CHAPTER 1

INTRODUCTI
ON

1.1. BACKGROUND OF THE STUDY:

The global escalation of obesity represents one of the most pressing and
complex public health concerns of the 21st century. Characterized by an excessive
accumulation of body fat, obesity has witnessed a dramatic rise in prevalence across both
industrialized and developing nations. This trend is fundamentally driven by a sustained
positive energy balance, wherein energy intake consistently surpasses energy expenditure.
Over the past few decades, profound transformations in food systems—marked by the
widespread availability of calorie-dense, nutrient-poor foods—have been paralleled by
increasingly sedentary lifestyles, diminishing the role of physical activity in daily routines.
While obesity was once considered a condition exclusive to affluent society, it now exerts a
growing burden on low- and middle-income countries, often coexisting with undernutrition
and infectious diseases, thus contributing to what is known as the “double burden of
malnutrition.” The entrenchment of obesogenic environments—characterized by unhealthy
food landscapes, limited recreational spaces, and inadequate public health infrastructure—
has played a pivotal role in making obesity a global phenomenon.

The implications of this rise in obesity are both profound and far-reaching, particularly with respect to the burden
of non communicable diseases (NCDs). Obesity is a well-established risk factor for a range of chronic conditions;
most notably type 2 diabetes mellitus, cardiovascular diseases, certain forms of cancer, and significantly,
hypertension. Excess adiposity is known to disrupt normal metabolic and vascular function, contributing to
elevated blood pressure through pathways involving insulin resistance, inflammatory cytokines, and altered renal
sodium handling. In children and adolescents, the early onset of obesity is particularly alarming, as it predisposes
individuals to long-term health complications, including juvenile hypertension, while also affecting psychosocial
well-being through experiences of stigma, discrimination, and reduced quality of life. Beyond the human cost, the
economic implications are staggering, with global obesity-related healthcare expenditures projected to exceed US$
18 trillion by 2060 if current trends persist. Combating obesity thus demands an integrated, multisectoral
response that not only empowers

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individuals but also addresses the structural determinants of health—through public policy,
food industry regulation, urban planning, and strengthened primary health care systems. Only
by fostering environments that support and promote healthy living can the trajectory of this
escalating global epidemic be meaningfully altered.

1.1.1. WOMEN’s HEALTH

Women’s health is uniquely shaped by physiological, hormonal, and social

factors that make them particularly vulnerable to the effects of rising obesity and lifestyle-
related diseases. Beyond reproductive concerns, excess body weight in women is strongly
associated with increased risks of hypertension, type 2 diabetes, dyslipidemia, and certain
cancers, all of which contribute significantly to long-term morbidity and mortality.
Hypertension, in particular, often emerges silently but carries serious consequences for
cardiovascular and renal health, especially when compounded by obesity and sedentary
behavior. The growing shift toward energy-dense diets and reduced physical activity—
fueled by urbanization, mechanization, and changing food systems—has contributed to a
global environment where maintaining metabolic health is increasingly challenging.
Recognizing obesity as a central driver of multiple chronic conditions, especially among
women in low- and middle-income contexts, underscores the need for early, gender-
sensitive interventions. Promoting women’s health through sustainable lifestyle
modifications not only reduces immediate disease risk but also enhances overall quality of
life and resilience across the life course.

Comparing dietary habits, lifestyle patterns, and health outcomes across

different communities provides critical insights into how cultural, social, and
environmental factors influence the development of obesity and related health conditions
like hypertension. Each community has unique traditions, food practices, and socio-
economic realities that shape daily behaviors and health risks differently. By examining
these variations, researchers can identify specific cultural and lifestyle factors that
contribute to either protection against or increased vulnerability to obesity and
hypertension. This comparative approach is especially important in understanding women’s
health, as gender roles and expectations within different communities strongly impact
dietary choices, physical activity, and weight

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 management. For example, married women in some cultures may face pressures that
deprioritize their own health and weight maintenance, while unmarried women might
experience different social influences related to body image. Understanding such nuances
allows for the design of targeted, culturally sensitive interventions that respect local
customs while promoting healthier behaviors. Ultimately, comparing communities
enhances the ability to develop effective public health strategies tailored to diverse
populations, thereby addressing the growing global burden of obesity and its complications
in a more equitable and sustainable manner.

