Table 5.

Showing the definition of variables used in the study.

Variable	Definition/measurements
Physical measurements	Height and weight were measured and body mass index (BMI) calculated as weight (kg.)/height (m2). Portable standard stature scale was used to measure height. Footwear (shoes, slippers, sandals) and hat were removed while measuring height. Respondents stood on a flat surface facing the interviewer with their feet together and heels against the backboard with knees straight. They were asked to look straight ahead and not tilt their head up, making sure that their eyes were at the same level as their ears. Height was recorded in centimetres. Weight was measured with a portable digital weighing scale (Seca, Germany). The instrument was placed on a firm, flat surface. Participants were requested to remove their footwear and socks, wear light clothes, stand on the scale with one foot on each side of the scale, face forward, place arms at their side and wait until asked to step off. Waist and hip circumference was measured using constant tension tapes (Seca, Germany) in centimeters37.
Blood Pressure measurements	Blood pressure was measured with a digital, automated blood pressure monitor (OMRON digital device) with medium cuff. Before taking the measurements, participants were asked to sit quietly and rest for 15 minutes with legs uncrossed. Three readings of the systolic and diastolic blood pressure were obtained using standard protocol. Participants rested for three minutes between each reading. The mean of the second and third readings was calculated. High blood pressure was defined as having systolic blood pressure ≥130 mm Hg and/or diastolic blood pressure ≥85 mm Hg during the study, or being previously diagnosed as having hypertension determined by sighting documentation such as a treatment record book or by the history of the participant taking medicine for high blood pressure.
Biochemical measurements	A separate mobile laboratory setting was used to collect biochemical data. The mobile laboratory contained all of the logistics and human resources required for the set up including a semi auto analyser and all of the chemicals required for blood glucose testing and lipid profile measurement. To ensure that the cold chain was maintained for the collected samples and for the preservation of the chemicals used for the tests, continuous electricity was ensured with an electric generator and refrigerator. Participants were instructed to fast overnight for 12 hours and diabetic patients on medication were reminded to bring their medicine/insulin with them and take their medicine after providing the blood sample to measure fasting glucose. Wet (liquid) method was used to measure blood lipids. A venous blood sample (4 ml of blood) was taken using a flashback needle with an aseptic technique and kept in plain and fluoride treated tubes. Those samples were kept in an ice pack carrier and brought to the mobile laboratory within an hour. Biochemical measurements of blood glucose and lipids were done using semi-automated procedures (Bioanalyzer, Analyticon, Germany) and commercially available kits (Analyticon, Germany). Plasma glucose was estimated using the GOD-PAP (glucose oxidase/peroxidise – phenol-4-amenophenazone) method. Serum triglycerides were estimated using the GPO-PAP (glycerol-3-phosphate oxidase/peroxidase-4-chlorophenol and 4-aminophenazone) method. HDL cholesterol was determined using the CHOD-PAP (cholesteroloxidase/peroxidase – 4-phenol-aminoantipyrine) method36. External quality control of these biochemical investigations was performed by sending 10% of the samples to the nearest reference laboratory with standardized fully-automated procedures for biochemical measurement.
Metabolic syndrome [NCEP ATP III criteria]38	Any three of the five criteria below: • Waist circumference: >102 cm (Male), >88 cm (Female). • Fasting glucose ≥100 mg/dl or Rx. • Triglycerides ≥150 mg/dl or Rx. • HDL cholesterol: <40 mg/dl (Male), <50 mg/dl (Female); or Rx ≥130 mmHg systolic or ≥85 mmHg diastolic or Rx.
Metabolic syndrome [IDF criteria]38	Central obesity (waist circumference: ≥90 cm (Male), ≥80 cm (Female)) plus two of the following criteria below: • Fasting glucose ≥100 mg/dl or Rx • Triglycerides ≥150 mg/dl or Rx • HDL cholesterol: <40 mg/dl (Male), <50 mg/dl (Female); or Rx ≥130 mmHg systolic or ≥85 mmHg diastolic or Rx
Current smoking	Those who smoked in the past 30 days were considered as a current smoker.
Harmful Alcohol consumption	Detailed information on number of standard drinks consumed and frequency of consuming standard drinks in the last 30 days was obtained from current users. One standard drinks was considered as 10 grams of ethanol, the number of standard drinks was calculated using the amount consumed by participants.
Insufficient fruits and vegetable intake	Information on fruit and vegetables consumption in a typical week. Also, the number of servings of fruit and vegetables consumed on average per day. The amount of fruit and vegetables was measured using pictorial show cards and measuring cups (one standard serving of fruit or vegetables equals 80 grams).
Low Physical activity	Global Physical Activity Questionnaire (GPAQ) was used to assess physical activities39. The GPAQ asks participants about activities for vigorous and moderate activity at work, and vigorous and moderate activity in leisure time and time spent sitting. Culturally relevant Show-cards with examples were used to classifying activities. Physical activity related to transport and recreation and time spent in sedentary behaviour were also assessed. Physical activity related to transport included travel to work or market by walking or using a bicycle. Recreational activity included two types of activities based on severity, i.e., vigorous and moderate. Vigorous recreational activity was defined as any recreational activity that causes a large increase in heart rate and breathing; for example, games such as football, fast swimming and rapid cycling. Ten minutes of such activity was considered as involvement in vigorous recreational activity. Moderate recreational activity was defined as any kind of recreational activity that causes a moderate increase in heart rate and breathing; examples include yoga and playing basketball. Sedentary behaviour was defined as a behaviour where an individual spends time sitting at a desk, sitting with friends, travelling in a car, bus or train, reading a book, and so on. Analysis and categorization followed existing guidelines40,41 and the low physical activities were categorized to those who did not meet the criteria for vigorous and moderate intensity activities.
Abnormal waist to hip ratio42	Abnormal waist to hip ratio is defined as a waist–hip ratio >0.90 for males and >0.85 for females.