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Arthur RS, Kirsh VA, Rohan TE. The association of the healthy eating index with risk of colorectal cancers (overall and by subsite) among Canadians. Cancer Epidemiol 2023; 87:102454. [PMID: 37879292 DOI: 10.1016/j.canep.2023.102454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/31/2023] [Accepted: 09/18/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Healthy dietary patterns characterized by high intake of fruits and vegetables, grains/cereals, and lean meat/fish, and low intake of red/processed meats and refined carbohydrates, have been shown to be associated with reduced risk of colorectal cancer, but evidence regarding their association with colorectal cancer subsites is limited. Hence, this study was conducted to assess the association of a healthy dietary pattern, as reflected in the Healthy Eating Index (HEI) (a composite score based on consumption of various food groups), with risk of colorectal cancer, overall and by subsite. METHODS We conducted a case-cohort study in the Canadian Study of Diet, Lifestyle and Health (CSDLH). The study included all cases of incident colorectal cancer in the entire cohort, and an age-stratified subcohort of 3185 women and 2622 men. Cox regression models were used to estimate hazard ratios (HR) for the association between the HEI and the risk of colorectal cancer, overall and by subsite. We also assessed the association by sex and by selected metabolic factors. RESULTS For both sexes combined, the highest quintile of the HEI score was inversely associated with risk of colorectal cancer, colon cancer and proximal colon cancer (HR: 0.65; 95% CI: 0. 49-0.85, HR: 0.60, 95% CI: 0.44-0.83 and HR: 0.54, 95% CI: 0.35-0.85, respectively). However, these associations were mostly observed among men (HR: 0.56; 95% CI: 0.38-0.81, HR: 0.44, 95% CI: 0.28-0.69 and HR: 0.26; 95% CI: 0.12-0.56, for colorectal cancer, colon cancer and proximal colon cancer, respectively; p-interactions=0.029, 0.032 and 0.063, respectively). An inverse association was also observed between the HEI and risk of colorectal cancer among normal weight participants, overweight/obese participants, non-smokers, non-alcohol drinkers and participants who were physically inactive. CONCLUSION A healthy dietary pattern may reduce risk of colorectal cancer, particularly among men.
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Affiliation(s)
- Rhonda S Arthur
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
| | | | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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Venkatesan P, Prakash SS, Ramasamy J. Association of dietary patterns and health outcomes by spatial regression analysis of nationally representative survey data from India. Indian J Public Health 2023; 67:399-407. [PMID: 37929382 DOI: 10.4103/ijph.ijph_112_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background Our aim was to study the regional differences in dietary patterns in India and their association with population-level nutrition-related health indicators such as the prevalence of anemia, overweight, undernutrition, and hyperglycemia. Objectives To identify and characterize the dietary patterns from publicly available nationally representative survey data on food consumption conducted by the National Sample Survey Office (NSSO) to study the regional differences in dietary patterns. Methods Dietary patterns were identified by factor analysis of per capita food consumption data from the household consumer expenditure survey (2011). Mean factor scores of dietary patterns were calculated for each district separately for urban and rural regions. Ecological association of factor scores with the district-level percentage prevalence of health indicators from the National Family Health Survey-4 (2015-2016) data was done by the Spatial Durbin Model of spatial regression analysis. Results Factor analyses revealed four dietary patterns which were similar in terms of the food items that characterized the factors for both rural and urban regions. Direct effects of dietary patterns by spatial regression analyses were observed with several health outcomes after adjusting for differences in socioeconomic development. Prevalence of anemia was positively associated with "Milk and wheat-rich diet" among men in the rural regions but negatively associated with other dietary patterns. Prevalence of overweight and high blood glucose was positively associated with "Rice and meat-rich diet" and "Coconut and seafood rich diet" in the rural regions. "Refined oil and tur dal-rich diet" was positively associated with the prevalence of overweight and hypertension in urban regions and negatively associated with underweight and anemia in men in rural and urban regions. Conclusions Spatial regression analyses revealed several important associations between dietary patterns and health outcomes, mostly in rural regions and some in urban regions. These results suggest the role of the major food items consumed in different regions and their impact on health outcomes in India and may have implications in tailoring dietary modifications accordingly.
