Association of dietary factors and other coronary risk factors with social class in women in five Indian cities

Dietary Approaches to Stop Hypertension via Indo-Mediterranean Foods, May Be Superior to DASH Diet Intervention

Western-type diet with high salt and sugar, sedentary behavior, obesity, tobacco and alcoholism are important risk factors for hypertension. This review aims to highlight the role of western diet-induced oxidative stress and inflammation in the pathogenesis of hypertension and the role of various types of diets in its prevention with reference to dietary approaches to stop hypertension (DASH) diet. It seems that it is crucial to alter the western type of diet because such diets can also predispose all CVDs. Western diet-induced oxidative stress is characterized by excessive production of reactive oxygen species (ROS) with an altered oxidation-reduction (redox) state, leading to a marked increase in inflammation and vascular dysfunction. Apart from genetic and environmental factors, one important cause for differences in the prevalence of hypertension in various countries may be diet quality, deficiency in functional foods, and salt consumption. The role of the DASH diet has been established. However, there are gaps in knowledge about the role of some Indo-Mediterranean foods and Japanese foods, which have been found to decrease blood pressure (BP) by improving vascular function. The notable Indo-Mediterranean foods are pulses, porridge, spices, and millets; fruits such as guava and blackberry and vegetables, which may also decrease BPs. The Japanese diet consists of soya tofu, whole rice, in particular medical rice, vegetables and plenty of fish rich in fish oil, fish peptides and taurine that are known to decrease BPs. Epidemiological studies and randomized, controlled trials have demonstrated the role of these diets in the prevention of hypertension and metabolic diseases. Such evidence is still meager from Japan, although the prevalence of hypertension is lower (15-21%) compared to other developed countries, which may be due to the high quality of the Japanese diet. Interestingly, some foods, such as berries, guava, pumpkin seeds, carrots, soya beans, and spices, have been found to cause a decrease in BPs. Omega-3 fatty acids, fish peptide, taurine, dietary vitamin D, vitamin C, potassium, magnesium, flavonoids, nitrate and l-arginine are potential nutrients that can also decrease BPs. Larger cohort studies and controlled trials are necessary to confirm our views.

Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review

BACKGROUND

Non-communicable diseases are the leading global cause of death and disproportionately afflict those living in low-income and lower-middle-income countries (LLMICs). The association between socioeconomic status and non-communicable disease behavioural risk factors is well established in high-income countries, but it is not clear how behavioural risk factors are distributed within LLMICs. We aimed to systematically review evidence on the association between socioeconomic status and harmful use of alcohol, tobacco use, unhealthy diets, and physical inactivity within LLMICs.

METHODS

We searched 13 electronic databases, including Embase and MEDLINE, grey literature, and reference lists for primary research published between Jan 1, 1990, and June 30, 2015. We included studies from LLMICs presenting data on multiple measures of socioeconomic status and tobacco use, alcohol use, diet, and physical activity. No age or language restrictions were applied. We excluded studies that did not allow comparison between more or less advantaged groups. We used a piloted version of the Cochrane Effective Practice and Organisation of Care Group data collection checklist to extract relevant data at the household and individual level from the included full text studies including study type, methods, outcomes, and results. Due to high heterogeneity, we used a narrative approach for data synthesis. We used descriptive statistics to assess whether the prevalence of each risk factor varied significantly between members of different socioeconomic groups. The study protocol is registered with PROSPERO, number CRD42015026604.

FINDINGS

After reviewing 4242 records, 75 studies met our inclusion criteria, representing 2 135 314 individuals older than 10 years from 39 LLMICs. Low socioeconomic groups were found to have a significantly higher prevalence of tobacco and alcohol use than did high socioeconomic groups. These groups also consumed less fruit, vegetables, fish, and fibre than those of high socioeconomic status. High socioeconomic groups were found to be less physically active and consume more fats, salt, and processed food than individuals of low socioeconomic status. While the included studies presented clear patterns for tobacco use and physical activity, heterogeneity between dietary outcome measures and a paucity of evidence around harmful alcohol use limit the certainty of these findings.

