Dietary patterns in stroke patients in Northwest India

Rural Stroke Surveillance and Establishment of Acute Stroke Care Pathway Using Frontline Health Workers in Rural Northwest India: The Ludhiana Experience

BACKGROUND AND PURPOSE

The role of community health workers (CHWs) in stroke surveillance and in establishing the stroke care pathway has not been studied. The aim of the study was to evaluate the feasibility of using CHWs in the public health system to identify stroke patients for population-based stroke registration and to study the establishment of acute stroke care pathway in rural areas of Ludhiana, Punjab, Northwest India.

METHODS

Two rural blocks in Ludhiana district, comprising 164 villages and a population of 259,778, were selected. Phase-1 (feasibility study) was from August to November 2016 and phase-2 from December 2016 to November 2018. All first-ever stroke cases in adults (aged ≥18 years) were included. The accredited social health activists (ASHAs) were trained to identify stroke patients in the community, who were later evaluated by a neurologist. Stroke characteristics were recorded, and the outcome was assessed at 6 months using modified Rankin scale (0-2, good outcome).

FINDINGS

During phase-2, 359 first-ever stroke patients and 102 stroke mimics were identified. The age-standardized incidence rate was 218.5/100,000 and 197∙6/100,000 for each year. Half (52.4%) of the patients reached health-care facilities within 4.5 h, yet none of them received thrombolysis. Very few patients (1.9%) utilized free government 108 ambulance service to reach a health-care facility. Out of 359 stroke cases, the majority (306, 85.23%) were reported by ASHAs and 14.77% were reported by other sources. Brain imaging was available in 127 (35.4%) patients, and 100 (78.7%) had ischemic stroke. The most common risk factor was hypertension (320, 89%) and drug abuse (154, 42.9%). At 6 months, 168 (64%) patients had a good outcome.

CONCLUSION

ASHAs were able to identify stroke patients in the villages. Despite high numbers of patients reaching health-care facilities within a window period, the hospitals were unable to provide acute stroke treatment like thrombolysis. The health-care system needs to be strengthened to improve stroke care.

Depression may not be a risk factor for mortality in stroke patients with nonsurgical treatment: A retrospective case-controlled study

Patients with depression have more comorbidities than those without depression. The cost of depression-associated comorbidities accounts for the largest portion of the growing cost of depression treatment. Patients with depression have a higher risk of stroke with poor prognoses than those without depression; however, previous studies evaluating the relationship between depression and stroke prognosis have not accounted for surgical treatment or other risk factors. Therefore, we investigated whether depression is a risk factor for mortality in stroke patients with nonsurgical treatment after adjusting for other risk factors.We retrospectively analyzed the data of patients with major depressive disorder (MDD) and age and sex-matched controls without MDD during 1999 to 2005. We then identified patients who developed stroke in both groups and analyzed risk factors for death in these stroke patients who received nonsurgical treatments during a follow-up period from 2006 to 2012.Patients with MDD had higher Charlson Comorbidity Index Scores (CCISs) and exhibited higher frequencies of comorbidities such as diabetes mellitus, hypertension, hyperlipidemia, and coronary heart disease than controls without MDD, and most of MDD patients had very low or high socioeconomic status (SES) and lived in urban settings. Most stroke patients with MDD who received nonsurgical treatment were female, had very low or high SES, and lived in urban settings; in addition, stroke patients with MDD who received nonsurgical treatment had higher CCISs and frequencies of hyperlipidemia and coronary heart disease than those without MDD who received nonsurgical treatment. However, depression was not a risk factor for death in stroke patients with nonsurgical treatment.Hemorrhagic stroke, age, sex, and CCISs were risk factors for death in stroke patients with nonsurgical treatment, but depression did not affect the mortality rate in these patients.

Dietary pattern in Adult Patients with Acute Stroke in South India: A Case-Control Study from a Tertiary Care Center in Hyderabad

BACKGROUND AND OBJECTIVE

Diet plays a crucial role in the occurrence of stroke. But very few studies have so far been conducted with focus on this aspect of acute stroke in India. The objective of the study was to identify the dietary pattern in patients with acute stroke in South India.

MATERIALS AND METHODS

Patients with first-ever acute stroke (ischemic and hemorrhagic) admitted between June 2017 and November 2017 were enrolled and compared with age- and sex-matched controls. Information was collected using a pro forma.

RESULTS

Out of 293 acute stroke patients, 150 were enrolled and compared with 150 controls. The mean age was 52.3 ± 12.6; years 112 (74.6%) patients were male. The majority of them were on traditional diet that included a daily intake of rice (98.6%) and pulses (40.6%). Hypertension (73.3%) was the major vascular risk factor for stroke (P < 0.0001). Significant differences were observed in risk factors such as diabetes (P < 0.0001), smoking (P = 0.0001), alcohol use (P = 0.0017), and heart disease (P = 0.0002), when stroke patients were compared with controls. Stroke patients reported a lower intake of green leafy vegetables (P = 0.0001; odds ratio [OR] 0.17), roots and tubers (P = 0.0016; OR 0.21), and fruits (P = 0.0022; OR 0.29). There was at the same time a higher intake of red meat products (P = 0.04; OR 2.41), organ meats (P = 0.0093; OR 4.35), fried snacks (P = 0.0038; OR 2.01), and pickles (P = 0.04; OR 1.81) although the data suggested lesser consumption of prawn and crab (P = 0.04; OR 0.55) and water (P = 0.0001 OR 4.59) among stroke patients. Higher consumption of fruit juices (P = 0.0008) and junk foods (P = 0.03) was observed in young stroke patients (age ≤45 years) whereas the intake of chicken (P = 0.03) and alcohol (P = 0.0001) was observed to be more among men than among women.

