Silent surge: Obesity, prediabetes grip young adults in rural areas in Andhra Pradesh

Visakhapatnam: Rural adults in the Telugu states are developing obesity, prediabetes, and other metabolic risk factors at increasingly younger ages, significantly raising their risk of cardiovascular disease, according to a new analysis of data from the Andhra Pradesh Children and Parents Study (APCAPS).APCAPS tracked a multigenerational cohort of 3,815 participants from 29 villages over four survey rounds conducted between 2003 and 2023. The study followed 2,086 children born between 1987 and 1990, and 1,729 of their mothers, documenting changes in their cardiovascular and metabolic health over two decades.Using the APCAPS data, the researchers found that male participants reached the World Health Organization (WHO) South Asian BMI risk threshold of 23 kg/m² at an average age of 27.7 years and the overweight threshold of 25 kg/m² at 34.2 years.

Female participants reached the same thresholds slightly later, at 30.6 and 34.9 years, respectively. In contrast, mothers crossed these thresholds much later in life, with the youngest subgroup reaching them at 42.9 and 50.8 years.Fasting blood glucose levels in males increased by 0.76 mg/dL annually, compared with 0.49 mg/dL in females. As a result, the average male participant entered the prediabetes range (≥100 mg/dL) by the age of 36, while females generally remained below that threshold.

The findings of the analysis -- titled ‘Life-course trajectories of cardiovascular disease risk factors in rural India: Andhra Pradesh Children and Parents Study (APCAPS), 2003-2023‘ -- were published in the ‘International Journal of Epidemiology’. The research was conducted by scientists from the University of Tasmania, Australia; the National Institute of Nutrition; the Public Health Foundation of India; the London School of Hygiene & Tropical Medicine; the University of Bristol; the University of Delhi; and several other institutions in India, Australia, and the UK.The study also found that males accumulated abdominal fat more rapidly, reaching adult cardiovascular risk cut-offs for waist circumference, waist-to-hip ratio and waist-to-height ratio in their early thirties. Females, by contrast, retained relatively more fat beneath the skin of the arms and legs until around the age of 25.According to the researchers, the higher cardiovascular risk among males was driven by increasing fat accumulation around the abdomen relative to the hips, causing the waist-to-hip ratio to rise sharply after the age of 25.

In both sexes, measurements of supra-iliac skinfold thickness (the layer of skin and fat just above the hip bone) declined over time, suggesting that fat accumulation increasingly occurred as visceral fat surrounding internal organs or as deep subcutaneous fat beneath the skin, rather than as superficial fat directly under the skin.Male participants also exhibited characteristics of the 'thin-fat' South Asian phenotype, in which individuals appear relatively lean despite carrying excess fat around the abdomen and internal organs.

This body composition, marked by accumulation of trunk fat despite relatively low body weight, is strongly associated with insulin resistance, hyperinsulinaemia, and early-onset metabolic syndrome.The researchers noted that the accelerated weight gain observed in these rural cohorts mirrors trends seen in high-income countries several decades ago. They attributed the worsening cardiovascular and metabolic risk profile to rapid rural development, including a dietary shift towards ultra-processed foods, reduced physical labour, rising air pollution, and built environments that promote sedentary lifestyles.The findings also align with broader health trends across rural India. National data cited in the study show that the prevalence of overweight and obesity among rural Indians aged 15 to 49 nearly tripled from 6.9% in 2005 to 19.4% in 2021. By 2021, abdominal obesity affected more than one-third of rural women and one-10th of rural men, while diabetes prevalence in rural India rose from 5.6% to 8% between 2015 and 2021.