INTERPRETATION

Despite significant heterogeneity in exposure and outcome measures, clear evidence shows that the burden of behavioural risk factors is affected by socioeconomic position within LLMICs. Governments seeking to meet Sustainable Development Goal (SDG) 3.4-reducing premature non-communicable disease mortality by a third by 2030-should leverage their development budgets to address the poverty-health nexus in these settings. Our findings also have significance for health workers serving these populations and policy makers tasked with preventing and controlling the rise of non-communicable diseases.

FUNDING

WHO.

Women's health in India: the role of body mass index

We examined the health status of women in relation to their body mass indices and waist-to-hip ratio (WHR) by analyzing data from a follow-up study of 325 women, selected from the Indian National Family Health Survey (NFHS-2/1998-99) Delhi samples, reinterviewed after 4 years (2003). Obese women were five times more likely (OR = 4.87; p <.0001) and women with a higher WHR (> 0.90) were two times more likely (OR = 1.70; p =.050) to perceive their health condition as worse than others. Arthritis, hypertension, and shortness of breath were found to be higher among obese women and women with a high WHR. Healthy lifestyle choices must be promoted to contain the growing burden of obesity-related health problems among Indian women.

Obesity and asthma

Asthma is a chronic disorder affecting millions of people worldwide. The prevalence of asthma is around 300 million and is expected to increase another 100 million by 2025. Obesity, on the other hand, also affects a large number of individuals. Overweight in adults is defined when body mass index (BMI) is between 25 to 30 kg/m(2) and obesity when the BMI >30 kg/m(2). It has been a matter of interest for researchers to find a relation between these two conditions. This knowledge will provide a new insight into the management of both conditions. At present, obese asthma patients may be considered a special category and it is important to assess the impact of management of obesity on asthma symptoms.

The tsim tsoum approaches for prevention of cardiovascular disease

The Tsim Tsoum Concept means that humans evolved on a diet in which nature recommends to ingest fatty acids in a balanced ratio (polyunsaturated(P) : saturated(S) =w-6 : w-3 = 1 : 1)as part of dietary lipid pattern where monounsaturated fatty acids(MUFA) is the major fatty acid(P : M : S = 1 : 6 : 1) in the background of other dietary factors; antioxidants, vitamins, minerals and fiber as well as physical activity and low mental stress. Several hundred years ago, our diet included natural foods; fruits, vegetables, green vegetables, seeds, eggs and honey. Fish, and wild meat were also available to pre-agricultural humans which shaped modern human genetic nutritional requirement. Cereal grains (refined), and vegetable oils that are rich in w-6 fatty acids are relatively recent addition to the human diet that represent dramatic departure from those foods to which we are adapted. Excess of linoleic acid, trans fatty acids (TFA), saturated and total fat as well as refined starches and sugar are proinflammatory. Low dietary MUFA and n-3 fatty acids and other long chain polyunsarurated fatty acids (LCPUFA) are important in the pathogenesis of metabolic syndrome. Increased sympathetic activity with greater secretion of neurotransmitters in conjunction of underlying long chain PUFA deficiency, and excess of proinflammatory nutrients, may damage the neurons via proinflammatory cytokines, in the ventromedial hypothalamus and insulin receptors in the brain.Since, 30–50% of the fatty acids in the brain are LCPUFA, especially omega-3 fatty acids, which are incorporated in the cell membrane phospholipids, it is possible that their supplementation may be protective.Blood lipid composition does reflect one's health status: (a) circulating serum lipoproteins and their ratio provide information on their atherogenicity to blood vessels and (b) circulating plasma fatty acids, such as w-6/w-3 fatty acid ratio, give indication on proinflammatory status of blood vessels, cardiomyocytes, liver cells and neurones; (a) and (b) are phenotype-related and depend on genetic, environmental and developmental factors. As such, they appear as universal markers for holistic health and these may be important in the pathogenesis of cardiovascular diseases and cancer, which is the main consideration of Tsim Tsoum concept.