1.2. WHAT ACTUALLY IS OBESITY?

Obesity is a chronic, multifaceted, and increasingly prevalent medical condition

marked by an excessive or abnormal accumulation of fat in the body that negatively affects
health and overall well-being. The term “obesity” is rooted in the Latin word obesus,
meaning "plump" or "fat," derived from ob (meaning “over”) and edere (meaning “to eat”),
suggesting an overconsumption of food. Although traditionally associated with overeating
and a sedentary lifestyle, obesity is now acknowledged as a complex health disorder driven
by numerous interrelated factors. It is not simply a matter of personal choice or willpower;
rather, it results from a convergence of genetic predispositions, metabolic imbalances,
behavioral habits, and environmental influences. Over the last few decades, obesity has
emerged as a global epidemic, cutting across age groups, socioeconomic strata, and
national boundaries. It is especially concerning because of its close association with a host
of chronic diseases including type 2 diabetes mellitus, cardiovascular disorders, certain
cancers, and musculoskeletal conditions. The increasing burden of obesity has significant
implications not only for individual health but also for public healthcare systems and
national economies.

A number of medical and scientific authorities have attempted to define obesity in

ways that reflect its multifactorial nature.

According to the World Health Organization (WHO, 2000), “Obesity is a condition

in which excess body fat has accumulated to the extent that it may impair health.” This
global perspective frames obesity as a medical issue that extends beyond physical
appearance.

Similarly, Bray (1998) defined it as “the accumulation of fat in such quantity that it
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may be detrimental to health,” emphasizing the health risks associated with excess fat.

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 Earlier, Garrow (1988) described obesity as “a condition of excess body fat to the
extent that health is impaired,” highlighting its impact on well-being.

Expanding the view, James et al. (2001) termed obesity as “a chronic disease
resulting from an imbalance between energy intake and expenditure, leading to excessive
fat accumulation,” pointing to the behavioral and metabolic underpinnings of the
condition.

Furthermore, Spiegelman and Flier (2001) explained that “obesity results from a
complex interaction of genetic, metabolic, behavioral, and environmental factors,”
underscoring the intricate causes of obesity.

These definitions collectively emphasize the need to approach obesity as a serious

health disorder that requires comprehensive understanding and intervention.

The global rise in obesity is fueled by rapid lifestyle changes such as urbanization,
technological advances, and increased screen time, which reduce physical activity and
increase consumption of calorie-dense, nutrient-poor processed foods high in fats and
sugars. This shift has led to sedentary habits from childhood through adulthood,
heightening long- term obesity risks. Obesity assessment goes beyond body mass index
(BMI) to include parameters like waist circumference, waist-to-hip ratio, and visceral fat
levels, which better reflect health risks linked to fat distribution and metabolic dysfunction.
Societal norms and economic pressures often prioritize convenience over healthy living,
embedding obesogenic environments. Combating obesity requires integrated strategies
involving education, environmental improvements, and behavior modification,
emphasizing its serious physiological and metabolic consequences.

1.2.1. BODY MASS INDEX (BMI) :

The concept of Body Mass Index (BMI) was first introduced in the early 19th
century by Belgian mathematician and statistician Adolphe Quetelet. In the 1830s, Quetelet
developed the Quetelet Index as part of his work in social physics to describe the “average
man” using statistical methods. This index related an individual’s weight to their height,
creating a simple number to represent body mass. Though not originally intended for
medical use, this measure laid the foundation for BMI’s modern role. In the 1970s,
physiologist Ancel Keys popularized the term Body Mass Index and promoted its use in

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epidemiology to study obesity and related health risks. Today, BMI is widely used by
organizations like the World

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Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) as
a simple, cost-effective tool for assessing obesity on a population level.

