Built for Indian bodies
Where a standard report misreads an Indian body.
Most reference lines were set on other populations. For a few measures, guidelines publish South Asian lines; for others, the line is the same but the reading needs Indian context. Seven of them, each cited.
01 of 7
BMI, the line moves down.
The WHO expert consultation found that many Asian populations carry high risk of type 2 diabetes and heart disease below a BMI of 25, and proposed extra action points at 23 and 27.5.9 NICE now tells UK clinicians to use 23 and 27.5 for South Asian adults.8
What this means for your report
If a report calls a BMI of 24 “normal”, it is reading you on the standard scale. On the South Asian scale it is past the overweight line.
02 of 7
Waist, where the weight sits.
The Indian consensus sets abdominal obesity at a waist of 90 cm for men and 80 cm for women.4 The waist-to-height ratio needs no ethnic adjustment: NICE uses 0.5 as the line for increased central adiposity in every group.8
What this means for your report
Most blood reports do not include your waist. Measure it yourself, or ask for it at your assessment.
03 of 7
Thin-fat, the scale can’t see it.
At the same BMI, Asian Indians tend to carry more body fat, more of it around the organs.5 The Indian consensus moves the overweight line to a BMI of 23, with waist action points of 90 cm for men and 80 cm for women.4 DEXA measures the visceral fat a BMI hides. Because the limits of a healthy BMI sit lower for Asian Indians,4 fasting sugar can look normal while insulin is working harder than it should. So we measure fasting insulin and the HOMA-IR score, not only sugar.
What this means for your report
A normal fasting sugar with a normal BMI does not rule out insulin resistance. Fasting insulin is the marker that shows it.
| Measure | Standard | Indian context |
|---|---|---|
| Body fat | Estimated from BMI | Measured: DEXA or InBody |
| TG:HDL as an insulin signal | Often read against 3.0 | Not reliable in South Asian women11 |
04 of 7
Lp(a), inherited, test it once.
An inherited cholesterol particle, set mostly by your genes and missing from most routine checkups. European guidance advises measuring it at least once in every adult’s life.1 In UK Biobank, the median level was 31 nmol/L in South Asian participants and 19 nmol/L in White participants.10
What this means for your report
Lp(a) is in mg/dL on some reports and nmol/L on others, and the European panel advises against converting between them with a fixed factor.10 Read it against the line in the same unit.
05 of 7
HbA1c, never read alone.
HbA1c is measured on red cells, so anaemia and low iron can make it read wrong.2 Anaemia affects 57% of Indian women aged 15–49.3 We always read HbA1c beside haemoglobin and ferritin.
What this means for your report
If your haemoglobin or ferritin is low, an HbA1c on the same report may not mean what it seems. Fasting glucose gives a second view.
06 of 7
Vitamin D, low despite the sun.
In a survey of 1,403 adults around Delhi, the median vitamin D level in the city was 7.7 ng/mL, below the 10 ng/mL line the study calls severe deficiency. City dwellers, women and people with abdominal fat were the most likely to be severely low.6
What this means for your report
Vitamin D can be printed in ng/mL or nmol/L. Check the unit before comparing a result with any line.
07 of 7
Vitamin B12, if you are vegetarian.
B12 comes almost only from animal foods, and metformin and long-term acid reducers lower it further.7 A shortfall can cause tingling and forgetfulness before the blood count changes. We read it with homocysteine.
What this means for your report
B12 is easy to leave off a routine panel. If it is on yours, homocysteine read beside it gives a second view.
| Measure | Standard | Indian context |
|---|---|---|
| Who should check | Not routine on many panels | Vegetarians, and anyone on metformin or long-term acid reducers7 |
Questions people ask.
Are Indian reference ranges different from the ones on my lab report?
Most lab ranges are set from the healthy people a method was tested on. For a few measures, guidelines publish separate lines for South Asian adults, mainly BMI. For most blood markers the line is the same and what changes is how a physician reads it in Indian context, such as HbA1c beside haemoglobin and ferritin.
Which scale should I use for BMI?
For a South Asian adult, NICE uses 23 as the start of overweight and 27.5 as the start of obesity. The standard 25 and 30 lines still appear on most reports, which is why we show both.
Is a high Lp(a) common in Indians?
Levels vary with ancestry. In UK Biobank the median in South Asian participants was higher than in White participants. Lp(a) is set mostly by your genes, which is why European guidance advises measuring it at least once in adult life.
Does this page tell me what to do about a result?
No. It explains which lines apply and why. What a result means for you depends on your history and other results, and a physician decides that with you.
Work out your own numbers with the India-calibrated calculators, or see how every marker is explained in the biomarker library.
References
- Kronenberg F et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J 2022;43:3925–3946. Read the source (opens in a new tab)
- MedlinePlus (US National Library of Medicine). Hemoglobin A1C (HbA1c) test: anaemia and other red-cell conditions can make results less accurate. Read the source (opens in a new tab)
- Let S et al. Prevalence and determinants of anaemia among women of reproductive age in Aspirational Districts of India: an analysis of NFHS 4 and NFHS 5 data. BMC Public Health 2024;24:437. National prevalence, women 15–49, NFHS-5. Read the source (opens in a new tab)
- Misra A et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians. J Assoc Physicians India 2009;57:163–170. Read the source (opens in a new tab)
- Yajnik CS, Yudkin JS. The Y-Y paradox. Lancet 2004;363:163. Two men of the same BMI, one Indian and one European, with very different body fat on DEXA. Read the source (opens in a new tab)
- Praveen PA et al. Prevalence and correlates of vitamin D deficiency among adults in urban and rural areas of the National Capital Region of Delhi. WHO South-East Asia J Public Health 2023;12:104–109. n = 1,403. Read the source (opens in a new tab)
- MedlinePlus Medical Encyclopedia. Vitamin B12 deficiency anemia: a strict vegetarian diet, long-term metformin and long-term heartburn medicines as causes. Read the source (opens in a new tab)
- NICE guideline NG246. Overweight and obesity management, 2025: recommendations 1.9.10 (BMI classes), 1.9.11 (lower BMI thresholds of 23 and 27.5 for South Asian and other groups) and 1.9.14 (waist-to-height ratio 0.4–0.49, 0.5–0.59 and 0.6 or more, for all ethnicities and both sexes, BMI under 35). Read the source (opens in a new tab)
- WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157–163. Public health action points at BMI 23.0 and 27.5. Read the source (opens in a new tab)
- Kronenberg F et al., European Atherosclerosis Society consensus 2022 (full text). Lp(a) “rule-out” below 30 mg/dL (75 nmol/L) and “rule-in” above 50 mg/dL (125 nmol/L); UK Biobank medians of 19 nmol/L in White and 31 nmol/L in South Asian participants. Read the source (opens in a new tab)
- Mostafa SA et al. The association of the triglyceride-to-HDL cholesterol ratio with insulin resistance in White European and South Asian men and women. PLoS One 2012;7:e50931. The ratio was not associated with insulin resistance in South Asian women. Read the source (opens in a new tab)
Educational content. Nothing on this page is a diagnosis or a treatment recommendation.
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