No association between body height and metabolic risk factors in historically short height Asian Indian tribes

Keywords: Height, India, Tribes, Diabetes, Hypertension, St. Nicolas House Analysis


Background: Asian Indians often get predisposed to non-communicable diseases for which the “thin-fat” or “hidden obese” Indian phenotype is usually regarded responsible. In Europe, America and in some low-middle-income countries (LMICs) short height is often associated with a high risk of metabolic syndrome (MetS). Indians and particularly tribal Indian people are relatively short.

Aim: To assess the associations of height with MetS risk factors among tribal people of India.

Sample and methods: This study was conducted among tribes of India under life-style transition. The height range was 163.2 cm to 156.5 cm (males) and 151.6 cm to 146.9 cm (females). The participants were 1066 men and 1090 women aged 20 to 60 years. Anthropometric and metabolic markers included in the study were height, body mass index (BMI), waist circumference (WC), skinfolds (biceps, triceps, sub-scapular, and supra-iliacal), fasting blood glucose (FBG), blood pressure (systolic and diastolic) and pulse rate (PR).

Results: The highest correlation existed between height and WC (male: 0.21; female: 0.15). Correlations of body composition variables (BMI, WC, skinfolds) with MetS risk factors (FBG, SBP, DBP, PR) were not reliable (r < 0.30) among both sexes. St. Nicolas House Analysis revealed WC among males and WC and sub-scapular skinfolds among females sharing more connections with other nodes variables.

Conclusions: Unlike the people of the wealthy and often obese social strata of low-middle-income countries, and in Europe and North America, height of tribal Indian populations is not associated with metabolic risk factors, such as hypertension, elevated fasting blood sugar, and central obesity. Rather than linked to the phenotype, obesity appears to be associated with an obesogenic environment. Public health policy should focus on problems associated with obesogenic environments.


American Diabetes Association (2022). Diagnosis. Available online at (accessed 4/20/2022).

Asao, K./Kao, W. H. L./Baptiste-Roberts, K./Bandeen-Roche, K./Erlinger, T. P./Brancati, F. L. (2006). Short stature and the risk of adiposity, insulin resistance, and type 2 diabetes in middle age: the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994. Diabetes Care 29 (7), 1632–1637.

Bhar, D./Bhattacherjee, S./Das, D. K. (2019). Behavioral and biological risk factors of noncommunicable diseases among tribal adults of rural siliguri in Darjeeling District, West Bengal: A cross-sectional study. Indian Journal of Public Health 63 (2), 119–127.

Bose, K./Mascie-Taylor, C. G. N. (1995). Association of truncal subcutaneous adiposity with some risk factors of type II diabetes in adult white and migrant Pakistani males. Journal of Human Ecology (Madrid) 4 (2/3), 301–310.

Bose, K./Chakraborty, F. (2005). Anthropometric characteristics and nutritional status based on body mass index of adult Bathudis: a tribal population of Keonjhar District, Orissa, India. Asia Pacific Journal of Clinical Nutrition 14 (1), 80–82. Available online at (accessed 8/10/2022).

Bose, K./Bisai, S./Chakraborty, F. (2006a). Age variations in anthropometric and body composition characteristics and underweight among male Bathudis – a tribal population of Keonjhar District, Orissa, India. Collegium Antropologicum 30 (4), 771–775. Available online at (accessed 8/10/2022).

Bose, K./Chakraborty, F./Mitra, K./Bisai, S. (2006b). Nutritional status of adult Santal men in Keonjhar District, Orissa, India. Food and Nutrition Bulletin 27 (4), 353–356.

Bose, K./Ganguly, S./Mamtaz, H./Mukhopadhyay, A./Bhadra, M. (2006c). High prevalence of undernutrition among adult Kora Mudi tribals of Bankura District, West Bengal, India. Anthropological Science 114 (1), 65–68.

Chakraborty, R./Bose, K./Koziel, S. (2011). Use of mid-upper arm circumference in determining undernutrition and illness in rural adult Oraon men of Gumla District, Jharkhand, India. Rural and Remote Health 11 (3), 1754.

Cornier, M.-A./Dabelea, D./Hernandez, T. L./Lindstrom, R. C./Steig, A. J./Stob, N. R./van Pelt, R. E./Wang, H./Eckel, R. H. (2008). The metabolic syndrome. Endocrine Reviews 29 (7), 777–822.