Body Mass Index (BMI) is calculated by dividing a person’s weight in kilograms

by the square of their height in meters. It estimates body fat and classifies individuals as
underweight, normal weight, overweight, or obese. BMI is a useful screening tool to
identify those at risk of conditions like heart disease, diabetes, and hypertension. However,
it has limitations: it cannot distinguish between fat and muscle mass, nor account for
factors like age, sex, and ethnicity. For example, athletes may have a high BMI but low
body fat. Therefore, BMI should be combined with other health measures such as waist
circumference and blood pressure for a fuller health assessment.

Beyond healthcare, BMI has important applications in anthropology.

Anthropologists use BMI to study human growth, nutritional status, and health differences
among populations. It helps explain how diet, lifestyle, genetics, and environment affect
body composition across cultures and historical periods. BMI also aids in bioarchaeology,
where researchers estimate the health of past populations from skeletal remains. By
providing a standardized measure, BMI enables comparisons between groups and offers
insight into human adaptation, evolution, and the increasing prevalence of obesity
worldwide

1.2.2. WAIST HIP RATIO (WHR):

The waist-hip ratio (WHR) is a simple yet powerful indicator of abdominal or

central obesity, calculated by dividing the waist circumference by the hip circumference.
While Body Mass Index (BMI) reflects overall weight status, WHR highlights the pattern
of fat distribution, particularly the accumulation of fat around the abdomen. This central
fat, often referred to as visceral fat, is more metabolically active and more strongly
associated with chronic diseases. For women, especially those undergoing physiological
and lifestyle transitions after marriage—such as reduced physical activity, altered dietary
habits, and weight gain—WHR becomes a crucial tool for assessing obesity-related health
risks.

The World Health Organization (WHO), through multiple expert consultations

including the 2008 meeting in Geneva, has emphasized the use of WHR alongside BMI for
better prediction of noncommunicable diseases (NCDs) such as hypertension, type 2
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diabetes, and cardiovascular disease. Evidence from longitudinal studies indicates that even
when BMI is within normal limits, a high WHR can signal a substantially elevated risk of

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premature death and cardiovascular events. Notably, in women, WHR has been found to be
an independent and often stronger predictor of such diseases than BMI. This underscores
its importance in public health research targeting married women in low- and middle-
income countries, where underdiagnosed central obesity is emerging as a hidden
contributor to rising NCD burdens.

In present times, the need for reliable, ethnically relevant and easily applicable
obesity markers has grown, especially in Asian populations who may develop visceral fat
at lower BMI levels. WHO recommends that waist circumference and WHR should be
considered in population-specific guidelines, as cultural dietary practices—such as high
intake of carbohydrates, animal fats, or fermented foods—can contribute to abdominal fat
deposition. For researchers and policymakers addressing obesity among married women,
WHR serves not just as a diagnostic tool but also as a foundation for targeted intervention,
enabling early identification of those at risk before overt obesity or hypertension sets in.

1.3. HYPERTENSION:

Hypertension, commonly known as high blood pressure, is a chronic condition

characterized by persistently elevated pressure of blood against the arterial walls, typically
defined as a reading above 130/80 mmHg. The understanding of hypertension as a distinct
medical condition has evolved over centuries, beginning with Reverend Stephen Hales's
1733 experiment, which marked the first recorded measurement of blood pressure—
conducted on a horse using a glass tube inserted into an artery. However, it was not until
the late 19th century that hypertension was recognized in humans as a standalone disease
entity. A pivotal moment came with Frederick Mahomed's 1874 observations using a
sphygmograph, wherein he documented consistently elevated blood pressure in individuals
who did not exhibit signs of kidney disease. This was the first significant step toward
defining hypertension as a primary or essential condition, rather than a symptom of another
ailment.

