India is facing a significant health crisis, with alarming rates of heart attacks, diabetes, and non-alcoholic fatty liver disease (NAFLD), particularly among younger individuals. This post explores the complex factors contributing to this vulnerability, including genetics, lifestyle, and historical influences. Dr. Sumaiya Nutricare Clinic aims to provide clarity on this issue and offer practical preventative advice.
Why Indians Are More Vulnerable to Heart Attacks
Heart disease affects Indians earlier and more severely than other populations. The Indian Heart Association reports that 50% of heart attacks in Indian men occur before age 50, and 25% before 40. High mortality rates from cardiac diseases also affect Indian women [1, 4, 10].
- Genetic Predisposition: Indians have smaller coronary arteries, increasing blockage risk. They also face a higher risk of premature coronary artery disease (CAD), often developing heart problems a decade earlier than Western populations [1, 10].
- Lifestyle Changes: Urbanization has brought sedentary lifestyles, diets high in trans fats, and increased stress – all major contributors to heart disease [1].
- Diabetes and Obesity: These conditions are prevalent in India and significantly increase heart attack risk. Insulin resistance and abdominal obesity are particularly common [7].
- Smoking and Alcohol: These lifestyle choices worsen cardiovascular risks, especially among young adults [1].
Expert Advice: Dr. Senthilkumar Nallusamy stresses the importance of early check-ups: “Do not ignore symptoms like breathlessness or chest pain. Even those in their 20s and 30s should undergo regular screenings if they have a family history of heart disease” [1].
Why Diabetes Is a Growing Epidemic in India
India is often called the “Diabetes Capital of the World,” with over 77 million diabetics in 2020, a number projected to rise significantly by 2030 [2, 5]. Indians develop Type 2 diabetes at younger ages and lower body weights compared to other ethnic groups.
- Genetic Susceptibility: Indians have a higher familial aggregation of diabetes. Around 75% of Type 2 diabetics have a first-degree relative with the condition [2, 11].
- Body Composition: Indians tend to have less lean muscle mass but more central fat (visceral fat), increasing insulin resistance even at lower BMIs [5, 8].
- Urbanization: Rapid lifestyle changes have led to unhealthy diets high in refined carbohydrates and sedentary behavior, fueling the diabetes epidemic [8].
- Maternal Nutrition: Poor maternal nutrition during pregnancy can predispose Indian babies to low birth weight and higher fat deposition, increasing their risk of diabetes later in life [5, 8].
Expert Insights: Dr. Fall explains: “Indians don’t need to be as overweight as people of other ethnicities to develop diabetes because they naturally have more body fat and less lean mass” [5].
Why Fatty Liver Disease Is Alarmingly Common Among Indians
Non-alcoholic fatty liver disease (NAFLD) affects nearly 38.6% of Indian adults and a growing number of children. It is a leading cause of liver cirrhosis and cancer in India [3, 9].
- Genetic Predisposition: Variants like PNPLA3 and TM6SF2 genes make Indians more susceptible to NAFLD. These genes can also lead to fatty liver disease in lean individuals, a common phenomenon in India [3, 6].
- Dietary Habits: A carbohydrate-heavy diet rich in refined grains (e.g., white rice) significantly contributes to fat accumulation in the liver [3].
- Lifestyle Changes: Sedentary behavior combined with increasing obesity rates has worsened NAFLD prevalence.
- Historical Adaptations: The “thrifty gene hypothesis” suggests Indians evolved efficient fat storage mechanisms during historical famines. While beneficial during food scarcity, these traits now predispose individuals to metabolic disorders like NAFLD in an environment of caloric abundance [6].
Expert Recommendations: Dr. Sood highlights the role of early intervention: “Screening children with obesity or family history for fatty liver is crucial as it can lead to severe complications like diabetes or liver cancer later in life” [12].
Understanding Fatty Liver Disease: Types, Risks, and Treatments.
The Common Thread: Evolutionary Mismatch
A recurring theme is the evolutionary mismatch between India’s genetic makeup and modern lifestyles:
- Historically, Indians faced frequent famines, leading to genetic adaptations favoring fat storage (e.g., visceral fat). These traits are now detrimental with abundant calories.
