension in 2015. A recent trend indicates that the number of individuals with hypertension has significantly risen from 594 million in 1975 to a higher rate of 1.13 billion in 2015, which primarily increased among low- and middle-income countries. Overweight, obesity, and hypertension are enormous global health issues and are among the clinical challenges in the modern contemporary world. This study aims to determine the prevalence of overweight, obesity, and its association with hypertension using anthropometric and physiological variables among Chiru females of Manipur.
Brief profile of the study population
Chiru is one of the 33 recognized Scheduled tribes of Manipur, inhabiting mainly in Manipur and Assam of northeast India. In Manipur, they are mainly settled in the hill districts of Kangpokpi, Senapati, Noney, and Churachandpur. The Chiru belongs to the Mongoloid race, and linguistically, they come under the Tibeto-Burman linguistic family. They primarily practice agriculture, and shifting cultivation is their primary occupation. The population of the Chiru tribe in Manipur was 8599 individuals, consisting of 4395 males and 4204 females, according to the census report 2011. Although the Chiru tribe is one of the last to receive western education and Christianity, many changes have occurred in the past 85 years in every aspect of life, such as the socioeconomic, political, religious, and overall standard of living. This development has led to changes in dietary intake, food consumption patterns, and sedentary lifestyles. It may also have contributed to the increased prevalence of overweight and obesity, hypertension, and other diseases.
| Materials and Methods|| |
Study design and setting
The present study is a cross-sectional study conducted in the hill districts of Manipur. Participants comprised individuals belonging to the Chiru tribe. The materials and methods for data collection and analysis in the present study were employed only after getting “Human Ethical Clearance certificate” from Institutional Human Ethics Committee, Manipur University. The objectives and protocols of the present study were explained to the village chiefs before conducting anthropological fieldwork. Participants were included in the study only after obtaining their consent on the forms applied to them.
The present sample size was calculated using formula  where, Z = 1.96 (at 95% confidence interval [CI]), error of estimate d = ±7, assumed prevalence P = 50%, the required estimated sample size for the present study was 196 individuals. A total sample size consisting of 207 adult women was drawn from four villages based on the population size of each village by following a random sampling method. The random sampling method was carried out at the village level using a table of random numbers. The four villages are Kangchup, Dolang, Charoi Khullen, and Khoirok.
Inclusion and exclusion criteria
The inclusion criteria included Chiru women aged 20–79 years. The subjects, who gave their informed consent, provided all the necessary information from reliable documents and answered all the schedules and questionnaires. The exclusion criterion included physically challenged women, pregnant women, individuals taking antihypertensive medication, and those who failed to fulfill any of the inclusion criteria were excluded from the present study to avoid biases and to represent the appropriate measurement of the study population.
Anthropometric and blood pressure
The anthropometric measurements of stature and body weight were taken following Weiner and Lourie. The physiological measurement of blood pressure was recorded using a standard mercury sphygmomanometer and a stethoscope. Blood pressure was taken on the left arm while the subject was seated. Systolic and diastolic blood pressures (DBP) were classified based on the 7th Report of the Joint National Committee (JNC) on Prevention, Detection, Evaluation, and the Treatment of High Blood Pressure. The diagnosis of hypertension systolic blood pressure (SBP), 140 mmHg, DBP, 90 mm Hg were the readings criteria. At the same time, the level of 139 mm Hg (SBP) or 89 mm Hg (DBP) was considered normotension. BMI was classified based on WHO classification for the Asian population. BMI value of <18.5 kg/m2 as underweight; 18.5–22.9 kg/m2 (normal); 23–27.5 kg/m2 (overweight); and ≥27.5 kg/m2 as obese.
