Prevalence and risk factors of hypertension and age-specific blood pressures in five cities: a study of Indian women. NKP Salve Institute of Medical Sciences, Nagpur, India. Five City Study Group

OBJECTIVE

To measure the prevalence of hypertension and age-specific blood pressure in urban populations from five Indian cities. Cross-sectional surveys were conducted in six-twenty urban streets in different cities from five different corners of India, using similar methods of sample selection and criteria. There were 3212 randomly selected women from Moradabad (n=902), Trivandrum (n=760), Calcutta (n=365), Nagpur (n=405) and Bombay (n=780), aged 25-64 years, inclusive. Evaluation was by a physician and a dietitian, an administered questionnaire, a physical examination and using a sphygmomanometer. The diagnosis of hypertension was based on old World Health Organisation criteria and new World Health Organisation/International Society of Hypertension criteria. The prevalence of hypertension (>140/90 mm Hg) was significantly (P<0.01) high in Trivandrum, South India (30.7%), and Bombay, West India (28.0%), compared to Moradabad, which is in northern India (22.6%), Nagpur, in central India (24.2%), and Calcutta, in east India (19.1%). Mean systolic and diastolic blood pressures were significantly higher in Trivandrum and Bombay compared to the other three cities. The overall prevalence of hypertension was 25.6% (n=823) and isolated diastolic hypertension was the most common form of hypertension (50.5%, n=1506) in the five Indian cities. According to old criteria, the overall prevalence of hypertension (>160/95 mm Hg) was 14.8% (n=481). Multivariate logistic regression analysis on pooled data from the five cities, after adjustment for age, showed that age (odds ratio 1.16), body mass index (1.68) and obesity were strongly associated with hypertension. A sedentary lifestyle and salt intake were weakly associated and alcohol intake was not a factor with these women.

Prevalence of coronary artery disease and coronary risk factors in rural and urban populations of north India

OBJECTIVE

This study was conducted to determine and compare the prevalence of coronary artery disease and coronary risk factors in both a rural and an urban population of Moradabad in north India.

DESIGN AND SETTING

A cross-sectional survey of two randomly selected villages from the Moradabad district and 20 randomly selected streets in the city of Moradabad.

SUBJECTS AND METHODS

The 3575 subjects were between 25 and 64 years old; 1769 (894 men and 875 women) lived in the countryside and 1806 (904 men and 902 women) lived in the city. The survey methods were questionnaires, physical examination and electrocardiography.

RESULTS

The overall prevalence of coronary artery disease, based on a clinical diagnosis and an electrocardiogram, was 9.0% in the urban and 3.3% in the rural population. The prevalences were significantly (P < 0.001) higher in the men compared with the women in both urban (11.0 vs 6.9%) and rural (3.9 vs 2.6%) populations, respectively. The prevalence of symptomatic coronary artery disease (known coronary disease and Rose questionnaire-positive angina) was 2.3% in the men (n = 19) and 1.5% in the women (n = 13) in the rural subjects, and 8.5% in the men (n = 77) and 3.4% in the women (n = 31) in the urban population. When diagnosed on the basis of electrocardiographic changes alone, the prevalences were 1.5% (n = 26) in the rural population and 3.0% (n = 55) in the urban. Coronary risk factors were two- or three-fold more common among urban subjects compared to the rural population in both sexes. Central obesity was four times more common in the urban population compared to the rural in both sexes. Sedentary lifestyle and alcohol intake were significantly (P < 0.01) higher in the urban population compared to the rural subjects. There was a significant association between coronary disease and age, hypercholesterolaemia, hypertension and central obesity in both sexes. Smoking was a significant risk factor of coronary disease in men.

CONCLUSIONS

Coronary artery disease and coronary risk factors were two or three times higher among the urban compared with the rural subjects, which may be due to greater sedentary behaviour and alcohol intake among urbans. It is possible that some Indian populations can benefit by reducing serum cholesterol, blood pressure and central obesity and increasing physical activity.

Epidemiological study of hypertension and its determinants in an urban population of North India

OBJECTIVES

To determine age-specific prevalence of hypertension and blood pressure (BP) levels in relation to diet and lifestyle factors in North Indians.

DESIGN AND SETTING

Cross-sectional survey in 20 randomly selected streets in Moradabad, North India.