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Affiliation(s)
- Padmanaban Venkatesan
- Associate Professor, Department of Biochemistry, Christian Medical College (Affiliated to the Tamil Nadu Dr. MGR Medical University, Chennai, India), Vellore, Tamil Nadu, India
| | - S S Prakash
- Associate Professor, Department of Biochemistry, Christian Medical College (Affiliated to the Tamil Nadu Dr. MGR Medical University, Chennai, India), Vellore, Tamil Nadu, India
| | - Jagadish Ramasamy
- Associate Professor, Department of Biochemistry, Christian Medical College (Affiliated to the Tamil Nadu Dr. MGR Medical University, Chennai, India), Vellore; Associate Professor, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
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Ganpule A, Dubey M, Pandey H, Srinivasapura Venkateshmurthy N, Green R, Ann Brown K, Maddury AP, Khatkar R, Jarhyan P, Prabhakaran D, Mohan S. Snacking Behavior and Association with Metabolic Risk Factors in Adults from North and South India. J Nutr 2023; 153:523-531. [PMID: 36894244 DOI: 10.1016/j.tjnut.2022.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Snacks are increasingly contributing to daily diets around the world. Studies from high-income countries have demonstrated the link between snack consumption and metabolic risk factors, but there are very few studies from low- and middle-income countries. OBJECTIVES The objective of this study was to assess snack behavior and its associations with metabolic risk factors in Indian adults. METHODS Adults from the UDAY study (October 2018-February 2019, n = 8762) from rural and urban Sonipat (North) and Vizag (South) India were studied for snack consumption (food frequency questionnaire), demographic factors, including age, sex, etc. and metabolic risk factors, including BMI, waist circumference, fat percentage, plasma glucose, and blood pressure. We compared snack consumption by categories of sociodemographic factors (Mann-Whitney U test, Kruskal-Wallis test) and studied the likelihood for metabolic risk (logistic regression analysis). RESULTS Half of the study participants were women and resided in rural locations. Savory snacks were the most preferred; 50% of the participants consumed them 3-5 times/wk. Participants preferred to purchase out-of-home prepared snacks and eat them at home (86.6%) while watching television (69.4%) or with family/friends (49.3%). The reasons for snacking were hunger, craving, liking, and availability. Snack consumption was higher in Vizag (56.6%) than in Sonipat (43.4%), among women (55.5%) than men (44.5%), and the wealthiest; it was similar in rural-urban locations. Frequent consumers of snacks had 2 times higher likelihood for having obesity (OR: 2.22; 95% CI: 1.51, 3.27) central obesity (OR: 2.35; 95% CI: 1.60, 3.45), and higher fat percentage (OR: 1.92; 95% CI: 1.31, 2.82) and higher fasting glucose levels (r=0.12 (0.07-0.18) than consumers who consumed snacks rarely (all P ≤ 0.05). CONCLUSIONS Snack (savory and sweet) consumption was high among adults from sexes in both urban and rural locations of north and south India. This was associated with higher risk of obesity. There is a need to improve the food environment by promoting policies for ensuring healthier food options to reduce snacking and associated metabolic risk.
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Affiliation(s)
| | - Manisha Dubey
- Centre for Chronic Disease Control, New Delhi, India
| | | | | | - Rosemary Green
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India; London School of Hygiene and Tropical Medicine, London, UK
| | - Sailesh Mohan
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India; Deakin University, Melbourne, Australia
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Sachdev M, Misra A. Heterogeneity of Dietary practices in India: current status and implications for the prevention and control of type 2 diabetes. Eur J Clin Nutr 2023; 77:145-155. [PMID: 35039630 DOI: 10.1038/s41430-021-01067-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/06/2021] [Accepted: 12/30/2021] [Indexed: 02/06/2023]
Abstract
Diet is one of the important modifiable factors in prevention of type 2 diabetes (T2D), making it important to understand geographical variations of food consumption pattern, their similarities and differences across various regions. Asian Indian diet patterns are mostly carbohydrate-based and with vast regional diversity. Staple food, food groups consumed, meat consumption pattern, type of fermented foods, food preparations, type of cooking oil used and food ingredients vary with different regions of India. There has been a slow transition from consumption of coarse grains to refined grains owing to socio-economic, cultural and other factors. Consumption of fruits and vegetables, fats, ready-to-eat foods and sugar is higher in urban population whereas consumption of carbohydrates in the form of cereals and millets is higher among the rural population. Cereal grains followed by pulses and legumes are main sources of protein, given that the frequency of meat consumption is low even among non-vegetarians in India compared to other countries. Overall, there is a tendency towards consumption of calorie-dense foods at the cost of food diversity, which may also result in micronutrient deficiencies as well as development of T2D and related metabolic diseases. Public health strategies and policy level decisions involving stakeholders with diet and lifestyle modification as focal points are absolute priorities to prevent and manage the burden of obesity and T2D in India.
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Affiliation(s)
- Meenakshi Sachdev
- Tamil Nadu Government Multi Super Specialty Hospital, Chennai, India
| | - Anoop Misra
- Diabetes Foundation (India), Safdarjung Development Area, New Delhi, 110016, India. .,National Diabetes Obesity and Cholesterol Foundation (N-DOC), Safdarjung Development Area, New Delhi, 110016, India. .,Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi, India.