Dorjee, B. (2015). Thinness and overweight among children belonging to Bengalee population aged 3-10 years. South Asian Anthropologist 15 (2), 135–144. Available online at (accessed 8/10/2022).

Førde, O. H./Thelle, D. S. (1980). The Tromsø heart study. A multiple regression analysis of the relationship between coronary risk factors and some physical and social variables. Scandinavian Journal of Public Health 8 (2), 49–54.

Ghosh-Jerath, S./Kapoor, R./Barman, S./Singh, G./Singh, A./Downs, S./Fanzo, J. (2021). Traditional food environment and factors affecting indigenous food consumption in Munda tribal community of Jharkhand, India. Frontiers in Nutrition 7, 600470.

Ghurye, G. S. (1969). Caste and race in India. Bombay, Popular Prakashan.

Groth, D./Scheffler, C./Hermanussen, M. (2019). Body height in stunted Indonesian children depends directly on parental education and not via a nutrition mediated pathway - Evidence from tracing association chains by St. Nicolas House Analysis. Anthropologischer Anzeiger 76 (5), 445–451.

Gupta, R. D./Akonde, M./Sajal, I. H./Al Kibria, G. M. (2021). Association between height and hypertension among US adults: analyses of National Health and Nutrition Examination Survey 2007-18. Clinical Hypertension 27 (1), 6.

Hermanussen, M./Aßmann, C./Groth, D. (2021). Chain reversion for detecting associations in interacting variables: St. Nicolas house analysis. International Journal of Environmental Research and Public Health 18 (4), 1741.

Hills, A. P./Arena, R./Khunti, K./Yajnik, C. S./Jayawardena, R./Henry, C. J./Street, S. J./Soares, M. J./Misra, A. (2018). Epidemiology and determinants of type 2 diabetes in south Asia. The Lancet. Diabetes & Endocrinology 6 (12), 966–978.

Huang, P. L. (2009). A comprehensive definition for metabolic syndrome. Disease Models & Mechanisms 2 (5-6), 231–237.

Islam, T./Siraj, S./Hassan, Z./Nayem, M./Chandra Nag, D./Islam, A./Islam, R./Mazumder, T./Choudhury, S. R./Siddiquee, A. T. (2020). Influence of height on blood pressure and hypertension among Bangladeshi adults. International Journal of Cardiology. Hypertension 5, 100028.

Janghorbani, M./Momeni, F./Dehghani, M. (2012). Hip circumference, height and risk of type 2 diabetes: systematic review and meta-analysis. Obesity Reviews 13 (12), 1172–1181.

Kirchengast, S./Hagmann, D. (2021). Obesity in the City" – urbanization, health risks and rising obesity rates from the viewpoint of human biology and public health. Human Biology and Public Health 2.

Kshatriya, G. K./Acharya, S. (2016). Triple burden of obesity, undernutrition, and cardiovascular disease risk among Indian tribes. PloS One 11 (1), 147934.

Kshatriya, G. K./Acharya, S. K. (2019). Prevalence and risks of hypertension among Indian tribes and its status among the lean and underweight individuals. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 13 (2), 1105–1115.

Kshatriya, G. K./Das, M./Bose, K. (2021). Ethnic heterogeneity in body composition patterning and CVD risk factors: a multi-ethnic study of Asian Indian Tribes. Ethnicity & Health, 1–24.

Langenberg, C./Hardy, R./Kuh, D./Wadsworth, M. E. (2003). Influence of height, leg and trunk length on pulse pressure, systolic and diastolic blood pressure. Journal of Hypertension 21 (3), 537–543.

Langenberg, C./Hardy, R./Breeze, E./Kuh, D./Wadsworth, M. E. J. (2005). Influence of short stature on the change in pulse pressure, systolic and diastolic blood pressure from age 36 to 53 years: an analysis using multilevel models. International Journal of Epidemiology 34 (4), 905–913.

Lawlor, D. A./Ebrahim, S./Davey Smith, G. (2002). The association between components of adult height and Type II diabetes and insulin resistance: British Women’s Heart and Health Study. Diabetologia 45 (8), 1097–1106.