SUBJECTS AND METHODS

A total of 1806 subjects from North India (904 males and 902 females) age range 25-64 years. The survey methods were as follows: dietary diaries for 7 days food intake record; BP measurements; physician administered questionnaire and anthropometric measurements. Diagnosis of hypertension was based on new World Health Organization/International Society of Hypertension (WHO/ISH) criteria. Risk factors were assessed based on WHO guidelines.

RESULTS

The prevalence of hypertension according to WHO/ISH criteria was 23.7% and by old WHO criteria 13.3%. In the WHO/ISH hypertensive group, isolated diastolic hypertension was present in 47.3% males and 40.6% females. Males have a slightly higher prevalence than females in the young age group, however, the prevalence rates are comparable in the older age groups. In both sexes, the prevalence rates and BP level increased with older age. Multivariate analysis revealed that age, higher body mass index, central obesity and higher socioeconomic status were independently and strongly associated with hypertension in both sexes. Higher dietary fat and salt intake and lower physical activity were weakly but significantly associated with hypertension.

CONCLUSION

Association of higher socioeconmic status, higher body mass index and central obesity in North Indian adults with higher fat intake, lower physical activity and higher prevalence and level of hypertension indicate that these populations may benefit by decreasing the dietary fat intake and increasing physical activity, with an aim to decrease central obesity for decreasing hypertension in North Indians.

Antioxidant effects of lovastatin and vitamin E on experimental atherosclerosis in rabbits

The effects of the administration of vitamin E (10 mg/day) plus lovastatin (2 mg/day; group A, n = 10), lovastatin alone (2 mg/day; group B, n = 10), and placebo (group C, n = 10) were compared over 24 weeks in a randomized, single-blind controlled trial. All groups of rabbits received a trans fatty acid (TFA)-rich diet (5-10 g/day) for 36 weeks. Treatment with vitamin E plus lovastatin (group A) and lovastatin (group B) started after 12 weeks of administration of TFA-rich diet was associated with a significant but similar decline in serum cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides in both groups at 36 weeks. Lipid peroxides and diene conjugates showed a significant decline in association with a significant increase in the plasma level of vitamin E in group A rabbits at 36 weeks. However, the lovastatin group B showed a lesser but significant decrease in lipid peroxides and diene conjugates at 36 weeks, indicating that lovastatin may have antioxidant activity. In control group C, the increase in blood lipids and oxidative stress at 36 weeks was much greater than the decrease in groups A and B. After experimental lipid peroxidation at 24 weeks in all of the rabbits, 2 of 10 group B and 3 of 10 group C rabbits died due to coronary thrombosis; there were no deaths in group A. Thus antioxidant therapy with vitamin E can provide protection against death due to free radical stress. Aortic lipids and sudanophilia indicating athorosclorosis were significantly lower in groups A and B than in group C. The atherosclerotic coronary plaque sizes were significantly smaller in group A (18.5 +/- 3.6 microns) than in groups B (41.6 +/- 4.2 microns) and C (85 +/- 6.7 microns). Aortic plaque sizes were also smaller in group A than in group B and C. It is possible that antioxidant therapy with vitamin E, as an adjunct to lipid lowering with lovastatin, can provide additional benefit in the inhibition of oxidative stress and atherosclerosis. The antioxidant activity of lovastatin has not been reported, to our knowledge.

Magnesium status and risk of coronary artery disease in rural and urban populations with variable magnesium consumption