SOCIOECONOMIC CHANGES AS COVARIATES OF OVERWEIGHT AND OBESITY AMONG TANGKHUL NAGA TRIBAL WOMEN OF MANIPUR, NORTH-EAST INDIA

The prevalence of overweight/obesity is increasing worldwide. Although countries like India are typically thought of as having a high prevalence of undernutrition, significant proportions of overweight/obese now co-exist with the undernourished. This study aims to find the prevalence of overweight/obesity, and its association with socioeconomic change, among Tangkhul women in India. The cross-sectional study was carried out among 346 Tangkhul women aged 20–70 years, who were divided into five 10-year age groups. Mean BMI was found to be lowest among the youngest age group, and it increased with age until the age of 59 and then declined. The prevalence of overweight and obesity was found to be 27.1%, as assessed from the Asian cut-off point. Although the prevalence of obesity (2.0%) was low when compared with Indian non-tribal female populations, the prevalence of overweight (25.1%) was not far behind. Overweight and obesity were found to be associated with age, marital status, physical activity level, lifestyle and improvement in socioeconomic status, especially occupation and income. When compared with urban non-tribal Indian females, who have a higher socioeconomic status, the prevalence of overweight/obesity among Tangkhul females is lower, indicating its association with socioeconomic status. Tangkhul Naga is a population where the majority are believed to be thin traditionally owing to the difficult hilly terrain and their physically active lifestyle. With urbanization and economic development, nutritional transition, improved socioeconomic status and an increasingly sedentary lifestyle have been observed, which have contributed to the increasing prevalence of overweight/obesity among Tangkhul Naga women.

Effect of obesity on asthma among adult Indian women

OBJECTIVE

Both obesity and asthma are on the rise worldwide. This study examined the association between obesity and asthma prevalence in adult women in India.

METHODS

The analysis used information on 82 464 nonpregnant, ever-married women aged 15-49 y, included in India's 1998-99 National Family Health Survey. The effects of measured Body Mass Index (BMI) on reported asthma were estimated using logistic regression, after adjusting for tobacco smoking (active and passive), cooking smoke, age, education, work status, media habits, food habits, house type, separate kitchen, indoor crowding, religion, caste/tribe, household living standard, urban/rural residence, and geographic region.

RESULTS

Obese women (BMI>/=30.0 kg/m(2)) were about twice as likely as those with a normal BMI (18.5-25.0 kg/m(2)) to report suffering from asthma (OR=1.92; 95% CI: 1.40-2.65). The association between obesity and asthma remained strong and statistically significant even when the effects of other selected risk factors and potential confounders were controlled (OR=1.85; 95% CI: 1.30-2.63). Overweight women (25.0</=BMI<30.0 kg/m(2)) also reported significantly higher adjusted asthma prevalence than those with a normal BMI (OR=1.32; 95% CI: 1.07-1.63). Results hold in separate analysis for younger (15-29 y) and older (30-49 y) women.

CONCLUSION

The study finds a strong positive association between obesity and asthma among adult Indian women. To validate this relationship and to establish causality, prospective epidemiological studies, with better measures of overweight conditions and clinical measures of asthma, are needed in developing-country settings.

Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial

BACKGROUND

The rapid emergence of coronary artery disease (CAD) in south Asian people is not explained by conventional risk factors. In view of cardioprotective effects of a Mediterranean style diet rich in alpha-linolenic acid, we assessed the benefits of this diet for patients at high risk of CAD.

METHODS

We did a randomised, single-blind trial in 1000 patients with angina pectoris, myocardial infarction, or surrogate risk factors for CAD. 499 patients were allocated to a diet rich in whole grains, fruits, vegetables, walnuts, and almonds. 501 controls consumed a local diet similar to the step I National Cholesterol Education Program (NCEP) prudent diet.

FINDINGS

The intervention group consumed more fruits, vegetables, legumes, walnuts, and almonds than did controls (573 g [SD 127] vs 231 g [19] per day p<0.001). The intervention group had an increased intake of whole grains and mustard or soy bean oil. The mean intake of alpha-linolenic acid was two-fold greater in the intervention group (1.8 g [SD 0.4] vs 0.8 g [0.2] per day, p<0.001). Total cardiac end points were significantly fewer in the intervention group than the controls (39 vs 76 events, p<0.001). Sudden cardiac deaths were also reduced (6 vs 16, p=0.015), as were non-fatal myocardial infarctions (21 vs 43, p<0.001). We noted a significant reduction in serum cholesterol concentration and other risk factors in both groups, but especially in the intervention diet group. In the treatment group, patients with pre-existing CAD had significantly greater benefits compared with such patients in the control group.

INTERPRETATION

An Indo-Mediterranean diet that is rich in alpha-linolenic acid might be more effective in primary and secondary prevention of CAD than the conventional step I NCEP prudent diet.