Lohman, T. G./Roche, A. F./Martorell, R. (1988). Anthropometric standardization reference manual. Champaign, Illinois, Human Kinetics Books.

Martin, L./Dorjee, B./Groth, D./Scheffler, C. (2020). Positive influence of parental education on growth of children - statistical analysis of correlation between social and nutritional factors on children’s height using the St. Nicolas House Analysis. Anthropologischer Anzeiger 77 (5), 375–387.

Mungreiphy, N. K./Dhall, M./Tyagi, R./Saluja, K./Kumar, A./Tungdim, M. G./Sinha, R./Rongmei, K. S./Tandon, K./Bhardwaj, S./Kapoor, A. K./Kapoor, S. (2012). Ethnicity, obesity and health pattern among Indian population. Journal of Natural Science, Biology and Medicine 3 (1), 52–59.

National Health Portal Of India (2022). Non-communicable diseases. Available online at (accessed 5/1/2022).

National Heart, Lung, and Blood Institute (2022). Metabolic Syndrome - What Is Metabolic Syndrome? Available online at (accessed 5/1/2022).

NCD Risk Factor Collaboration (2016). A century of trends in adult human height. Elife 5, e13410.

NNMB III Repeat Rural Survey (2012). Diet and nutritional status of rural population, prevalence of hypertension and diabetes among adults, and infant and young child feeding practices. National Institute of Nutrition, ICMR, Hyderabad. Available online at

Office of the Registrar General & Census Commissioner, India (2001). Census of India 2001. Available online at (accessed 5/1/2022).

Puchner, K. P./Lopez-Ridaura, R./Ortiz-Panozo, E./Vieitez, I./Lajous, M. (2017). Stature is inversely associated with self-reported diabetes in middle-aged Mexican women. Revista Panamericana de Salud Pública = Pan American Journal of Public Health 41, 32.

Rhee, E. J./Cho, J. H./Kwon, H./Park, S. E./Jung, J. H./Han, K. D./Park, Y. G./Kim, Y. H./Lee, W. Y. (2019). Relation between baseline height and new diabetes development: a nationwide population-based study. Diabetes & Metabolism Journal 43 (6), 794–803.

Risley, H. H. (1891). The tribes and castes of Bengal. Calcutta, Bengal Secretariat Press.

Rizwan, S. A./Kumar, R./Singh, A. K./Kusuma, Y. S./Yadav, K./Pandav, C. S. (2014). Prevalence of hypertension in Indian tribes: a systematic review and meta-analysis of observational studies. PloS One 9 (5), e95896.

Sajeev, P./Soman, B. (2018). Prevalence of noncommunicable disease risk factors among the Kani tribe in Thiruvananthapuram district, Kerala. Indian Heart Journal 70 (5), 598–603.

Sarkar, S./Das, M./Mukhopadhyay, B./Sekhar Chakraborty, C./Majumder, P. P. (2005). Prevalence of metabolic syndrome in two tribal populations of the sub-Himalayan region of India: ethnic and rural-urban differences. American Journal of Human Biology 17 (6), 814–817.

Saxena, V./Bhattacharya, P. C. (2018). Inequalities in LPG and electricity consumption in India: The role of caste, tribe, and religion. Energy for Sustainable Development 42, 44–53.

Scheffler, C./Krützfeldt, L.-M./Dasgupta, P./Hermanussen, M. (2018). No association between fat tissue and height in 5019 children and adolescents, measured between 1982 and in 2011 in Kolkata/India. Anthropologischer Anzeiger 74 (5), 403–411.

Scheffler, C./Hermanussen, M./Bogin, B./Liana, D. S./Taolin, F./Cempaka, P. M. V. P./Irawan, M./Ibbibah, L. F./Mappapa, N. K./Payong, M. K. E./Homalessy, A. V./Takalapeta, A./Apriyanti, S./Manoeroe, M. G./Dupe, F. R./Ratri, R. R. K./Touw, S. Y./K, P. V./Murtani, B. J./Nunuhitu, R./Puspitasari, R./Riandra, I. K./Liwan, A. S./Amandari, P./Permatasari, A. A. I./Julia, M./Batubara, J./Pulungan, A. (2020). Stunting is not a synonym of malnutrition. European Journal of Clinical Nutrition 74 (3), 377–386.