The development of reliable measurement tools greatly accelerated the clinical

recognition and study of hypertension. In 1896, Italian physician Scipione Riva-Rocci
introduced the cuff-based sphygmomanometer, revolutionizing the way blood pressure was
measured. Later, in 1905, Nikolai Korotkoff improved this method by identifying the now-
standard Korotkoff sounds, which enabled accurate determination of both systolic and
diastolic pressure. These innovations made routine and non-invasive blood pressure
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monitoring possible, thereby facilitating early diagnosis and long-term management.
Today,

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hypertension is typically staged into categories—prehypertension, stage 1, and stage 2—
based on blood pressure readings, with thresholds defined by leading bodies such as the
American Heart Association (AHA) and World Health Organization (WHO).

In modern times, hypertension is globally acknowledged as the “silent

killer”, due to its asymptomatic nature and strong association with cardiovascular diseases,
stroke, renal failure, and mortality. Although its causes are often idiopathic (primary
hypertension), lifestyle factors such as high-sodium diets, obesity, stress, and lack of
physical activity are known contributors, particularly among married women whose roles
and routines may shift post-marriage. Effective management involves a combination of
pharmacological interventions (e.g., ACE inhibitors, beta-blockers, diuretics), lifestyle
modifications, and regular monitoring. Recognizing the historical trajectory of
hypertension—from an obscure vascular phenomenon to a central public health concern—
underscores the importance of integrating early detection tools, like blood pressure
screening and waist–hip ratio assessment, into community-level health interventions
targeting high-risk groups.

1.3.1. HYPERTENSION AND ITS STAGES:

Hypertension is categorized into specific stages based on the severity of

blood pressure elevation and its associated health risks. Prehypertension, also termed
elevated blood pressure, marks the earliest warning level, defined by a systolic pressure of
120–129 mmHg and a diastolic reading of less than 80 mmHg. Although not yet falling
under clinical hypertension, this stage signals the onset of vascular stress and an increased
likelihood of disease progression. Stage 1 hypertension is diagnosed when systolic readings
reach 130– 139 mmHg or diastolic ranges between 80–89 mmHg. Here, lifestyle
intervention and possible medication become essential. Stage 2 hypertension, the most
advanced before crisis level, involves readings of 140/90 mmHg or above. If left untreated,
it sharply raises the risk of cardiovascular events such as heart attacks and strokes. In rare
but dangerous cases, patients may experience a hypertensive crisis—a medical emergency
where systolic pressure exceeds 180 mmHg or diastolic exceeds 120 mmHg—demanding
immediate intervention to prevent organ failure.

The rising incidence of hypertension, particularly among married women in

socio-culturally transitioning regions like Manipur, is increasingly understood as a
biocultural phenomenon. Post-marital lifestyle changes often include a decline in physical
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activity, shifts in traditional dietary patterns, and a rise in salt, oil, and processed food

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 consumption. Among both Meitei and Kabui women, these changes are compounded by
domestic stress, hormonal fluctuations, and reduced time for personal health. Notably, even
when Body Mass Index (BMI) lies within normal limits, elevated Waist-Hip Ratio (WHR)
— a key indicator of central obesity—has been linked to early-onset hypertension. This
reflects a broader trend where urbanization, economic strain, and nutritional transition
contribute to chronic diseases in communities that previously relied on traditional
subsistence diets and physically active livelihoods.

From an anthropological perspective, the study of hypertension intersects

meaningfully with medical and nutritional anthropology, offering insights into how cultural
practices, gender roles, and socio-economic pressures shape health outcomes.
Anthropology contextualizes hypertension not merely as a biomedical condition but as a
socially embedded illness—one influenced by marriage customs, food taboos, gendered
labor divisions, and access to healthcare. In field studies among indigenous communities
like the Kabui or the valley-based Meitei, anthropologists can explore how perceptions of
body size, diet, and aging influence health-seeking behavior. This approach aids in
designing culturally appropriate interventions, such as community awareness programs
rooted in traditional food systems or gender-sensitive public health policies. By integrating
biomedical definitions with cultural insights, anthropology helps unravel the layered causes
of hypertension and supports more holistic, community-specific responses to its growing
prevalence.