Individuals engaged in moderate-to-vigorous-intensity physical activity, achieving at least 600 MET-minutes, were considered physically active. Data on lifestyle risk factors were measured as per the WHO STEPwise approach to the noncommunicable diseases risk factors surveillance guideline. Tobacco users are those who use tobacco products at least once a day. Similarly, smokers are those who smoke regularly. Paan (betel leaf) users are those participants that have the habit of chewing paan regularly or almost every day. Data on alcohol consumption were also collected from each participant using drinking categories such as never drinkers, former drinkers, light drinkers, moderate drinkers, and risk drinkers suggested by National Institute on Alcohol Abuse and Alcoholism. Never drinkers are those participants who had never drunk alcohol at baseline; former drinkers are those individuals who had not used alcohol in previous years but had drunk in the past; light drinkers are those individuals who drink <4 drinks/week (for women); moderate drinkers are those individuals who drink 4–7 drinks/week (for women); and risk drinkers are those individuals who drink >7 drinks/week (for women). Data on salt intake were also collected and classified as “extra salt” and “no extra salt.” The average daily consumption of salt in grams per person per day was evaluated from the total monthly consumption divided by the family size and then by 30. JNC has recommended a daily intake of 6 g salt.
Statistical analysis of the data collection was done with the help of IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, N.Y., USA). The subjects' age groups were categorized into six such as 20–29 (years), 30–39 (years), 40–49 (years), 50–59 (years), 60–69 (years), and 70–79 (years). Descriptive statistics (mean and standard deviation) were presented to examine the trend of stature, body weight, BMI, systolic and DBP. Frequency and percentages were to summarize the BMI and blood pressure classification of the participants. A Chi-square test was used to determine the significant distribution of age group and BMI categories and blood pressure (SBP and DBP). Binary logistic regression and Pearson correlation were applied to determine the association between BMI, blood pressure, age, and impact of behavioral factors on hypertension with a significant level at P < 0.05, P < 0.01, and P < 0.001.
| Results|| |
[Table 1] displays the essential characteristics of anthropometric measurements among Chiru females in six different age groups. The surveyed population's average mean stature, weight, BMI, systolic, and DBP were (149.2 ± 5.49 cm), (51.6 ± 8.75 kg), (23.2 ± 4.04 kg/m2), (118.4 ± 21.44 mmHg), and (76.90 ± 12.88 mmHg), respectively. The maximum mean value of stature (150.9 ± 4.80 cm), weight (56.7 ± 9.72 kg), BMI (25.6 ± 6.31 kg/m2), systolic (143.0 ± 32.50 mmHg), and diastolic (84.51 ± 15.24 mmHg) blood pressure were found in the age groups, 30–39, 40–49, 40–49, 70–79, and 50 59 years, respectively. In contrast, minimum mean values of stature (145.6 ± 6.33 cm) and weight (46.3 ± 10.98 kg) were observed in the age group of 70–79 years. Further, the minimum mean values of BMI (21.4 ± 2.60 kg/m2), systolic (104.3 ± 13.85 mmHg), and diastolic (69.80 ± 10.29 mmHg) were observed in the age group of 20–29 years.
|Table 1: Descriptive statistics of stature, body weight, body mass index, systolic and diastolic blood pressure of the Chiru females in different age groups|
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The classification of obesity markers of BMI, systolic, and DBP categories of hypertension is shown in [Table 2]. Out of a total of 207 females, 5.8% were underweight, 49.3% normal, 33.3% overweight, and 11.6% obese, respectively. The highest frequency of underweight (33.3%) and normal (37.3%) was in the age group of 20–29 years, overweight (24.6%) in the age group of 30–39 years, and obese (33.3%) in the age group of 30–39 and 40–49 years. Furthermore, significant differences were observed (χ2 = 43.048, P < 0.001) between the proportion of BMI categories in different age groups.
|Table 2: Age-wise distribution of Chiru females in different categories of body mass index, systolic and diastolic blood pressure|
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With respect to SBP, 40.6% were normal, 45.4% were prehypertension, 8.7% hypertension Stage I, and 5.3% hypertension Stage-II, respectively. The maximum number of normal (45.2%) were found in the age group of 20–29 years, prehypertension (22.3%) in the age group 40–49 years, hypertension Stage 1 (38.9%) in the age group 60–69 years, and hypertension Stage II (27.3%) in the age groups 50–59, 60–69, and 70–79 years. The differences in the proportion of various SBP categories and different age groups were statistically significant (χ2 = 85.135, P < 0.001). Overall, it indicates that hypertensive individuals (SBP ≥140) are more inclined toward higher age groups [Table 2].
