People of normal weight but with high blood sugar are at a higher risk for heart and metabolic diseases than obese people who have normal blood sugar. Such was the findings from a study done in India and reported at the 2011 International Diabetes Federation (IDF) World Diabetes Congress.
Before we go into the details of the study, here are three key terms you need to know-
Dysglycemia refers to a ‘disturbed’ blood sugar regulation, which causes unstable blood glucose levels, whether that be low blood sugar, as in the case of hypoglycemia, or the high blood sugar we see in pre-diabetes and diabetes.
In this study, the participants were evaluated for abnormally high blood sugar.
The term ‘cardiometabolic risk’ refers to the chance of developing type 2 diabetes and/or cardiovascular disease, which can include conditions such as strokes and heart attacks.
Cardiometabolic syndrome is a group of risk factors in individuals which has been shown to increase cardiometabolic risk. These risk factors include:
- High blood pressure
- High LDL cholesterol
- High blood sugar
- Belly fat, especially the inner belly fat
- Insulin resistance
- Low HDL cholesterol
- High Triglycerides
- Inflammatory markers, which are blood tests that indicate some type of inflammation is going on in the body
Other names for cardiometabolic syndrome include:
- Syndrome X
- Cardiovascular Dysmetabolic Syndrome
- Insulin-Resistance Syndrome
- Metabolic Syndrome
- Beer Belly Syndrome
Typically, overweight and obese people appeared to be at a higher risk for developing cardiometabolic diseases, including diabetes. In fact, the connection between diabetes and obesity is so strong that a new term was coined- ‘diabesity’.
However, this recent study from the Madras Diabetes Research foundation in Chennai, India and led by Dr. Deepa Mohan, may shed new light on the importance of a healthy blood sugar regardless of body weight.
Chennai Urban Rural Epidemiology Study (CURES)
The CURES study examined the relationship between obesity and cardiometabolic parameters in 2350 individuals who had been pre-screened for diabetes. In this group, 435 people were at a normal weight but who had high fasting blood sugars of at least 100 mg/dl. and high blood sugar levels of at least 140 mg/dl. two hours following a high-glucose meal.
There were also 392 people who were obese but with normal blood sugar levels at both the fasting level and two hours post high-glucose meals.
After making the adjustments for other factors such as age, sex, blood pressure, cholesterol and triglycerides, the study concluded that there was an increased risk for cardiometabolic conditions in the normal weight group that had high blood sugar.
The risk factors more common to this group were:
- Higher blood pressures
- Higher fasting blood sugars
- Higher hemoglobin A1c test
- Higher total cholesterol levels
- Higher triglyceride levels
- Increased presence of coronary artery disease
Study Specific to People of Asian Indian Origin
The findings of this study were specific to people of Asian Indian origin. In fact, the combination of high blood sugar with normal weight is so common in Asian Indians that the phenotype has been called the “Asian Indian phenotype”, according to Dr. Mohan. She continues on to compare Caucasians of comparable BMI and age and points out that Asian Indians are found to have higher insulin resistance, greater waist circumferences, increased diabetes and cardiovascular risk.
Dr. Arya Sharma, MD, Phd, professor of medicine and chair of obesity research and management at the University of Alberta in Edmonton, Canada, and co-chair of the session in which the study was presented, commented, in response to the CURES study, that defining obesity only on BMI is in error. As he pointed out, body composition, body fat and levels of the insulin-sensitizer adiponectin will vary depending on the racial heritage of the individual.
High Blood Sugar, Obesity and Cardiometabolic Risk
Despite the argument regarding obesity being defined by the BMI, the important lesson learned from this study is that tight control of blood sugars is necessary to prevent not only diabetes but cardiovascular diseases. This means that you should really think long and hard before rewarding yourself with a candy bar or even an energy drink following that next 2k run!