title: Socio-economic position and cardiovascular risk in rural Indian adolescents: evidence from the Andhra Pradesh children and parents study (APCAPS).
abstract: OBJECTIVE
  This study examined association between socio-economic position and cardiovascular risk factors in adolescents to investigate whether childhood socio-economic position is a risk factor for future cardiovascular disease, independently of adult behaviours.
  
  
  METHODS
  Participants (n = 1128, 46% girls, aged 13-18 years) were members of a birth cohort (Andhra Pradesh Children and Parents Study or APCAPS) established to investigate long-term effects of a pregnancy and childhood nutritional supplementation trial conducted in 29 villages near Hyderabad in South India. Cross-sectional associations between socio-economic position and cardiovascular risk factors were examined using linear regression models.
  
  
  RESULTS
  The mean BMI was 16.7 kg/m(2) for boys and 17.8 kg/m(2) for girls. Socio-economic position was positively associated with fat mass index (0.15 kg/m(2); 95% CI: 0.05-0.25) and inversely associated with central-peripheral skinfold ratio (-0.04; 95% CI: -0.06 to -0.01) and, in boys, fasting triglycerides (-0.05; 95% CI: -0.09 to -0.01). Association of socio-economic position with other risk factors (blood pressure, arterial stiffness, fasting glucose, insulin and cholesterol) was weak and inconsistent, and did not persist after adjustment for potential confounders, including age, sex, pubertal stage, height, adiposity and nutrition supplementation.
  
  
  CONCLUSIONS
  The study thus showed that lower socio-economic position may be associated with greater central adiposity and higher triglyceride levels in these settings. Socio-economic gradient in cardiovascular risk may strengthen in future with later economic and lifestyle changes. Cardiovascular disease prevention strategies should therefore focus on the youth from the low income group.
authors.affiliation: Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom. Electronic address: sanjay.kinra@lshtm.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: Kinra
authors.affiliation: Cegedim Strategic Data Medical Research Ltd, London, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Clinical Division, National Institute of Nutrition, Hyderabad, India.
authors.forename: B
authors.initials: B
authors.lastname: Kulkarni
authors.affiliation: Education and Training Division, National Institute of Nutrition, Hyderabad, India.
authors.forename: K V
authors.initials: KV
authors.lastname: Rameshwar Sarma
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Y
authors.initials: Y
authors.lastname: Ben-Shlomo
authors.affiliation: MRC Centre for Causal Analyses in Translational Epidemiology, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: G D
authors.initials: GD
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D056128:Obesity, Abdominal / Q000453:epidemiology; D011247:Pregnancy; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D012923:Social Class; D014280:Triglycerides / Q000097:blood
chemical_list: D014280:Triglycerides
keywords: Adolescents; Cardiovascular risk; Cohort studies; Fat mass index; Indian; Socio-economic position