This survey was conducted to determine the association between amount of magnesium intake and prevalence of coronary artery disease (CAD) and coronary risk factors in north India. There were 3575 subjects aged 25-64 years including 1769 rural (894 men, 875 women) and 1806 urban (904 men, 902 women) subjects. The survey methods were questionnaires for 7-day food intake record, physical examination and electrocardiography using World Health Organization criteria. The overall prevalence of CAD was three-fold greater in urban compared to rural subjects (9.0 vs 3.3 per cent, p < 0.001). The prevalence of CAD was significantly higher among subjects consuming lower dietary magnesium. Lower magnesium status was inversely associated with risk of CAD in both rural and urban subjects in both sexes. Among subjects with low magnesium status, there was a higher prevalence of hypertension, hypercholesterolemia and diabetes mellitus showing a significant increasing trend with decrease in magnesium status. Multivariate logistic regression analysis after pooling of data from rural and urban subjects and after adjustment of age showed that magnesium intake had an inverse association with prevalence of CAD. Serum magnesium (odds ratio: men 1.14, women 1.05), dietary magnesium (men 1.21, women 1.12), serum cholesterol (men 1.15, women 1.15), blood pressure (1.26 men, women 1.21), diabetes mellitus (men 1.20, women 1.18) in both sexes and smoking in men (1.05) were significant risk factors of CAD. Lower consumption of dietary magnesium and low serum Mg level in north India have a higher prevalence of CAD and of the coronary risk factors hypertension, hypercholesterolemia and diabetes mellitus. It is possible that increased intake of magnesium to about 500 mg/day may be of benefit in the prevention of CAD.

Randomized, double-blind, placebo-controlled trial of fish oil and mustard oil in patients with suspected acute myocardial infarction: the Indian experiment of infarct survival--4

In a randomized, placebo-controlled trial, the effects of treatment with fish oil (eicosapentaenoic acid, 1.08 g/day) and mustard oil (alpha-linolenic acid, 2.9 g/day) were compared for 1 year in the management of 122 patients (fish oil, group A), 120 patients (mustard oil, group B), and 118 patients (placebo, group C) with suspected acute myocardial infarction (AMI). Treatments were administered about (mean) 18 hours after the symptoms of AMI in all three groups. The extent of cardiac disease, rise in cardiac enzymes, and lipid peroxides were comparable among the groups at entry into the study. After 1 year total cardiac events were significantly less in the fish oil and mustard oil groups compared with the placebo group (24.5% and 28% vs. 34.7%, p < 0.01). Nonfatal infarctions were also significantly less in the fish oil and mustard oil groups compared with the placebo group (13.0% and 15.0% vs. 25.4%, p < 0.05). Total cardiac deaths showed no significant reduction in the mustard oil group; however, the fish oil group had significantly less cardiac deaths compared with the placebo group (11.4% vs. 22.0%, p < 0.05). Apart from the decrease in the cardiac event rate, the fish oil and mustard oil groups also showed a significant reduction in total cardiac arrhythmias, left ventricular enlargement, and angina pectoris compared with the placebo group. Reductions in blood lipoproteins in the two intervention groups were modest and do not appear to be the cause of the benefit in the two groups. Diene conjugates showed a significant reduction in the fish oil and mustard oil groups, indicating that a part of the benefit may be caused by the reduction in oxidative stress. The findings of this study suggest that fish oil and mustard oil, possibly due to the presence of n-3 fatty acids, may provide rapid protective effects in patients with AMI. However, a large study is necessary to confirm this suggestion.

Blood pressure trends, plasma insulin levels and risk factors in rural and urban elderly populations of north India

OBJECTIVE

To compare the prevalence of hypertension and its risk factors with age-specific blood pressures in rural and urban subjects.

DESIGN AND SETTING

A cross-sectional survey of two randomly selected villages and 20 randomly selected streets in Moradabad, north India.

SUBJECTS AND METHODS

The subjects were 255 rural people (140 men, 115 women) and 311 urban people (172 men, 139 women) aged 60-84 years. The survey methods were questionnaires, blood pressure and anthropometric measurements and electrocardiography.

RESULTS

The mean +/- SD blood pressures, both systolic (137.7 +/- 13 versus 131.2 +/- 12 mmHg) and diastolic (89.8 +/- 41 versus 85.8 +/- 9 mmHg) were significantly higher in urban men than they were in rural men. Similar differences between systolic (135.6 +/- 11 versus 129.2 +/- 10 mmHg) and diastolic (90 +/- 10 versus 87.6 +/- 9 mmHg) blood pressures were found among urban and rural women, respectively. A significant correlation between systolic blood pressures and increasing age was observed both for rural and for urban subjects of both sexes. The overall prevalences of hypertension based on World Health Organization criteria (17.6 versus 5.0%) and Joint National Committee fifth report criteria (34.0 versus 10.1%) were significantly higher among urban than they were among rural subjects. Multivariate logistic regression analysis revealed that age, body mass index, central obesity, glucose intolerance, 2 h plasma insulin and triglyceride level were associated independently with hypertension.