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Tak M, Law C, Green R, Shankar B, Cornelsen L. Processed foods purchase profiles in urban India in 2013 and 2016: a cluster and multivariate analysis. BMJ Open 2022; 12:e062254. [PMID: 36207045 PMCID: PMC9558783 DOI: 10.1136/bmjopen-2022-062254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Sales of ultraprocessed foods (UPFs) and beverages are rising in low-income and middle-income countries. Such foods are often linked with weight gain, obesity, type 2 diabetes and hypertension-diseases that are on the rise in India. This paper analysed patterns in purchases of processed and UPF by urban Indian households. SETTING Panel data from Kantar -Worldpanel Division, India for 2013 and 2016. PARTICIPANTS 58 878 urban Indian households. METHODS We used K-mean partition clustering and multivariate regression to analyse patterns in processed food (PF) and UPF purchase for urban India. RESULTS Three-quarters of urban Indian households purchased over ten PF groups. Mean per person annual PF purchase was 150 kg. UPF purchase was low at 6.4 kg in 2016 but had grown by 6% since 2013. Cluster analysis identified three patterns of consumption, characterised by low (54% of the households in 2016), medium (36%) and high (10%) PF purchase quantities. High cluster households purchased over three times as much PFs and UPF as the low cluster households. Notably, salt purchases were persistently high across clusters in both years (>3.3 kg), while sweet snack and ready-to-eat food purchases grew consistently in all clusters between 2013 and 2016. A positive and significant association was found between household purchases of UPF and their socioeconomic status as well as ownership of durables, such as refrigerator, colour television and washing machine (all p<0.001). Spatial characteristics including size of town (p<0.05) in which the household is located were also positively associated with the purchase of UPF. CONCLUSION Results suggest the need for tailored regional and city level interventions to curb the low but growing purchase of UPF. New data on obesity and rise of non-communicable diseases, the results are concerning given the links between lifestyle changes and the speed of urbanisation in Indian cities.
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Affiliation(s)
- Mehroosh Tak
- Veterinary Epidemiology, Economics and Public Health, The Royal Veterinary College, London, UK
| | - Cherry Law
- Department of Agri-Food Economics and Marketing, School of Agriculture, Policy and Development, University of Reading, Reading, UK
| | - Rosemary Green
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Bhavani Shankar
- Institute for Sustainable Food, University of Sheffield, Sheffield, UK
| | - Laura Cornelsen
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Sharma K, Basu-Ray I, Sayal N, Vora A, Bammidi S, Tyagi R, Modgil S, Bali P, Kaur P, Goyal AK, Pal DK, Arvind H, Jindal K, Garg V, Matyal B, Thakur N, Chhikara A, Kaur N, Maanju P, Bhatia KS, Pannu V, Gupta V, Malik N, Malik R, Kumar R, Kaur R, Bhatt V, Bhalla A, Mohanty M, Singh G, Sharma SK, Sivapuram MS, Mathur D, Khanra D, Anand A. Yoga as a Preventive Intervention for Cardiovascular Diseases and Associated Comorbidities: Open-Label Single Arm Study. Front Public Health 2022; 10:843134. [PMID: 35769774 PMCID: PMC9234218 DOI: 10.3389/fpubh.2022.843134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/27/2022] [Indexed: 11/20/2022] Open
Abstract
Aim Common Yoga Protocol (CYP) is a standardized yoga protocol authored by experts from all over the world under the aegis of the Ministry of AYUSH, Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa Rigpa and Homeopathy (AYUSH). The potential of CYP can be determined as a cost-effective lifestyle modification to prevent the risk of developing cardiovascular diseases (CVD). Methods In this prospective trial, we compared the effect of CYP at baseline and after 1 month. A total of 374 yoga-naïve participants performed CYP under the supervision of experienced trainers. Physiological [body mass index (BMI), blood pressure, percent oxygen saturation], biochemical (fasting blood glucose and lipid profile), and neurocognitive parameters were measured before and after the intervention. Results At day 30 of yoga practice, serum levels of low-density lipoprotein (LDL), total cholesterol (TC), and high-density lipoprotein (HDL) were found significantly improved as compared to the baseline levels observed at the time of enrollment. Similarly, the lipid profile was also obtained from experienced trainers and found to be significantly different from those of yoga-naïve volunteers. When the intervention was compared between the healthy yoga-naïve participants with yoga-naïve participants suffering from medical issues, it was found that cholesterol profile improved significantly in the healthy-naive group as compared to the diseased group (hypertension, diabetes, underwent surgery, and CVD). Conclusion These results highlight the need for further research to better understand the effects of yoga on the primary prevention of CVD.