Shriraam, V./Mahadevan, S./Arumugam, P. (2021). Prevalence and risk factors of diabetes, hypertension and other non-communicable diseases in a tribal population in South India. Indian Journal of Endocrinology and Metabolism 25 (4), 313.

Soren, S. K./Sahu, S./Kujur, A./Dandpat, A./Kashyap, V./Kumari, P./Ragini, K. J./Kumari, A./Kumar, D. (2021). Predictors of breastfeeding initiation among postnatal mothers at tertiary care center of a tribal dominant state in India: A regression analysis. Cureus 13 (8), e16936.

Stefan, N./Häring, H.-U./Hu, F. B./Schulze, M. B. (2016). Divergent associations of height with cardiometabolic disease and cancer: epidemiology, pathophysiology, and global implications. The Lancet. Diabetes & Endocrinology 4 (5), 457–467.

Swinburn, B./Egger, G./Raza, F. (1999). Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Preventive Medicine 29 (6), 563–570.

Tchernof, A./Després, J.-P. (2013). Pathophysiology of human visceral obesity: an update. Physiological Reviews 93 (1), 359–404.

Toro-Huamanchumo, C. J./Pérez-Zavala, M./Urrunaga-Pastor, D./La Fuente-Carmelino, L. de/Benites-Zapata, V. A. (2020). Relationship between the short stature and the prevalence of metabolic syndrome and insulin resistance markers in workers of a private educational institution in Peru. Diabetes & Metabolic Syndrome 14 (5), 1339–1345.

Vangipurapu, J./Stancáková, A./Jauhiainen, R./Kuusisto, J./Laakso, M. (2017). Short adult stature predicts impaired β-cell function, insulin resistance, glycemia, and type 2 diabetes in Finnish men. The Journal of Clinical Endocrinology and Metabolism 102 (2), 443–450.

Weber, M. A./Schiffrin, E. L./White, W. B./Mann, S./Lindholm, L. H./Kenerson, J. G./Flack, J. M./Carter, B. L./Materson, B. J./Ram, C. V. S./Cohen, D. L./Cadet, J.-C./Jean-Charles, R. R./Taler, S./Kountz, D./Townsend, R. R./Chalmers, J./Ramirez, A. J./Bakris, G. L./Wang, J./Schutte, A. E./Bisognano, J. D./Touyz, R. M./Sica, D./Harrap, S. B. (2014). Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. The Journal of Clinical Hypertension 16 (1), 14–26.

WHO (2008). Waist circumference and waist–hip ratio: report of a WHO expert consultation. Available online at (accessed 8/17/2022).

WHO (2022). Associated indicators, mean fasting blood glucose. Available online at (accessed 4/20/2022).

WHO/IASO/IOTF (2000). The Asia-Pacific perspective: redefining obesity and its treatment. Melbourne, Health Communications Australia.

Wittenbecher, C./Kuxhaus, O./Boeing, H./Stefan, N./Schulze, M. B. (2019). Associations of short stature and components of height with incidence of type 2 diabetes: mediating effects of cardiometabolic risk factors. Diabetologia 62 (12), 2211–2221.

Yajnik, C. S./Fall, C. H. D./Coyaji, K. J./Hirve, S. S./Rao, S./Barker, D. J. P./Joglekar, C./Kellingray, S. (2003). Neonatal anthropometry: the thin-fat Indian baby. The Pune Maternal Nutrition Study. International Journal of Obesity 27 (2), 173–180.

Yuan, Y./Zhou, B./Wang, S./Ma, J./Dong, F./Yang, M./Zhang, Z./Niu, W. (2020). Adult body height and cardiometabolic disease risk: The China National Health Survey in Shaanxi. Frontiers in Endocrinology 11, 587616.

Zdrojewicz, Z./Popowicz, E./Szyca, M./Michalik, T./Śmieszniak, B. (2017). TOFI phenotype - its effect on the occurrence of diabetes. Pediatric Endocrinology, Diabetes, and Metabolism 23 (2), 96–100.

How to Cite
Dorjee, B., Sen, J., Das, M., Bose, K., Scheffler, C., & Kshatriya, G. K. (2022). No association between body height and metabolic risk factors in historically short height Asian Indian tribes. Human Biology and Public Health, 1.