CONCLUSIONS

The findings indicate that urban subjects had higher blood pressures than did rural subjects and that age, body mass index, central obesity and 2 h plasma insulin levels were significant risk factors for hypertension in an elderly population.

Embryogenesis of a sac containing a Meckel's diverticulum

The embryogenesis of a previously unreported mesothelial pouch containing a Meckel's diverticulum is presented.

Diet and lifestyle guidelines and desirable levels of risk factors for the prevention of diabetes and its vascular complications in Indians: a scientific statement of The International College of Nutrition. Indian Consensus Group for the Prevention of Diabetes

BACKGROUND

There has been a rapid increase in the prevalence of diabetes and cardiovascular disease in India, in association with rapid changes in diet and lifestyle. In adults, the prevalence of diabetes, hypertension and coronary artery disease is two- to threefold greater in the urban population than in rural populations; it is associated with modest insulin resistance in urban groups.

METHODS

In response to a proposal by the International College of Nutrition that specialist experts should develop consensus recommendations for the prevention of chronic diseases, Indian specialists in diabetes and vascular disease have collaborated to produce guidelines relevant to the population of India.

RECOMMENDATIONS

Because Indian urban populations have a modest increase in overweight and low rates of obesity in association with the rapid emergence of diabetes and cardiovascular risk, a body mass index of 21 kg/m2 should be considered safe, with a range of 19-23 kg/m2 acceptable; > 23 kg/m2 should be considered overweight, and > 25 kg/m2 should be taken to indicate obesity. A waist:hip ratio > 0.88 in males and > 0.85 in females should be considered to indicate central obesity, because the prevalence of coronary disease, hypertension and associated disturbances of insulin resistance are more common above these limits. For the prevention of vascular disease, there is general international consensus that the desirable serum concentration of cholesterol should be < 170 mg/dl (> 4.42 mmol/l), which may also be optimal for Indians; values between 170 and 200 mg/dl (4.42-5.2 mmol/l) should be considered borderline. The critical values for low density lipoprotein cholesterol may be < 90 mg/dl (ideal), 90-110 mg/dl (borderline high) and > 110 mg/dl (high) (< 2.32, 2.32-2.84 and > 2.84 mmol/l, respectively). Fasting triglycerides should be < 150 mg/dl (< 1.69 mmol/l) and high-density lipoprotein cholesterol > 35 mg/dl (> 0.9 mmol/l). The limit for the total energy derived from fat intake should be < 21%/day (7% each for saturated, polyunsaturated and mono-unsaturated fatty acids). The carbohydrate intake should provide more than 65% of daily energy, mainly from complex carbohydrates. A daily dietary intake of 400 g fruits, vegetables and legumes, 400 g cereals, in conjunction with 25 g soya bean or mustard or canola oils (rich in n-3 fatty acids) in place of fats rich in saturated fat, may be protective against diabetes and vascular disease. Moderate physical activity with the aim of burning 300 Kcal/day (> 1255 KJ/day), and cessation of tobacco and alcohol consumption, may provide an effective programme for prevention of diabetes and its vascular complications in Indians.

Social class and coronary disease in rural population of north India. The Indian Social Class and Heart Survey

OBJECTIVE

To demonstrate the association of socio-economic status with prevalence of coronary artery disease and coronary risk factors.

DESIGN AND SETTING

Cross-sectional survey in two randomly selected villages in the Moradabad district in North India.

SUBJECTS AND METHODS

One thousand seven hundred and sixty-seven subjects (894 males and 875 females; 25-64 years of age) were randomly selected from two villages. They were divided into social classes 1 to 4, according to education, occupation, housing conditions, ownership of land, ownership of consumer durables and per capita income. The survey was based on questionnaires administered by dietitians and physicians, physical examination and electrocardiography.