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Affiliation(s)
- Kaushal Sharma
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
- Centre for Systems Biology and Bioinformatics, Panjab University, Chandigarh, India
| | - Indranill Basu-Ray
- Department of Cardiology, St. Francis Hospital, Memphis, TN, United States
- Department of Cardiology, All India Institute of Medical Sciences, Virbhadra Marg, Rishikesh, India
- Department of Cardiology, Swami Vivekananda Yoga Anusandhana Samsthana, Union Territory (SVYASA), Bengaluru, India
| | - Natasha Sayal
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ariana Vora
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, United States
| | - Sridhar Bammidi
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Tyagi
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shweta Modgil
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
- Department of Zoology, Panjab University, Chandigarh, India
| | - Parul Bali
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
- Department of Biophysics, Panjab University, Chandigarh, India
| | - Paramvir Kaur
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Kumar Goyal
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
- Department of Otolaryngology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Kumar Pal
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harshita Arvind
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Khushboo Jindal
- Department of Bioinformatics, Jaypee University, Shimla, India
| | - Vincy Garg
- Department of Cardiology, Swami Vivekananda Yoga Anusandhana Samsthana, Union Territory (SVYASA), Bengaluru, India
| | - Bandu Matyal
- Department of Zoology, Panjab University, Chandigarh, India
| | - Neha Thakur
- Department of Zoology, Panjab University, Chandigarh, India
| | - Amit Chhikara
- Department of Physical Education, Panjab University, Chandigarh, India
| | - Navneet Kaur
- Department of Physical Education, Panjab University, Chandigarh, India
| | - Preety Maanju
- Department of Physical Education, Panjab University, Chandigarh, India
| | | | | | | | - Neeru Malik
- Department of Physical Education, Dev Samaj College of Education, Chandigarh, India
| | - Rakesh Malik
- Department of Physical Education and Sports, Panjab University, Chandigarh, India
| | | | - Ravneet Kaur
- Department of Zoology, Panjab University, Chandigarh, India
| | - Vinod Bhatt
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manju Mohanty
- Department of Neurosurgery, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gurmeet Singh
- Department of Physical Education, Panjab University, Chandigarh, India
| | - Suresh Kumar Sharma
- Centre for Systems Biology and Bioinformatics, Panjab University, Chandigarh, India
- Department of Statistics, Panjab University, Chandigarh, India
| | - Madhava Sai Sivapuram
- Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, India
| | - Deepali Mathur
- School of Biotechnology, KIIT University, Bhubaneswar, India
| | - Dibbendu Khanra
- Department of Cardiology, All India Institute of Medical Sciences, Virbhadra Marg, Rishikesh, India
| | - Akshay Anand
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
- *Correspondence: Akshay Anand
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Cao Y, Huynh Q, Kapoor N, Jeemon P, de Mello GT, Oldenburg B, Thankappan KR, Sathish T. Associations between Dietary Patterns and Cardiometabolic Risk Factors—A Longitudinal Analysis among High-Risk Individuals for Diabetes in Kerala, India. Nutrients 2022; 14:nu14030662. [PMID: 35277021 PMCID: PMC8838960 DOI: 10.3390/nu14030662] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 12/07/2022] Open
Abstract
The association between dietary patterns and cardiometabolic risk factors is not well understood among adults in India, particularly among those at high risk for diabetes. For this study, we analyzed the data of 1007 participants (age 30–60 years) from baseline and year one and two follow-ups from the Kerala Diabetes Prevention Program using multi-level mixed effects modelling. Dietary intake was measured using a quantitative food frequency questionnaire, and dietary patterns were identified using principal component analysis. Two dietary patterns were identified: a “snack-fruit” pattern (highly loaded with fats and oils, snacks, and fruits) and a “rice-meat-refined wheat” pattern (highly loaded with meat, rice, and refined wheat). The “snack-fruit” pattern was associated with increased triglycerides (mg/dL) (β = 6.76, 95% CI 2.63–10.89), while the “rice-meat-refined wheat” pattern was associated with elevated Hb1Ac (percentage) (β = 0.04, 95% CI 0.01, 0.07) and central obesity (OR 1.16, 95% CI 1.01, 1.34). These findings may help inform designing dietary interventions for the prevention of diabetes and improving cardiometabolic risk factors in high-diabetes-risk individuals in the Indian setting.
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Affiliation(s)
- Yingting Cao
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia; (N.K.); (B.O.); (T.S.)
- Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne 3004, Australia
- Correspondence: or
| | - Quan Huynh
- Imaging Research, Baker Heart and Diabetes Institute, Melbourne 3004, Australia;
| | - Nitin Kapoor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia; (N.K.); (B.O.); (T.S.)
- Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne 3004, Australia
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore 632004, India
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India; (P.J.); (K.R.T.)
| | - Gabrielli Thais de Mello
- Research Centre for Physical Activity and Health (NuPAF), Federal University of Santa Catarina, Florianópolis 88040-900, Brazil;
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia; (N.K.); (B.O.); (T.S.)
- Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne 3004, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia
| | - Kavumpurathu Raman Thankappan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India; (P.J.); (K.R.T.)
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod 671316, India
| | - Thirunavukkarasu Sathish
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia; (N.K.); (B.O.); (T.S.)
- Population Health Research Institute (PHRI), McMaster University, Hamilton, ON L8L 2X2, Canada
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Carpenter CL, Kapur K, Ramakrishna P, Pamujula S, Yadav K, Giovanni JE, Julian O, Ekstrand ML, Sinha S, Nyamathi AM. Lean Mass Improvement from Nutrition Education and Protein Supplementation among Rural Indian Women Living with HIV/AIDS: Results from Cluster Randomized Factorial Trial at 18-Month Follow-Up. Nutrients 2021; 14:179. [PMID: 35011054 PMCID: PMC8746930 DOI: 10.3390/nu14010179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/24/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
Loss of lean muscle mass impairs immunity and increases mortality risk among individuals with HIV/AIDS. We evaluated the relative contributions of protein supplementation and nutrition education on body composition among 600 women living with HIV/AIDS in rural Andhra Pradesh, India. We conducted a cluster randomized controlled 2 × 2 factorial trial lasting six months with follow up at twelve and eighteen months. Interventions occurred in the Nellore and Prakasam regions of Andhra Pradesh by trained village women, ASHA (Accredited Social Health Activists), and included: (1) the usual supportive care from ASHA (UC); (2) UC plus nutrition education (NE); (3) UC plus nutritional protein supplementation (NS); (4) combined UC plus NE plus NS. A Bioimpedance Analyzer Model 310e measured body composition. SAS 9.4 analyzed all data. Mixed models using repeated measures evaluated lean mass change from baseline as primary and fat weight and total weight as secondary outcomes. Lean mass change was significantly associated with NS (p = 0.0001), NE (p = 0.0001), and combined NS plus NE (p = 0.0001), with similar associations for secondary outcomes. Stronger associations for total weight were observed with greater ART adherence. Nutritional interventions may improve physiologic response to HIV. Significant increases in lean mass resulted from independent and combined protein supplementation and nutrition education.