As far as DBP is concerned, 43.5% were normal, 39.6% pre-hypertension, 10.1% hypertension Stage I, and 6.8% hypertension Stage-II, respectively. The maximum number of normal (35.6%) and prehypertension (22.0%) were found in the age group of 20–29 years, hypertension Stage I (23.8%) was found in the age group of 40–49, 50–59, and 60–69 years, hypertension Stage-II (35.7%) was found in the age group of 50–59 years. Significant differences were observed between the proportion of categories of DBP in different age groups (χ2 = 38.638, P < 0.001). Further, this table indicates that hypertensive individuals (DBP ≥90) are more inclined toward higher age groups.
[Table 3] displays the result of Pearson's correlations between BMI, BP, age, and other behavioral factors with the level of significance. There were significant (P < 0.01) positive correlations between BMI with systolic and diastolic BP. Thus, it shows that BP increased with an increase in BMI. The correlation coefficient reveals that the relationship between BMI and systolic BP (0.200) was stronger than diastolic BP (0.195). Physical activity (−0.542) has the strongest significant correlation with BMI. A significant (P < 0.05) positive correlation between age and BMI was observed, but the magnitude of correlation of age with systolic and diastolic BP (P < 0.01) was more than that of age with BMI.
|Table 3: Correlation matrix between body mass index, blood pressure, and age, and other behavioral factors|
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Further, salt intake had a significantly (P < 0.01) positive correlation with SBP and DBP blood pressure, while physical activity has a negative but significant correlation with BP. Finally, smoking shows a significant positive correlation with both systolic and DBP. However, alcohol shows a negative correlation with both systolic and DBP.
The odds ratio (OR) of hypertension concerning BMI and other behavioral factors is shown in [Table 4]. The OR of overweight and obese is 2.62 times (Cl = 1.30–5.30, P < 0.05) at a higher risk of hypertension than normal. In contrast, underweight was 1.60 (Cl = 0.23–5.82, P > 0.05) times less likely to develop hypertension. This OR indicates that overweight and obese were higher risk factors of hypertension than underweight, with a normal range as a reference group. Individuals who were less engaged in physical activities were also found significant (OR = 3.38; Cl = 1.60–7.14, P < 0.05), suggesting that physically inactive individuals had a higher risk of hypertension as compared to those who were active. The odd ratio of hypertension among the extra salt intake individuals was significantly higher than those with low salt intake (OR = 3.27; Cl = 1.48–7.20, P < 0.05). No significant risk of hypertension was found among tobacco users (OR = 1.78; Cl = 0.31–10.06, P > 0.05) and pan users (OR = 1.47; Cl = 0.76–2.84, P > 0.05). The OR of hypertension among the smokers was significantly higher (OR = 4.65; Cl = 1.68–12.87, P < 0.05) than the nonsmoking individuals. Moreover, light drinkers were also found to have a significantly higher risk of hypertension than never drinkers/former drinkers (OR = 2.61; Cl = 0.99–6.84, P < 0.05). Therefore, the OR of univariate logistic regression analysis in [Table 4] indicates that smoking, physical activity, and salt intake were the major contributing factors for the risk of hypertension.