RESULTS

Social classes 1 and 2 were mainly high and middle socio-economic groups and 3 and 4 low income groups. The prevalence of coronary artery disease was significantly higher among classes 1 and 2 in both sexes, and there was a higher prevalence of hypercholesterolaemia, hypertension, and sedentary lifestyle. This population also showed a significant association with higher serum cholesterol, body mass index, triglycerides and blood pressures. Logistic regression analysis with adjustment for age showed that social class positively related to coronary disease (odds ratio: men 0.83, women 0.61), hypercholesterolaemia (men 0.85, women 0.87), hypertension (men 0.89, women 0.87), body mass index (men 0.91, women 0.93) and smoking in men (0.68). Smoking and sedentary lifestyle were not associated with social class in women. The association between coronary artery disease and social class abated after adjustment for smoking, sedentary lifestyle, body mass index and blood pressure (odds ratio: men 0.96, women 0.81).

CONCLUSION

Subjects in social classes 1 and 2 in rural North India have a higher prevalence of coronary artery disease and of the coronary risk factors hypercholesterolaemia, hypertension, higher body mass index and sedentary lifestyle. The overall prevalence of coronary artery disease was 3.3%.

Epidemiologic study of trace elements and magnesium on risk of coronary artery disease in rural and urban Indian populations

OBJECTIVE

To determine the association of trace elements and magnesium with risk of coronary artery disease (CAD) in rural and urban populations of India.

DESIGN AND SETTING

Cross-sectional surveys on the randomly selected municipal streets in Moradabad city and one village in Moradabad tahsil in North India.

SUBJECTS AND METHODS

There were 162 rural (86 men and 96 women) and 152 urban (80 men and 72 women) subjects between 26 to 65 years of age. Evaluations were obtained by physician- and dietitian-administered, validated questionnaires, physical examination, electrocardiogram and blood examination.

RESULTS

The prevalence of CAD and coronary risk factors was 2.5 times higher in the urban population compared to rural subjects (8.6 vs. 3.0%). In rural subjects, dietary intakes and plasma levels of vitamins and minerals were comparable with those of urban subjects except for higher dietary intake of magnesium in rural subjects and higher plasma vitamin A level in urban subjects. In both rural and urban subjects, low serum zinc (80 +/- 82 vs. 110 +/- 11.0 micrograms/dl, p < 0.05) and magnesium levels (1.60 +/- 0.36 vs. 1.71 +/- 0.41 mEQ/L, p < 0.05) and lower zinc/copper ratio (0.58 +/- 0.08 vs. 1.11 +/- 0.25 p < 0.50) were inversely associated with CAD. Serum levels of copper and iron were significantly higher and plasma levels of antioxidant vitamins A, E and C and beta-carotene were significantly lower in patients with CAD compared to the rest of the subjects. In both rural (7.1 +/- 1.2 mg/day) and urban subjects (8.6 +/- 1.6 mg/day), zinc consumption was half of the recommended dietary allowances. Higher prevalence of CAD in urban compared to rural subjects was attributed to higher dietary fat intake and higher prevalence of risk factors in urban subjects.

CONCLUSIONS

The findings suggest that lower serum levels of zinc and magnesium and lower zinc copper ratio were inversely associated with CAD. It is possible that urban populations with higher risk of CAD may benefit by decreasing dietary fat intake and by increasing their intake of foods rich in zinc and magnesium.

Association of higher saturated fat intake with higher risk of hypertension in an urban population of Trivandrum in south India

Saturated fat intake appears to be a risk factor of insulin resistance which is important in the pathogenesis of diabetes and cardiovascular disease. This study aims to demonstrate whether saturated fat intake may be a risk factor of hypertension. Cross-sectional survey in six randomly selected streets in Trivandrum city in south India was conducted to study 1497 randomly selected subjects (737 males and 760 females) of 25-64 years of age. The prevalence of hypertension by Joint National Committee V criteria (> 140/90 were 34.6% (n = 255) in males and 30.7% (n = 234) in females. The consumption of food groups showed that they were within desirable limits. However, the intake of fruit, vegetable, legume and coconuts was lower and saturated fat intake higher (> 10% kcal/day), although total fat intake was within desirable limits. Total and saturated fat intake, and the consumption of coconut oil and butter, flesh foods, milk and yogurt as well as sugar and jaggery were significantly associated with hypertension. Total visible fat (> 20 g/day) intake was positively associated whereas fruit, vegetable, legume and coconut intake (< 400 g/day) was inversely associated with hypertension. Salt intake (> 8 g/day), smoking and illiteracy were not associated with hypertension. Multivariate logistic regression analysis showed that saturated fat intake, age and body mass index were independently and strongly associated with hypertension whereas fruits, vegetable, legume and coconuts, coconut oil and butter and alcohol (males) intakes were weakly associated with hypertension. The odds ratio indicate higher risk of hypertension due to higher intake of saturated fat in both sexes (mean: odds ratio, 1.07, 95% confidence interval 1.05-1.09; women, 1.08, 1.06-1.12, P < 0.01). Significant determinants of hypertension were higher saturated fat, particularly coconut oil, and lower fruit, vegetable, legume and coconuts, particularly legumes and coconuts in the diet, apart from conventional risk factors.