The increasing prevalence of obesity and hypertension is a growing public health

concern worldwide, including in indigenous and rural communities of India. Among
married women in the Meitei and Kabui communities of Manipur, lifestyle changes after
marriage— such as reduced physical activity and shifts in dietary habits—are believed to
contribute to rising rates of obesity and hypertension. However, despite their distinct
cultural backgrounds and diets, limited research exists on how these factors differentially
affect the health of women in these two communities.

Body Mass Index (BMI) and Waist-Hip Ratio (WHR) are important measures for assessing general and central
obesity, both of which have been linked to hypertension and other cardiovascular risks. While studies suggest that
central obesity is a stronger predictor of hypertension than BMI alone, there is a lack of focused investigation on
these measures in the context of the Meitei and Kabui populations. Furthermore, the influence of traditional versus
modern dietary practices on these health outcomes remains understudied, particularly in married women who play
central roles in household food preparation and consumption.

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This study seeks to bridge these gaps by examining the prevalence of obesity and hypertension among married
women of the Meitei and Kabui communities, and by analyzing

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the association between these health indicators and cultural dietary patterns. Understanding these relationships is
crucial to designing effective, culturally sensitive public health interventions that can mitigate the rising burden of
lifestyle-related diseases and improve the overall well-being of these communities.

METHODS AND

METHODOLOGY

This chapter presents a comprehensive account of the research design and

methodology adopted in the present study, which investigates the prevalence of general
obesity and hypertension among married women belonging to the Meitei and Kabui
communities, with a special focus on the influence of cultural dietary practices. Recognizing
the complexity of health issues that are shaped by both physiological and socio-cultural
factors, the study employs a mixed-method approach—integrating both qualitative and
quantitative techniques—to capture a holistic picture. The methodology has been carefully
chosen to align with the research objectives, ensuring that the data gathered is both
meaningful and scientifically valid. This chapter details the nature of the study, including
the research design, universe of the study, sampling techniques, tools of data collection, and
procedures used for data analysis. Through household surveys, anthropometric
measurements, blood pressure assessments, and open-ended interviews, the research aims to
draw meaningful connections between dietary habits shaped by culture and measurable
health outcomes. The methodological framework thus serves as the foundation for
producing reliable, comparative insights between the two ethnic communities under study.

3.1. RESEARCH DESIGN

The present study adopts a mixed-method research design, incorporating both

qualitative and quantitative approaches to provide a well-rounded analysis of the research
problem. A total of 300 married women, equally divided between the Meitei and Kabui
communities, were selected as respondents. The participants ranged in age from 20 to 40
years, and the data was collected through a household survey conducted in the selected
localities. The qualitative aspect focused on understanding the dietary patterns and socio-
cultural norms related to food practices within each community, using open-ended
interviews and field observations. Simultaneously, the quantitative component involved the
collection of anthropometric and physiological data, including height, weight, waist
circumference (WC), hip circumference (HC), and blood pressure readings. This integrated
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approach enabled the researcher to examine the relationship between culturally rooted
dietary behaviors and measurable health indicators such as obesity and hypertension.

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3.2. DURATION OF FIELDWORK

The field work conducted for 10 days, starting from 5 th of March, 2025 to 14th of
March, 2025.

3.3. METHODOLODY

This study employs a mixed-method approach, integrating qualitative and

quantitative techniques to examine general obesity and hypertension among married Meitei
and Kabui women, with a focus on cultural dietary practices. Primary data was collected
through household surveys involving 300 respondents (150 from each community), aged
20–40, in Chingmeirong, Imphal. This setting allowed for insights into daily dietary and
lifestyle patterns. Semi-structured interviews and field observations enriched the cultural
context, while quantitative data on height, weight, waist and hip circumference, and blood
pressure provided measurable health indicators. This combined approach offered a
comprehensive and comparative understanding of the link between food culture and health
outcomes.