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Affiliation(s)
| | | | | | - Suresh Pamujula
- People’s Health Society, Nellore 524137, India; (P.R.); (S.P.)
| | - Kartik Yadav
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA 92697, USA; (K.Y.); (A.M.N.)
| | - Jennifer E. Giovanni
- Center for Human Nutrition, University of California, Los Angeles, CA 90024, USA;
| | - Olivia Julian
- College of Medicine, Drexel University, Philadelphia, PA 19129, USA;
| | - Maria L. Ekstrand
- Center for AIDS Prevention, Department of Medicine, University of California, San Francisco, CA 94158, USA;
| | - Sanjeev Sinha
- All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India;
| | - Adeline M. Nyamathi
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA 92697, USA; (K.Y.); (A.M.N.)
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9
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Sharma S, Maheshwari S, Kuwatada J, Chandrashekhar, Mehra S. Assessing Dietary Intake Patterns Through Cluster Analysis Among Adolescents in Selected Districts of Bihar and Assam From India: A Cross-Sectional Survey. Front Nutr 2021; 8:592581. [PMID: 34901099 PMCID: PMC8655107 DOI: 10.3389/fnut.2021.592581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background: In the recent decade, dietary pattern assessment has evolved as a promising tool to describe the whole diet and represent inter-correlations between different dietary components. We aimed to derive the dietary patterns of adolescents (10–19 years) using cluster analysis on food groups and evaluate these patterns according to their socio-demographic profile. Methods: This community-based cross-sectional study was conducted in two districts, each from Bihar and Assam in India. Adolescents (10–19 years) were enrolled from both rural and urban areas. The dietary intake was assessed through a pre-validated single food frequency questionnaire. Cluster analysis was performed by a 2-step procedure to explore dietary patterns, pre-fixed at 2 clusters. Clusters were analyzed with respect to socio-demographic characteristics using binomial logistic regression. Results: A total of 826 girls and 811 boys were enrolled in the study. We found two major dietary patterns, namely a low- and high-mixed diet. The low-mixed diet (76.5% prevalence) had daily consumption of green vegetables, including leafy vegetables, with less frequent consumption of other foods. The high-mixed diet (23.5% prevalence) had more frequent consumption of chicken, meat, egg, and milk/curd apart from green vegetables. Adolescent boys had 3.6 times higher odds of consuming a low-mixed diet compared to girls. Similarly, adolescents with lower education grades and from marginalized social classes had two times higher odds of taking a low-mixed diet than their respective counterparts. Conclusions: The high consumption of a low-mixed diet and relatively less milk consumption limit the comprehensive growth of adolescents. Improvement in dietary intake of adolescents from marginalized sections of society can prove to be an important deterrent in mitigating India's nutritional challenges.
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Affiliation(s)
- Shantanu Sharma
- Department of Clinical Sciences, Lund University, Malmo, Sweden.,Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Sonali Maheshwari
- Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Jitesh Kuwatada
- Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Chandrashekhar
- Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Sunil Mehra
- Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA Health Institute for Mother and Child, New Delhi, India
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Pestoni G, Riedl A, Breuninger TA, Wawro N, Krieger JP, Meisinger C, Rathmann W, Thorand B, Harris C, Peters A, Rohrmann S, Linseisen J. Association between dietary patterns and prediabetes, undetected diabetes or clinically diagnosed diabetes: results from the KORA FF4 study. Eur J Nutr 2021; 60:2331-2341. [PMID: 33125578 PMCID: PMC8275503 DOI: 10.1007/s00394-020-02416-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/13/2020] [Indexed: 11/07/2022]
Abstract
PURPOSE Diet is one of the most important modifiable risk factors for the development of type 2 diabetes. Here, we aim to identify dietary patterns and to investigate their association with prediabetes, undetected diabetes and prevalent diabetes. METHODS The present study included 1305 participants of the cross-sectional population-based KORA FF4 study. Oral glucose tolerance test (OGTT) measurements together with a physician-confirmed diagnosis allowed for an accurate categorization of the participants according to their glucose tolerance status into normal glucose tolerance (n = 698), prediabetes (n = 459), undetected diabetes (n = 49), and prevalent diabetes (n = 99). Dietary patterns were identified through principal component analysis followed by hierarchical clustering. The association between dietary patterns and glucose tolerance status was investigated using multinomial logistic regression models. RESULTS A Prudent pattern, characterized by high consumption of vegetables, fruits, wholegrains and dairy products, and a Western pattern, characterized by high consumption of red and processed meat, alcoholic beverages, refined grains and sugar-sweetened beverages, were identified. Participants following the Western pattern had significantly higher chances of having prediabetes (odds ratio [OR] 1.92; 95% confidence interval [CI] 1.35, 2.73), undetected diabetes (OR 10.12; 95% CI 4.19, 24.43) or prevalent diabetes (OR 3.51; 95% CI 1.85, 6.67), compared to participants following the Prudent pattern. CONCLUSION To our knowledge, the present study is one of the few investigating the association between dietary patterns and prediabetes or undetected diabetes. The use of a reference group exclusively including participants with normal glucose tolerance might explain the strong associations observed in our study. These results suggest a very important role of dietary habits in the prevention of prediabetes and type 2 diabetes.