Cardiac rupture complicating cerebral intraarterial thrombolytic therapy

We report a case of fatal cardiac rupture occurring during intraarterial thrombolytic therapy for acute embolic stroke in a patient with recent myocardial infarction.

Prevalence and determinants of hypertension in the Indian social class and heart survey

To determine the association of socio-economic status (SES) and prevalence of hypertension and its risk factors in a rural population, a cross sectional survey was conducted in two randomly selected villages in the Moradabad district in North India. There were 1935 residents aged over 25 (984 men and 951 women) who were randomly selected and categorised into social classes 1-4 depending upon SES based on occupation, housing conditions, land holding, total per capita income, ownership of consumer durables and education. The prevalence of hypertension diagnosed by JNC V criteria (>140/90 mm Hg) was significantly higher among social class 1 and 2 and showed positive relation with SES in both sexes. Among social class 1 and 2 subjects, there was a higher prevalence of overweight and obesity and sedentary lifestyle. Logistic regression analysis with adjustment of age showed that SES had a positive relation with hypertension (odds ratio: men 1.09, 95% CI 1.05-1.14; women 1.08, 95% CI 1.05-1.13), body mass index (odds ratio: men 1.12, 1.08-1.18; women 1.11, 1.06-1.16) and sedentary lifestyle (odds ratio: men 1.45, 1.32-1.58; women 1.38, 1.26-1.49). Only weak but significant associations were observed with smoking, alcohol and salt intake. The association of hypertension with social class was reduced after adjustment of body mass index, sedentary lifestyle, smoking and salt intake (odds ratio: men 0.96, 0.81-1.14; women 0.73, 0.54-1.04). There was an increase in the prevalence of hypertension and age-specific blood pressure (BP) with increasing age in both sexes. The overall prevalence of hypertension by WHO criteria (>160/95) was 4.6% and by JNC V criteria 20.8%, and the rates were comparable in both sexes. Social class 1 and 2 subjects in rural North India have a higher prevalence of hypertension and its risk factors of overweight and sedentary lifestyle.

Recommendations for the prevention of coronary artery disease in Asians: a scientific statement of the International College of Nutrition

There has been a rapid increase in coronary artery disease (CAD) in most Asian countries in association with rapid economic development; however, there is no consensus of opinion on diet and lifestyle guidelines and desirable levels of risk factors for prevention of CAD in these countries. The proportion of deaths due to cardiovascular diseases in Asians may be about 15% but there are wide variations. In view of the lower fat intake of the low-risk rural populations of India, the People's Republic of China, Indonesia, Korea, Thailand and Japan compared with that of urban subjects, the limit for total energy from fat intake in an average should be 21% (7% each from saturated, polyunsaturated and mono-unsaturated fatty acids). The n-6: n-3 fatty acids ration should be < 5.0. The carbohydrates intake should be > 65% and mainly from complex carbohydrates (> 55%). A body mass index of 21 kg/m2 may be safe but the range may be 18.5-23.0 kg/m2 and someone with a body mass index > 23 kg/m2 should be considered overweight. A waist: waist:hip ratio > 0.88 for men and > 0.85 for women should be considered to define central obesity. The desirable limit for serum total cholesterol may be 170 mg/dl, the borderline high level may be 170-199 mg/dl and the high level 200 mg/dl or above. The corresponding values for low-density lipoprotein cholesterol may be 90, 90-109 and 110 mg/dl or above. Fasting serum triglycerides may be < 150 mg/dl and high-density lipoprotein cholesterol > 35 mg/dl, which are close to the levels in low-risk rural populations. Fasting blood glucose > 140 mg/dl and postprandial blood glucose > 200 mg/dl may be considered conditions for diabetes, and 140-200 mg/dl, glucose intolerance. An intake of 400 g/day fruit, vegetables and legumes, mustard or soybean oil (25 g/day) instead of hydrogenated fat, coconut oil or butter in conjunction with moderate physical activity (1255 kJ/day), cessation of tobacco consumption and moderation of alcohol intake may be an effective package of remedies for prevention of CAD in Asians.