|Table 4: Univariate association of hypertension and lifestyle factors among Chiru female|
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| Discussion|| |
Mean values of different age group categories for stature show a decreasing trend from youngest to oldest. Compared to Martin's classification, Chiru females are within the range-variation of short to lower medium (i.e., 140.0 cm to 152.9 cm). A statistical mean value of body weight and BMI increases up to 49 years and declines in mean values afterward. The above mentioned decreasing trend of height and increasing body weight and BMI with advancing age of the present study is similar to the finding of other studies. According to the NFHS-5 2019–2020 reports, 34.1% of adult women of Manipur are overweight and obese, and 7.2% are below normal (BMI <18.5 kg/m2). In this study, 44.9% are found overweight and obese. Compared to NFHS-5, 2019–2020, the prevalence of overweight and obesity was higher than that of the state average. A higher prevalence (42.41%) of overweight and obesity was found in a study conducted among the female stone crushers of Manipur valley. However, in the underweight category, the present study shows more or less equal to the state level (NFHS-5, 2019–2020). In comparison, the normal BMI range in the present study is 49.3%, which is lower than the state levels (NFHS-5, 2019–2020).
According to NFHS-5, 2019–2020, 19.5% were diagnosed with hypertension in Manipuri women. In this study, the prevalence of hypertension was 22.2% which is higher than the percentage of (NFHS-5) at the state level. The prevalence of hypertension in this study was less than in the earlier studies. The present study shows that age was positively correlated with both SBP and DBP blood pressure. Earlier studies on hypertension also reported that high blood pressure is associated with age. The current study shows a significant positive correlation between BMI and BP; many studies reported similar findings. This study shows that physical activity has significant correlations with BMI and BP. Earlier studies conducted by Singh et al. in five cities of India reported that sedentary lifestyle was significantly correlated (P < 0.05) with obesity. A comparable finding has been accounted for in the study conducted in the European Union. The beneficial role of physical activity in reducing blood pressure has been well documented. The ORs of physically inactive individuals were 3.38 times more at risk of hypertension than physically active individuals.
Various epidemiological, experimental, and clinical investigations have established that extra salt intake is related to blood pressure and leads to hypertension. This study noted a significant positive correlation between salt intake and BP. The participants with extra salt intake were 3.27 times more likely to develop hypertension than their nonconsuming counterparts.
According to the Global Adult Tobacco Survey assessments in India, 274.9 million people use tobacco, and 206 million are users of smokeless tobacco. The NFHS-5 reported that 43.1% of Manipuri women use tobacco. The use of tobacco among Chiru women was found to be 2.8%. Tobacco users had a 1.78 times higher risk of developing hypertension than nontobacco users. Tobacco use is a modifiable risk factor for evaluating predictors for hypertension.
According to current literature, smoking is an independent risk factor for hypertension. This study found that smoking significantly correlates with systolic and DBP. Further, odd ratio analysis shows that smokers are 4.65 times more at risk of hypertension than nonsmokers.
Recent epidemiological and clinical studies have demonstrated that excessive and chronic alcohol consumption is associated with hypertension regardless of the beverage type. The present study found that alcohol consumption has a significant correlation with systolic and DBP. Further, light drinkers were 2.61 times more likely to have hypertension than never drinkers/former drinkers. According to a recent report (NFHS-5), alcohol use by Manipuri women was 0.9% at the state level. However, in the present study, it was observed that 9.7% are light drinkers of alcohol, which is higher than the state levels.
| Conclusion|| |
This study computed the prevalence of hypertension, overweight, obesity, and lifestyle factors among the Chiru women of Manipur. The findings indicate that the percentage of overweight and obesity was very high. The prevalence of hypertension was moderately higher than that of the state average. BMI was observed to be significantly correlated with systolic and DBP, age, and other lifestyle factors. In addition, the risk of hypertension was higher among smokers, physically inactive, those with extra salt intake, light drinkers, the overweight, and the obese. These results will provide valuable information in preventing cardiovascular diseases and other health-related complications.
The authors are grateful to all in this community the participants for giving moral support during data collection of this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]