![]() ![]() Furthermore, there is also a need to validate novel clinical and genetic indicators that can be used for mass screening such that the burden of non-communicable disorders in this region can be decreased ( 10). Following this, several studies have examined the underlying pathophysiology of this phenotype ( 8, 9) however, better understanding of the utility and role of the conventional obesity indicators in this phenotype is needed. ![]() It showed how despite both having a similar normal body mass index (22.3 kg/m 2), the body fat content was much higher in the Indian doctor. This pictorial abstract compared the body mass index and body composition of a Caucasian and an Indian physician. This unique south Asian phenotype was classically described in a seminal paper published in the Lancet in the year 2004 called the YY Paradox ( 7). In this review, we discuss this unique thin fat phenotype seen in tropical countries, its prevalence, pathogenesis, clinical implications, and discuss the current evidence-based management. This complex situation highlights the need to appropriately identify at risk individuals and intervene in those who have a high cardiometabolic risk irrespective of their apparently lean phenotype. Moreover, this problem is further compounded by a younger age of development of these cardiometabolic disorders, a rapidly increasing prevalence, and significant financial constraints for most people to afford good healthcare in these countries ( 6). This paradox is largely due to the altered body composition with increased visceral adipose tissue and decreased lean mass leading to this unique thin fat phenotype that has been described in individuals of south Asian descent ( 5). Though countries like India and China are the leading countries with the largest number of people with diabetes there is paradoxically a much smaller number of people with obesity in these countries ( 4). One such example is of obesity and diabetes ( 2, 3). This dual burden of disease may appear as a transient phenomenon but may have deeper implications in determining the phenotype of cardiometabolic diseases in this population ( 1). Skinny faqt free#For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, INTRODUCTIONÄeveloping countries in the south Asian region are undergoing a rapid transition towards an increasing prevalence of non-communicable diseases but at the same time still grappling with undernutrition and infectious diseases. In this chapter we summarize the current existing literature of this unique disorder and its importance in tropical countries. The role of examining the underlying genetic makeup and the use of surrogate measures to estimate body fat could be useful adjuncts in the further characterization of this unique phenotype. While evidence for the best therapeutic protocols is still emerging, an improvement in lifestyle intervention shows a slow but a positive trend in improving the cardiometabolic risk of this phenotype. Moreover, the mortality associated with this phenotype is also significantly higher than nonobese subjects and thus this phenotype needs to be identified as a distinct entity. ![]() This phenotype is found to be very common in tropical countries and associated with a high cardiometabolic risk, which is similar to individuals with overt obesity. It is defined as an individual who has normal body weight (as measured by body mass index) but a disproportionately high body fat percentage (based on ethnicity and gender specific cutoffs). The thin-fat phenotype is known by several other names in the scientific literature including normal weight obesity, metabolic obesity, metabolically unhealthy non-obese, etc. Though this concept was described about 15 years ago, further evidence regarding its prevalence, pathophysiology, diagnosis, cardiometabolic risks, treatment, and implications for policy change are still emerging. This paradox is partly explained by the unique thin-fat phenotype prevalent in this region. Countries like India and China have the leading number of people living with type 2 diabetes mellitus but paradoxically a much lower number of people with obesity (as defined by body mass index). However, this problem is a little different in some tropical countries especially in the south Asian region. Disorders like diabetes and obesity have reached pandemic proportions globally. ![]()
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