CONCLUSION

Majority of stroke-afflicted patients in South India consume white rice and dal. There is lower intake of water, green leafy vegetables, and fruits and higher consumption of red meat, organ meat, and pickles among stroke patients.

Stroke profile and outcome between urban and rural regions of Northwest India: Data from Ludhiana population-based stroke registry

Introduction

The objective of this study is to compare the clinical profile, risk factors, type and outcome of stroke patients in urban and rural areas of Punjab, India.

Methods

The primary data source was from the Ludhiana urban population-based stroke registry. The data of first-ever stroke patients with age ≥18 years were collected using WHO stepwise approach from all hospitals, general practitioners, physiotherapy and scan centres between 26 March 2011 and 25 March 2013.

Results

A total of 4989 patients were included and out of 4989 patients, 3469 (69%) were from urban areas. Haemorrhagic stroke was seen more in rural as compared to urban regions (urban 1104 (32%) versus rural 552 (36%); p = 0.01). There were significant differences seen in stroke risk factors; hypertension (urban 1923 (84%) versus rural 926 (89%); p = 0.001) and hyperlipidaemia (urban 397 (18%) versus rural 234 (23%); p = 0.001) between two groups. In the multivariable analysis the rural patients were more likely to be younger (age < 40 years) (OR: 1.82; 95% CI: 1.24-2.68; p = 0.002), Sikhs (OR: 2.57; 95% CI: 1.26-5.22; p = 0.009), farmers (OR: 9.41; 95% CI: 5.36-16.50; p < 0.001), housewives (OR: 2.71; 95% CI: 1.45-5.06; p = 0.002), and consumed alcohol (OR: 1.57; 95% CI: 1.19-2.06; p = 0.001) as compared to urban patients. In addition, use of imaging was higher in rural patients (OR: 1.99; 95% CI: 1.06-3.74; p = 0.03) as compared to urban patients.

Discussion and Conclusion

In this large cohort of patients, rural and urban differences were seen in risk factors and type of stroke. Stroke prevention strategies need to take into consideration these factors including regional sociocultural practices.

Association between previously diagnosed circulatory conditions and a dietary inflammatory index

Inflammation is a key contributor to the development or recurrence of circulatory disorders. Diet is a strong modifier of inflammation. It was hypothesized that more pro-inflammatory diets, as indicated by higher Dietary Inflammatory Index (DII) scores, would be associated with self-reported previously diagnosed circulatory disorders using National Health and Nutrition Examination Survey (NHANES) data. This analysis included NHANES respondents from 2005-2010 (n = 15,693). The DII was calculated from micro and macronutrients derived from a single 24-hour recall. Logistic regression, stratified by sex and adjusted for important covariates, was used to determine the odds of previous circulatory disorder diagnoses by quartile of DII scores. Excluding hypertension, which had a prevalence of 30%, the prevalence of any circulatory disorder was 8%. Those in DII quartile 4 were 1.30 (95%CI = 1.06-1.58) times more likely to have a previous circulatory disorder (excluding hypertension) compared to those in DII quartile 1. Similar findings were observed for specific CVDs including congestive heart failure, stroke, and heart attack. Participants in DII quartile 4 were more likely to have a diagnosis of hypertension compared to those in DII quartile 1 (prevalence odds ratio = 1.19, 95%CI = 1.05-1.34). Results tended to be stronger among females. Individuals with a previous circulatory disorder diagnosis from NHANES appear to have more pro-inflammatory diets compared to those without a previous diagnosis. Because inflammation is an important factor related to recurrence of circulatory disorders, the DII could be used in treatment programs to monitor dietary modulators of inflammation among individuals with these conditions.

Dietary patterns and hypertension: a population-based study with women from Southern Brazil

This study investigated the association between dietary pattern and hypertension using the rank reduced regression (RRR). It was a cross-sectional population-based study with a representative sample of 1,026 women living in the city of São Leopoldo, Rio Grande do Sul State, Brazil. In order to identify dietary patterns, dietary variables from a dietary frequency questionnaire were used as predictors and sodium, potassium and saturated fat consumption were selected as response variables. The RRR identified three dietary patterns: Factor 1, Factor 2 and Factor 3. The association between hypertension and factors 1, 2 and 3, after adjustment for socio-demographic, behavioral and obesity variables, was not significant. After stratification by age, the association between hypertension and factor 2 was present in 40-60 year-old women (tertile 2 compared to 3 RP = 0.62, 95%CI: 0.43-0.91; p = 0,05). The new statistical method (RRR), proved to be a useful tool for identifying dietary patterns. In this study, healthier dietary pattern was directly associated with hypertension in women between 40 and 60 years of age.