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Affiliation(s)
- Giulia Pestoni
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Anna Riedl
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany
| | - Taylor A Breuninger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany
| | - Nina Wawro
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany
| | - Jean-Philippe Krieger
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Christa Meisinger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD E.V.), Neuherberg, Germany
| | - Barbara Thorand
- German Center for Diabetes Research (DZD E.V.), Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Carla Harris
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Division of Metabolic and Nutritional Medicine, Dr. Von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - Annette Peters
- German Center for Diabetes Research (DZD E.V.), Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jakob Linseisen
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany.
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Kawasaki H, Kawasaki M, Iki T, Matsuyama R. Genetics education program to help public health nurses improve their knowledge and enhance communities' genetic literacy: a pilot study. BMC Nurs 2021; 20:31. [PMID: 33579269 PMCID: PMC7881575 DOI: 10.1186/s12912-021-00549-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 02/03/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND As human genetics knowledge develops, public genetic literacy needs to be increased, though the educational capacity for this purpose has not yet been fully developed. Under this circumstance, the daily work of public health nurses can be viewed as an opportunity to enhance public genetic literacy. However, in Japan, there is not only a lack of public knowledge of human genomics but also a lack of public health nurses' recognition about genomic literacy. A short-term education program was implemented as a pilot study. This study aimed to examine the effectiveness of the program to support public health nurses' activity aimed at promoting health services-related genetic literacy. METHODS The genetics education program was implemented in December 2019, in Kagoshima, Japan. Twenty-three public health nurses cooperated with the research. The program was composed of a case study on consultation, a lecture on hereditary diseases, and a discussion on the role of public health nurses. Familial hypercholesterolemia was used as the topic of the case study. We evaluated scores for cognition, affect, and psychomotor characteristics related to their learning goals before and after the program using Wilcoxon signed-rank tests. Answers in the consultation were qualitatively analyzed. RESULTS The mean cognitive score, capturing provision of explanations of hereditary disease, was 6.3 before the program but increased significantly to 9.3 after the program (p < 0.001). For the affective score, the goal of which was deepening interest in human genetics, the mean score increased significantly from 8.5 before to 11.0 after (p < 0.001). For the psychomotor score, addressing the need for genetic consultation, the mean score increased significantly from 4.4 before to 8.1 after (p < 0.001). Prominent themes extracted from descriptions on the worksheet post training included, "providing advice and accurate information on genetic disorders" and "referral to a specialized organization." CONCLUSIONS Our findings indicated that this education program helps public health nurses be positively involved in human genetic disorders. Thus, they may connect to their local community to provide accurate genetics knowledge and advice for health management and promoting genetic literacy.
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Affiliation(s)
- Hiromi Kawasaki
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
| | - Masahiro Kawasaki
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Tomoko Iki
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Ryota Matsuyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
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Vinay B, Shastry C, Kodangala S, Mateti UV, Bhat K. Association of diet and lipid profile among coronary heart disease patients. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Biswas T, Magalhaes RJS, Townsend N, Das SK, Mamun A. Double Burden of Underweight and Overweight among Women in South and Southeast Asia: A Systematic Review and Meta-analysis. Adv Nutr 2020; 11:128-143. [PMID: 31634389 PMCID: PMC7442413 DOI: 10.1093/advances/nmz078] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/08/2018] [Accepted: 06/27/2019] [Indexed: 12/12/2022] Open
Abstract
The double burden of malnutrition (DBM) is characterized by the coexistence of underweight and overweight individuals in a population. The objective of this study was to assess the level of DBM, as well as its main determinants, in women in South and Southeast Asia. We searched scientific literature databases, including PubMed, EMBASE, CINAHL, and Google Scholar; gray literature; and reference lists from primary research published between 1969 and September 30, 2017. In total, 128 studies met our inclusion criteria, representing data of ∼5 million women >15 y of age from South and Southeast Asia. The findings show that prevalence rates of underweight and overweight varied by study from 7.0% to 61.0% and 1.0% to 64.0%, respectively. For the total study period, the pooled prevalence of underweight and overweight was 28% (95% CI: 25%, 31%) and 17% (95% CI: 15%, 19%) in South Asia, respectively, and 20% (95% CI: 15%, 26%) and 20% (95% CI: 15%, 24%) in Southeast Asia, respectively. In both regions, underweight was more prevalent in rural areas, among women of the youngest age group (15-19 y), and among those in the poorest wealth quintile. In contrast, overweight was higher in urban areas, among women of older age, and among those in the wealthiest households. This study also found that prevalence of overweight has recently exceeded that for underweight in this population.