Magnesium and antioxidant vitamin status and risk of complications of ageing in an elderly urban population

This cross-sectional survey was conducted in 20 randomly selected streets in Moradbad city in North India to determine the association of magnesium and antioxidant vitamins with risk of ageing. There were 595 subjects (314 males, 281 females) between 50-84 years of age inclusive. The overall prevalence of hypo-magnesemia was 11.8 per cent (n = 60) with a prevalence of 13.2 per cent (n = 33) in males and 10.6 per cent (n = 27) in females. The prevalence of hypomagnesemia showed significant declining trend in the concentration of serum magnesium, vitamin C, vitamin E and beta-carotene and a rising trend in lipid peroxides and diene conjugates with increase in age from 50-59 years to 70-84 years in both men and women. Multivariate logistic regression analysis showed that serum magnesium, vitamin C, vitamin E and beta-carotene were significant risk factors of ageing in both men and women. The findings suggest that some urban populations of India can benefit by consuming higher dietary magnesium, potassium and antioxidant vitamins for prevention of ageing.

Effect of diet and moderate exercise on central obesity and associated disturbances, myocardial infarction and mortality in patients with and without coronary artery disease

OBJECTIVE

To test whether a fat modified and fruit and vegetable enriched diet in conjunction with moderate physical activity reduces the cardiac event rate in patients with coronary artery disease (CAD) and its risk factors in an urban setting in India.

SUBJECTS AND METHODS

480 patients either with CAD or with risk factors. Those with definite or possible CAD including angina pectoris (n = 210) based on World Health Organization criteria and patients with risk factors were assigned to diet A (n = 231) or diet B (n = 232) for a period of 3 years. Both groups were advised to follow a fat modified diet. Group A was also advised to consume at least 400 g/day of fruits, vegetables and legumes according to World Health Organization advice and include moderate physical activity.

RESULTS

Waist-hip ratios, fasting and post-prandial blood glucose, plasma insulin levels, blood pressure and weight fell significantly in patients in group A compared with those in group B. While triglycerides in group A showed a significant decrease, high density lipoprotein cholesterol showed a significant increase. Both groups showed a significant reduction in total and low density lipoprotein cholesterol, although the decrease was greater in group A than group B. Central obesity decreased by 6.2% in group A vs. 1.2% in group B, 95% confidence interval of difference 2.3 to 7.8. The incidence of cardiac events was significantly lower in group A than group B (29 vs. 43 patients, p < 0.01). All-cause mortality also significantly declined in group A compared with group B (16 vs. 24 died, p < 0.05). The group A patients with better adherence to exercise and diet showed greater reduction in central obesity and greater decline in cardiac event rates and total mortality compared to control group B.

CONCLUSIONS

It is possible that moderate physical activity in conjunction with dietary changes in patients with CAD may cause substantial reductions in central obesity and associated disturbances corresponding to a significant decrease in cardiac events and mortality during the follow-up of 3 years.

Association of trans fatty acids (vegetable ghee) and clarified butter (Indian ghee) intake with higher risk of coronary artery disease in rural and urban populations with low fat consumption