3.4. PARAMETERS OF THE STUDY

 Weight

Measured in kilograms using a standard weighing scale to assess body mass.

 Height

Height is the vertical measurement of a person from head to toe while standing
upright. It is a key anthropometric indicator used to assess growth, nutritional status,
and calculate Body Mass Index (BMI).

 Waist Circumference (WC)

Measured at the midpoint between the lower rib and the iliac crest using a non-
stretchable measuring tape to assess abdominal obesity.

 Hip Circumference (HC)

Taken around the widest portion of the hips to evaluate fat distribution patterns.

 Blood Pressure

Measured manually using a standard mercury or aneroid sphygmomanometer and

stethoscope:
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Systolic Pressure – the pressure exerted when the heart contracts.

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 Diastolic Pressure – the pressure recorded when the heart relaxes between beats.
TABLE 5.8.: FREQUENCY DISTRIBUTION OF BLOOD PRESSURE
AMONG THE MEITEI AND KABUI

RANGE Meitei % Kabui %

NORMAL
102 68.00 73 48.67
PRE-HYPERTENSION 25 16.67 37 24.67
STG 1 HTN 21 14.00 40 26.67
STG 2 HTN 2 1.33 0 0.00
TOTAL 150 100.00 150 100

This table presents the distribution of blood pressure levels among Meitei and Kabui
women based on standard hypertension classifications. A majority of Meitei women (68%)
fall within the normal blood pressure range, compared to only 48.67% of Kabui women,
indicating a healthier cardiovascular profile in the Meitei group. However, a significant
proportion of Kabui women (26.67%) are in Stage 1 Hypertension, markedly higher than the
14% of Meitei women in the same category. Similarly, pre-hypertension is more prevalent
among Kabui women (24.67%) than Meitei women (16.67%), suggesting a greater risk of
developing hypertension in the Kabui community. Notably, Stage 2 Hypertension is
observed only among Meitei women (1.33%), though at a very low rate. Overall, the data
highlights a concerning trend of elevated blood pressure among Kabui women, underscoring
the need for targeted interventions such as regular screening, dietary adjustments, and
lifestyle changes to manage and prevent hypertension in this group.

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 TABLE 5.9.: STATISTICAL CONSTANT OF BLOOD PRESSURE OF THE MEITEI WOMEN

RANGE F SYSTOLIC DIASTOLIC

MEAN SD SE MEAN SD SE
20 - 24 7 119.57 ±14.16 5.35 77.14 ±9.51 3.59
25 – 29 35 120.31 ±9.67 1.63 76.57 ±6.39 1.08
30 – 34 40 117.92 ±7.95 1.26 75 ±6.88 1.09
35 – 39 61 123.32 ±13 1.66 79.34 ±7.77 1.00
40 & 7 119.28 ±4.48 1.69 77.14 ±4.89 1.85
above

The table presents the mean systolic and diastolic blood pressure values of Meitei
women across different age groups, along with standard deviation (SD) and standard error
(SE) to reflect variability and reliability of the data. Overall, systolic blood pressure shows
a slight increasing trend with age, peaking at 123.32 mmHg in the 35–39 age group.
Interestingly, the youngest group (20–24 years) has a mean systolic pressure of 119.57
mmHg, which is comparable to that of the oldest group (40 & above) at 119.28 mmHg,
though the standard error is higher in both due to the small sample size (F = 7). Diastolic
pressure also rises with age, from 75 mmHg in the 30–34 age group to 79.34 mmHg in the
35–39 group, indicating increasing cardiovascular strain in midlife. The lowest standard
errors are found in age groups with larger sample sizes (25–39), implying more reliable
estimates. Overall, the data suggest a pattern of increasing blood pressure in the mid-age
groups among Meitei women, which may require targeted health interventions for early
prevention of hypertension.