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Affiliation(s)
- Tuhin Biswas
- Institute for Social Science Research, University of Queensland, Indooroopilly, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Indooroopilly, Australia
| | - R J Soares Magalhaes
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, University of Queensland, Gatton, Australia
- Children's Health and Environment Program, Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - Nick Townsend
- Department for Health, University of Bath, Bath, United Kingdom
| | - Sumon Kumar Das
- Institute for Social Science Research, University of Queensland, Indooroopilly, Australia
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Child Health Division, Menzies School of Health Research, Tiwi, Australia
| | - Abdullah Mamun
- Institute for Social Science Research, University of Queensland, Indooroopilly, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Indooroopilly, Australia
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14
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Goda H, Kawasaki H, Masuoka Y, Kohama N, Rahman MM. Opportunities and challenges of integrating genetics education about human diversity into public health nurses' responsibilities in Japan. BMC Nurs 2019; 18:65. [PMID: 31827391 PMCID: PMC6902480 DOI: 10.1186/s12912-019-0391-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 11/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many genetic tests are now available due to evolution by the Human Genome Project. However, the growing use of genetic testing and screening may not only lead to improvements in public health and health promotion, but also trigger grave ethical, legal, and societal concerns. The involvement of community healthcare providers is expected in the future because they have direct contact with the residents through their health programs. The aims of the current study were to clarify how public health nurses perceive the relationship between genetics and professional duties and to identify opportunities and challenges of integrating genetics education into their professional duties. METHODS In 2017, data were collected through a focus group interview. Content related to the 'presence or absence of health consultation related to genetic issues as part of actual job duties' and 'training for handling genetic-related health consultations' was extracted. Entire sentences were coded and categorized based on similar semantic content. RESULTS Public health nurses had difficulties in recognizing genetic issues in public health activities. In some cases, genetic contents were included in conversation and consultation with the general public. Through the professional education and experiences, public health nurses needed specialized education, post-graduation studies and mentoring about genetics. CONCLUSIONS Public health nurses whose professional duties do not directly relate to genetics were exposed to genetics-related episodes on a regular basis without their awareness. The provision of accurate information and knowledge related to genetics by public health nurses would also provide an opportunity for clients to be informed about their latent genetic risks. Hence, there is a need for practical resources, the establishment of collaboration networks, and the development of professional organizations for public health nurses.
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Affiliation(s)
- Hiromi Goda
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553 Japan
| | - Hiromi Kawasaki
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553 Japan
| | - Yuko Masuoka
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553 Japan
| | - Natsu Kohama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553 Japan
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553 Japan
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Law C, Green R, Kadiyala S, Shankar B, Knai C, Brown KA, Dangour AD, Cornelsen L. Purchase trends of processed foods and beverages in urban India. GLOBAL FOOD SECURITY 2019; 23:191-204. [PMID: 31799110 PMCID: PMC6853021 DOI: 10.1016/j.gfs.2019.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/22/2019] [Accepted: 05/26/2019] [Indexed: 12/29/2022]
Abstract
•Unique dataset allows analysis of urban Indian shopping habits of processed foods.•Beyond staples, purchases of processed foods and beverages for home use are low.•Fastest rate of growth seen in sweet and salty snacks, and edible oil purchases.•Highest volume of processed foods and beverages purchased by Delhi population.•Large variations across states in level and trends of purchases over time.
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Affiliation(s)
- Cherry Law
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- (Honorary) College of Medicine & Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Rosemary Green
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Bhavani Shankar
- Centre for Development, Environment and Policy, SOAS University of London, London, WC1H 0XG, UK
| | - Cécile Knai
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Kerry A. Brown
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Alan D. Dangour
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Laura Cornelsen
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- (Honorary) College of Medicine & Health, University of Exeter, Exeter, EX1 2LU, UK
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Analysis of dietary patterns and cross-sectional and longitudinal associations with hypertension, high BMI and type 2 diabetes in Peru. Public Health Nutr 2019; 23:1009-1019. [PMID: 31456536 DOI: 10.1017/s1368980019002313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine if specific dietary patterns are associated with risk of hypertension, type 2 diabetes mellitus (T2DM) and high BMI in four sites in Peru. DESIGN We analysed dietary patterns from a cohort of Peruvian adults in four geographical settings using latent class analysis. Associations with prevalence and incidence of hypertension, T2DM and high BMI were assessed using Poisson regression and generalised linear models, adjusted for potential confounders. SETTING Four sites in Peru varying in degree of urbanisation. PARTICIPANTS Adults aged ≥35 years (n 3280). RESULTS We identified four distinct dietary patterns corresponding to different stages of the Peruvian nutrition transition, reflected by the foods frequently consumed in each pattern. Participants consuming the 'stage 3' diet, characterised by high proportional consumption of processed foods, animal products and low consumption of vegetables, mostly consumed in the semi-urban setting, showed the highest prevalence of all health outcomes (hypertension 32·1 %; T2DM 10·7 %; high BMI 75·1 %). Those with a more traditional 'stage 1' diet characterised by potato and vegetables, mostly consumed in the rural setting, had lower prevalence of hypertension (prevalence ratio; 95 CI: 0·57; 0·43, 0·75), T2DM (0·36; 0·16, 0·86) and high BMI (0·55; 0·48, 0·63) compared with the 'stage 3' diet. Incidence of hypertension was highest among individuals consuming the 'stage 3' diet (63·75 per 1000 person-years; 95 % CI 52·40, 77·55). CONCLUSIONS The study found more traditional diets were associated with a lower prevalence of three common chronic diseases, while prevalence of these diseases was higher with a diet high in processed foods and low in vegetables.
