Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jan 15, 2018; 9(1): 40-52
Published online Jan 15, 2018. doi: 10.4239/wjd.v9.i1.40
Association of obesity with hypertension and type 2 diabetes mellitus in India: A meta-analysis of observational studies
Giridhara R Babu, G V S Murthy, Yamuna Ana, Prital Patel, R Deepa, Sara E Benjamin-Neelon, Sanjay Kinra, K Srinath Reddy
Giridhara R Babu, Yamuna Ana, R Deepa, Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, Bangalore 560023, India
G V S Murthy, Indian Institute of Public Health-Hyderabad, Plot # 1, A.N.V.Arcade, Amar Co-op Society, Kavuri Hills, Madhapur, Hyderabad 500033, India
G V S Murthy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
Prital Patel, Indian School of Business, Hyderabad 500111, India
Sara E Benjamin-Neelon, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
Sanjay Kinra, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine and University College London Hospital, London WC1E 7HT, United Kingdom
K Srinath Reddy, Public Health Foundation of India, ISID Campus, 4 Institutional Area Vasant Kunj, New Delhi 110070, India
Author contributions: Babu GR conceived the study aims and design, contributed to the data extraction, planned the analysis, interpreted the results and drafted the final version of the paper; Murthy GVS has contributed to manuscript development and critical review; Ana Y and Deepa R evaluated the study articles and made decisions on inclusion and exclusion of the articles; Patel P was involved in manuscript development, provided inputs for estimations and critical review; Neelon SEB has reviewed the manuscript critically; Kinra S has contributed to the article critically for important intellectual content; Reddy KS has contributed to the article critically for important intellectual content and final approval of the version to be published.
Supported by Wellcome Trust DBT India Alliance Intermediate Fellowship (Clinical and Public Health) to Giridhara R Babu.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: All data generated or analysed during this study are included in this published article. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Giridhara R Babu, MBBS, MBA, MPH, PhD, Wellcome Trust-DBT India alliance Research Fellow in Public Health, Additional Professor, Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, 1st Cross, Magadi Road, Bangalore 560023, India.
Telephone: +91-080-23206124
Received: August 3, 2017
Peer-review started: August 7, 2017
First decision: September 7, 2017
Revised: November 5, 2017
Accepted: November 19, 2017
Article in press: November 19, 2017
Published online: January 15, 2018

To perform a meta-analysis of the association of obesity with hypertension and type 2 diabetes mellitus (T2DM) in India among adults.


To conduct meta-analysis, we performed comprehensive, electronic literature search in the PubMed, CINAHL Plus, and Google Scholar. We restricted the analysis to studies with documentation of some measure of obesity namely; body mass index, waist-hip ratio, waist circumference and diagnosis of hypertension or diagnosis of T2DM. By obtaining summary estimates of all included studies, the meta-analysis was performed using both RevMan version 5 and “metan” command STATA version 11. Heterogeneity was measured by I2 statistic. Funnel plot analysis has been done to assess the study publication bias.


Of the 956 studies screened, 18 met the eligibility criteria. The pooled odds ratio between obesity and hypertension was 3.82 (95%CI: 3.39 to 4.25). The heterogeneity around this estimate (I2 statistic) was 0%, indicating low variability. The pooled odds ratio from the included studies showed a statistically significant association between obesity and T2DM (OR = 1.14, 95%CI: 1.04 to 1.24) with a high degree of variability.


Despite methodological differences, obesity showed significant, potentially plausible association with hypertension and T2DM in studies conducted in India. Being a modifiable risk factor, our study informs setting policy priority and intervention efforts to prevent debilitating complications.

Keywords: Obesity, Meta-analysis, Hypertension, Type 2 diabetes mellitus

Core tip: India with population explosion and high burden of non-communicable diseases (NCDs) poses a great challenge for the public health specialists to find the route cause for it. Meta-analysis to find the association of obesity with hypertension and type 2 diabetes mellitus in India proved the statistical significance association of obesity with major NCD’s with high degree of variability. Results provided with the possible risk factors for the NCD’s and what need to be done for the preventive aspect of such diseases. As obesity being a risk factor, setting up a priority policy decisions related to interventions for the prevention of obesity can result in a huge dynamic change in the trend of NCD’s in the country like India.