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 TABLE 5.10.: STATISTICAL CONSTANSTANT OF BLOOD PRESSURE AMONG THE
KABUI WOMEN

SYSTOLIC DIASTOLIC
RANGE F
MEAN SD SE MEAN SD SE
20 - 24 1 120 - - 70 - -
25 – 29 26 122.15 ±8.02 1.57 80.38 ±7.20 1.41
30 – 34 53 122.84 ±8.36 1.15 78.67 ±7.85 1.08
35 – 39 69 123.97 ±10.20 1.23 80.07 ±7.49 0.90
40 &
1 120 - - 70 - -
above

The above table presents the mean, standard deviation (SD), and standard error (SE)
of systolic and diastolic blood pressure readings across five age groups. For the age group
25– 29, the average systolic pressure is 122.15 mmHg with a SE of 1.57, and diastolic is
80.38 mmHg with a SE of 1.41, indicating moderate variation. In the 30–34 group, systolic
pressure is slightly higher at 122.84 mmHg (SE = 1.15) and diastolic is 78.67 mmHg (SE =
1.08), showing more consistency. The highest systolic mean is observed in the 35–39 age
group at
123.97 mmHg (SE = 1.23), and diastolic at 80.07 mmHg (SE = 0.90), suggesting a peak in
blood pressure around this age. The groups 20–24 and 40 & above each include only one
participant, hence no SD or SE can be calculated. Overall, the data show a trend of
increasing systolic blood pressure with age among Kabui women, peaking around the late
30s, while diastolic values fluctuate within a relatively stable range.

TABLE 5.17.: INDEPENDENT SAMPLES T-TEST FOR MEAN SYSTOLIC BLOOD

PRESSURE BETWEEN MEITEI AND KABUI COMMUNITIES
MEAN STANDARD t- STATISTIC DEGREEOF P-VALUE t-CRITICAL
COMMU FREQUENCY VARIANCE
SYSTOLLIC DEVIATION FREEDOM (TWO (TWO
NITY (SD) (df) TAILED) TAILED)

MEITEI 150 120.82 123.235 11.10 2.033

287 <0.042 1.68
KABUI 150 123.21 83.386 9.13

The table presents the results of an independent samples t-test comparing

the mean systolic blood pressure between the Meitei and Kabui communities. The Meitei
group has a mean systolic BP of 120.82 mmHg (SD = 11.10), while the Kabui group has a
slightly higher mean of 123.21 mmHg (SD = 9.13). The calculated t-statistic is 2.033, with
287 degrees of freedom and a p-value < 0.0429. Since the p-value is below the standard 0.05
significance level and the t-statistic exceeds the critical value of 1.6826, this indicates a
statistically significant difference between the two groups. It suggests that Kabui individuals
have, on average, higher systolic blood pressure compared to Meitei individuals, which may

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reflect emerging cardiovascular health concerns within the Kabui populatio n.

This finding is supported by Dr. R. Singh et al. (2018) in their paper titled
“Blood Pressure Trends among Tribal and Non-Tribal Populations in Northeast India,”
which reported higher average systolic pressures among certain tribal groups due to recent
dietary changes, reduced physical labor, and increased psychosocial stress. Conversely, it
contradicts Naorem & Yumnam (2015) in their study “Hypertension Patterns among Urban
Meitei Adults,” which found higher systolic pressure among Meiteis, attributing it to
sedentary lifestyles and urban stressors. The current result points to a possible
epidemiological shift, where traditionally low-risk tribal populations like the Kabui are now
showing elevated blood pressure trends, calling for more focused public health surveillance
and culturally appropriate interventions.