These cross-sectional surveys included 1769 rural (894 men and 875 women) and 1806 urban (904 men and 902 women) randomly selected subjects between 25-64 years of age from Moradabad in North India. The total prevalence of coronary artery disease based on clinical history and electrocardiogram was significantly higher in urban compared to rural men (11.0 vs. 3.9%) and women (6.9 vs. 2.6%), respectively. Food consumption patterns showed that important differences in relation to coronary artery disease were higher intake of total visible fat, milk and milk products, meat, eggs, sugar and jaggery in urban compared to rural subjects. Prevalence of coronary artery disease in relation to visible fat intake showed a higher prevalence rate with higher visible fat intake in both sexes and the trend was significant for total prevalence rates both for rural and urban men and women. Subgroup analysis among urban (694 men and 694 women) and rural (442 men and 435 women) subjects consuming moderate to high fat diets showed that subjects eating trans fatty acids plus clarified butter or those consuming clarified butter as total visible fat had a significantly higher prevalence of coronary artery disease compared to those consuming clarified butter plus vegetable oils in both rural (9.8, 7.1 vs. 3.0%) and urban (16.2, 13.5 vs. 11.0%) men as well as in rural (9.2, 4.5 vs. 1.5%) and urban (10.7, 8.8 vs. 6.4%) women. Univariate and multivariate regression analysis with adjustment for age showed that sedentariness in women, body mass index in urban men and women, milk and clarified butter plus trans fatty acids in both rural and urban in both sexes were significantly associated with coronary artery disease. It is possible that lower intake of total visible fat (20 g/day), decreased intake of milk, increased physical activity and cessation of smoking may benefit some populations in the prevention of coronary artery disease.

Epidemiological study of magnesium status and risk of coronary artery disease in elderly rural and urban populations of north India

Cross-sectional surveys were conducted in 20 randomly selected streets in Moradabad city and two villages in Moradabad district in North India to determine the association of magnesium with risk of coronary artery disease (CAD). There were 501 rural (270 men and 231 women) and 505 urban (250 men and 255 women) subjects between 50-54 years of age inclusive. The overall prevalence of CAD was three times higher in urban than in rural subjects (11.7 vs. 3.98) and the rates were comparable in both sexes. Dietary intake of magnesium was significantly (P < 0.05) higher in rural subjects in both men (520 +/- 58 vs. 415 +/- 47 mg/d) and women (432 +/- 40 vs. 316 +/- 38 mg/d). Dietary magnesium intake and serum magnesium were inversely correlated with CAD. The odds ratio for dietary magnesium intake indicates a higher prevalence of CAD at lower intakes of magnesium in both rural (0.67, 95 per cent confidence interval 0.51 to 0.86) and urban (0.72, 95 per cent CI 0.54 to 0.90) subjects. Multivariate regression analysis showed that serum and dietary magnesium were significantly associated with CAD. Hypertension was not associated with CAD, and serum cholesterol showed only weak association in both rural and urban subjects. The inverse association of dietary and serum magnesium with CAD shows that some urban populations of India may benefit from increased consumption of dietary magnesium and higher serum magnesium levels.

Epidemiological study of magnesium status and risk of hypertension in a rural population of north India

This cross-sectional survey was conducted in two randomly selected villages in Moradabad in North India to demonstrate the association of magnesium status with hypertension in relation to socioeconomic status (SES) in a rural population. There were 1769 subjects (894 males, 875 females) between 25 and 64 years of age, randomly selected and divided into social classes 1-4 depending upon various sociological attributes. The survey methods were a validated questionnaire, blood pressure measurements by mercury manometer, and blood analysis for serum magnesium. Social class 1 and 2 were associated with a greater prevalence of hypertension. The overall prevalence of hypertension diagnosed by JNC-V criteria (> 140/90 mm Hg) was 17.7 per cent (n = 313) and the prevalence was comparable in both sexes and increased with age. Among social class 1 and 2 subjects, there was a higher prevalence of obesity and sedentary lifestyle, a lower intake of dietary magnesium, and a lower serum magnesium compared to social class 3. Logistic regression analysis with adjustment for age showed that SES has a positive relation with hypertension (odds ratio 1.08 men, 1.07 women, P < 0.05), body mass index (odds ratio 1.14 men, 1.13 women, P < 0.01), and sedentary lifestyle (odds ratio 1.38 men, 1.32 women, P < 0.05) in both sexes, and with salt intake in women (odds ratio 1.28, P < 0.05). The odds ratio indicated that a higher intake of magnesium (odds ratio 1.14 men, 1.17 women, P < 0.05) and a higher serum magnesium (odds ratio 1.12 men, 1.15 women, P < 0.05) were associated with a lower risk of hypertension. The findings suggest that social class 1 and 2 subjects in some rural populations of India have a higher prevalence of hypertension and dietary intake of magnesium, and serum magnesium levels were inversely associated with the risk of hypertension.