- Urbanization has introduced high-calorie diets and sedentary habits, amplifying these risks.
- Epigenetic changes from historical malnutrition may also predispose current generations to metabolic diseases.
Call to Action: What Can Be Done?
At Dr. Sumaiya Nutricare Clinic, we believe prevention is key. Here’s how to protect yourself:
- Get regular health check-ups, especially from your 20s if you have a family history of heart disease or diabetes.
- Adopt a balanced diet low in refined carbohydrates and trans fats.
- Exercise regularly – aim for at least 150 minutes of moderate activity per week.
- Manage stress through mindfulness practices like yoga or meditation.
- Avoid smoking and limit alcohol consumption.
Conclusion
The rising prevalence of heart attacks, diabetes, and fatty liver disease among Indians is a public health emergency rooted in genetics, lifestyle, and history. Early detection and lifestyle modifications are crucial. As Dr. Balasubramanian states, “Adopting an active lifestyle and avoiding fatty foods can go a long way in preventing these diseases” [1]. Let’s take proactive steps today for a healthier tomorrow!
References
- Joshi, P. (2021, September 5). Young Indians more vulnerable to heart attacks, say doctors. The New Indian Express. https://www.newindianexpress.com/lifestyle/health/2021/Sep/05/young-indiansmore-vulnerable-to-heart-attacks-say-doctors-2354637.html
- Anjana, R. M., Deepa, M., Pradeepa, R., & Mohan, V. (2016). Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR-INDIAB population-based cross-sectional study. The Lancet Diabetes & Endocrinology, 4(8), 660-679.
- Dhiman, P., et al. (2021). Epidemiology of nonalcoholic fatty liver disease in India. Journal of Clinical and Experimental Hepatology, 11(6), 671-681. https://pmc.ncbi.nlm.nih.gov/articles/PMC8518336/
- Mendis, S., Yusuf, S., Prabhakaran, D., Teo, K. K., & Ramasundarahettige, C. (2011). The burden of cardiovascular diseases among the poor in India. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 183(6), E201–E207. https://pmc.ncbi.nlm.nih.gov/articles/PMC3028954/
- Yajnik, C. S. (2012). The lifecycle effects of nutrition and body size on adult diabetes and obesity. Nature Reviews Endocrinology, 8(12 Suppl), S14-S23. https://www.nature.com/articles/485S14a
- Yajnik, C. S. S. T. (2020). The thrifty genotype revisited. Translational Gastroenterology and Hepatology, 5, 51. https://tgh.amegroups.org/article/view/8382/html
- Misra, A., Khurana, L., & Vikram, N. K. (2012). The metabolic syndrome in South Asians: epidemiology, determinants, and prevention. Metabolic Syndrome and Related Disorders, 10(4), 269–281. https://pmc.ncbi.nlm.nih.gov/articles/PMC3408699/
- Mohan, V., Deepa, M., & Anjana, R. M. (2016). Body weight and diabetes in India. Indian journal of medical research, 143(6), 657–669. https://pmc.ncbi.nlm.nih.gov/articles/PMC4935697/
- Singh, S. P., et al. (2022). Non-alcoholic fatty liver disease in India: A systematic review and meta-analysis of prevalence, risk factors, and outcomes. Journal of Gastroenterology and Hepatology, 37(9), 1633-1644. https://pmc.ncbi.nlm.nih.gov/articles/PMC9168741/
- Ambwani, S., & Kumar, P. (2021). The gamut of coronary artery disease in Indian women. Indian Journal of Clinical Disease and Women, 6(3), 179-184. https://ijcdw.org/the-gamut-of-coronary-artery-disease-in-indian-women/
- Bhat, Z. I., & Laway, B. A. (2021). Familial aggregation of type 2 diabetes mellitus in North Indians. Journal of Health Research, 35(1), 101-107. https://www.emerald.com/insight/content/doi/10.1108/jhr-08-2020-0320/full/pdf
- Sachdev, H. S., et al. (2024). Management of Nonalcoholic Fatty Liver Disease in Children: Indian Academy of Pediatrics Guidelines. Indian Pediatrics, 61(9 Suppl), S81–S92. https://indianpediatrics.net/epub092024/GUIDE-00697.pdf
