Reply to Letter to Editorial Entitled The Rising Tide of Prehypertension and Obesity in Rural India: A Nuanced Look at Cardiometabolic Risk Transition

We would like to thank the author for the letter to the editor, which provides a nuanced review of our published article. The author correctly observed that studies measuring changes in risk factors over an extended period are uncommon. Very few repeated cross-sectional surveys have been conducted in rural India, such as in the Vellore district in Tamil Nadu and New Delhi.[1,2] However, these studies were conducted (data collection time period) a decade ago, and no such studies have been reported in Western India. We agree with most of the observations made by the author. High levels of obesity and prehypertension observed in our study might be due to the epidemiological, economic, and nutritional transitions in the study area, similar to rural regions in India and other low- and middle-income countries.[3,4] Our study involved a single repetition of a cross-sectional survey using two independent samples, allowing us to compare two time points through standardization. We disagree with the authors’ mention of selection bias (line number 40) in the missing nonresponse data in the 2005 survey. As we understand that the missing nonresponse rate in the 2005 survey was quite low (2%), which is well within the acceptable range of nonresponse in cross-sectional studies, typically under 20%.[5] Moreover, the findings are specific to the Vadu Health and Demographic Surveillance System rural region in Pune district, and caution is advised when generalizing these results to the entire country, even if similar high burdens of risk factors have been identified in other cross-sectional studies from other regions in India. In the absence of recent similar studies, as the authors rightly pointed out, it is a wake-up call (line number 34) to focus on rural areas that are rapidly urbanizing, with further periodic assessments of noncommunicable diseases (NCD) risk factors and context-specific implementation research to identify barriers and facilitators for implementing the India’s National Program for NCD program (NP-NCD program) to better control of risk factors. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.