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 TABLE 5.18.: INDEPENDENT SAMPLES T-TEST FOR MEAN DIASTOLIC BLOOD
PRESSURE BETWEEN MEITEI AND KABUI COMMUNITIES
MEAN STANDARD t- STATISTIC DEGREEOF P-VALUE t-CRITICAL
COMM FREQUENCY VARIANCE
DIASTOLLIC DEVIATION FREEDOM (TWO (TWO
UNITY (SD) (df) TAILED) TAILED)

MEITEI 150 77.33 53.9149 2.5124

7.34 298 <0.0125 1.967
KABUI 150 79.5 57.6342 7.59

This table presents an independent samples t-test comparing the mean diastolic
blood pressure between the Meitei and Kabui communities. The Meitei group has a mean
diastolic BP of 77.33 mmHg with a standard deviation of 7.34, while the Kabui group has a
higher mean of 79.5 mmHg and a standard deviation of 7.59. The t-statistic is 2.512 with
298 degrees of freedom, and the p- value is less than 0.0125, which is below the 0.05
threshold. Since the t-statistic exceeds the t-critical value of 1.9679, we reject the null
hypothesis. This result indicates a statistically significant difference in mean diastolic BP
between the two groups, with Kabui individuals showing higher average diastolic pressure
than Meiteis.

This result supports the findings of Dr. S. Devi and Dr. L. Thangjam (2020) in their
study titled “Cardiovascular Health Risk in Tribal vs. Non-Tribal Populations of Manipur,”
which concluded that tribal groups, including the Kabui, were experiencing a rise in diastolic
blood pressure due to dietary changes, stress, and reduced physical activity. In contrast, the
result is at odds with Ranjan et al. (2016) in “Lifestyle and Blood Pressure Variations
among Ethnic Groups in Manipur,” where no statistically significant differences in diastolic
BP were observed between tribal and non-tribal populations, attributing the variations to
localized lifestyle habits rather than ethnicity. The present study’s statistically significant
difference points toward an emerging public health challenge within the Kabui community,
possibly linked to modernization and shifts in traditional living patterns

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TABLE 5.23.: ASSOCIATION OF BLOOD PRESSURE WITH EXTRA SALT
CONSUMPTION AMONG THE MEUTEI AND THE KABUI

MEITEI KABUI X2 P - value

VARIABLES
SALT CONSUMPTION SALT CONSUMPTION
yes no yes no MEITEI KABUI MEITEI KABUI
NORMAL 13(54) 89(71) 12(40) 61(51)
PRE- 3(13) 22(17) 7(23) 30(25)
HYPERTENSION 9.1107 2.0120 <0.02* >0.36
STG 1 HTN 8(33) 13(10) 11(37) 29(24)
STG 2 HTN 0 2(2) 0 0
TOTAL 24 126 30 120

The table investigates the relationship between salt consumption (categorized as

"yes" or "no") and blood pressure levels among the Meitei and Kabui communities. A
notable difference emerges: among Meiteis who consume extra salt, 33% are in Stage 1
hypertension, while only 10%of those not consuming extra salt fall into that category, a
statistically significant association (*χ² = 9.1107, p < 0.02*). In contrast, Kabui individuals
also show higher hypertension prevalence with salt consumption (Stage 1 HTN: 37% vs.
24%), but the association is not statistically significant (*χ² = 2.0120, p > 0.36*). This
suggests that Meiteis may be more salt- sensitive, showing a stronger hypertensive
response to salt intake compared to Kabuis. The trend also shows that normal blood
pressure is more common among non-salt users in both groups.

This finding is supported by the classic study “Salt Sensitivity of Blood Pressure in
Humans” by Weinberger MH (Hypertension, 1996), which highlights how individuals—
and certain ethnic groups—vary in their physiological response to salt, with salt-sensitive
people showing significant blood pressure increases with sodium intake. In contrast, this
relationship is questioned by O'Donnell et al. (2014)in “the PURE study” (New England
Journal of Medicine), which found that both very high and very low sodium intakes were
associated with adverse cardiovascular outcomes.

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