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The co-occurrence of anemia and cardiometabolic disease risk demonstrates sex-specific sociodemographic patterning in an urbanizing rural region of southern India



To determine the extent and sociodemographic determinants of anemia, overweight, metabolic syndrome (MetS) and the co-occurrence of anemia with cardiometabolic disease risk factors among a cohort of Indian adults.


Cross-sectional survey of adult men (n=3322) and nonpregnant women (n=2895) aged 18 years and older from the third wave of the Andhra Pradesh Children and Parents Study that assessed anemia, overweight based on body mass index, and prevalence of MetS based on abdominal obesity, hypertension and blood lipid and fasting glucose measures. We examined associations of education, wealth and urbanicity with these outcomes and their co-occurrence.


The prevalence of anemia and overweight was 40% and 29% among women, respectively, and 10% and 25% among men (P<0.001), respectively, whereas the prevalence of MetS was the same across sexes (15%; P=0.55). The prevalence of concurrent anemia and overweight (9%), and anemia and MetS (4.5%) was highest among women. Household wealth was positively associated with overweight and MetS across sexes (P<0.05). Independent of household wealth, higher education was positively correlated with MetS among men (odds ratio (95% confidence interval): MetS: 1.4 (0.99, 2.0)) and negatively correlated with MetS among women (MetS: 0.54 (0.29, 0.99)). Similar sex-specific associations were observed for the co-occurrence of anemia with overweight and MetS.


Women in this region of India may be particularly vulnerable to co-occurring anemia and cardiometabolic risk, and associated adverse health outcomes as the nutrition transition advances in India.

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We thank our dedicated field teams led by Santhi Bogadi and the study participants who made this study possible. PP, VG, BK, GDS, YBS, KVR and SK contributed to the design of the study; PP, VG, BK, KVR, PUK, CPB, AKMH and SK contributed to the implementation of the study; and ADJ analyzed the data and wrote the first draft of the manuscript. All authors contributed to the interpretation of the data, the writing of the manuscript and have read and approved the final manuscript. ADJ has primary responsibility for the final content of the manuscript. The Hyderabad Nutrition Trial (1987–1990) was funded by the Indian Council of Medical Research and the United States Agency for International Development (PI: KV Rameshwar Sarma). The third wave of data collection for the APCAPS study was funded by the Wellcome Trust (Grant: 084674/Z; PI: S Ebrahim). The National Institute of Nutrition (Indian Council of Medical Research) provided infrastructural support. PhD studentships were funded by the Wellcome Trust (Grant: 084754; P Prabhakaran), World Bank (M Matuzaki) and Bloomsbury consortium (T Sorensen) and a Research fellowship was funded by the Wellcome Trust (Grant: 084754; R Pant). The funders had no role in study design, data collection, analysis, decision to publish or preparation of the manuscript.

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Jones, A., Hayter, A., Baker, C. et al. The co-occurrence of anemia and cardiometabolic disease risk demonstrates sex-specific sociodemographic patterning in an urbanizing rural region of southern India. Eur J Clin Nutr 70, 364–372 (2016).

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