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Abstract
PURPOSE OF REVIEW Obesity has increased in South Asian countries that are still grappling with undernutrition. In this review, we highlight the characteristics of obesity, its relation to morbidities, and its management in South Asians. A literature search was conducted using relevant search engines and based on key words focusing on obesity in South Asians. RECENT FINDINGS The increasing trend in obesity prevalence is caused by imbalanced diets and physical inactivity. South Asians, in general, have higher body fat and lower skeletal muscle mass at the same or lower BMIs compared to white people ("high body fat-normal BMI-low muscle mass" phenotype). In addition, excess abdominal adiposity, typically seen in South Asians, and increased hepatic fat (non-alcoholic fatty liver disease) are associated with an increased risk for type 2 diabetes and cardiovascular disease. Challenges in treatment include lack of awareness regarding correct diets and non-compliance to diet and exercise regimens. Social and cultural issues limit physical activity in South Asian women. Finally, there is a lack of expert health professionals to deal with increased cases of obesity. Aggressive management of obesity is required in South Asians, with more intensive and earlier diet and exercise interventions (i.e., at lower BMI levels than internationally accepted). At a population level, there is no clear policy for tackling obesity in any South Asian country. Prevention strategies focusing on obesity in childhood and the creation of food and activity environments that encourage healthy lifestyles should be firmly applied. Obesity in South Asians should be evaluated with ethnic-specific guidelines and prevention and management strategies should be applied early and aggressively.
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Affiliation(s)
- Anoop Misra
- Metabolic Diseases and Allied Specialties, Fortis-C-DOC Hospital for Diabetes, B-16, Chirag Enclave, New Delhi, India.
- National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India.
- Diabetes Foundation (India), New Delhi, India.
| | - Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Shajith Anoop
- Metabolic Diseases and Allied Specialties, Fortis-C-DOC Hospital for Diabetes, B-16, Chirag Enclave, New Delhi, India
- National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India
- Diabetes Foundation (India), New Delhi, India
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Dietary patterns associated with hypertension risk among adults in Thailand: 8-year findings from the Thai Cohort Study. Public Health Nutr 2018; 22:307-313. [PMID: 30187840 PMCID: PMC6390399 DOI: 10.1017/s1368980018002203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective Dietary intake is a leading risk factor for hypertension. We aimed to assess longitudinal associations between overall dietary patterns and incident hypertension among adults in Thailand. Design Prospective large Thai Cohort Study (TCS) conducted nationwide from 2005 to 2013. Dietary patterns were identified using factor analysis based on usual intake of fourteen food groups. Multivariable logistic regression assessed associations between dietary patterns and hypertension prevalence and incidence. Setting Emerging hypertension and changing diets in Thailand. Subjects TCS participants who were normotensive at baseline in 2005. Results Among 36293 participants without hypertension at baseline, 1831 reported incident hypertension (5·1 % incidence) at follow-up. Two dietary patterns were identified: ‘Modern’ and ‘Prudent’. The Modern dietary pattern (high intakes of roasted/smoked foods, instant foods, canned foods, fermented fruits/vegetables, fermented foods, soft drinks, deep-fried foods) was associated with increased incident hypertension (comparing extreme quartiles, OR for incident hypertension=1·51; 95 % CI 1·31, 1·75 in 2013). The Prudent dietary pattern (high intakes of soyabean products, milk, fruits, vegetables) was not associated with incident hypertension in a fully adjusted model. The association between the Modern dietary pattern and hypertension was attenuated by BMI. Conclusions Modern dietary pattern was positively associated with hypertension among Thai adults. BMI had a great impact on the relationship between the Modern dietary pattern and incidence of hypertension. Reduction of Modern diets would be expected to prevent and control hypertension. Such a strategy would be worth testing.
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Consistency and Generalizability of Dietary Patterns in a Multiethnic Working Population. J Acad Nutr Diet 2018; 118:1249-1262.e3. [DOI: 10.1016/j.jand.2018.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 01/16/2018] [Indexed: 12/19/2022]
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Li KT, Naik S, Alexander M, Mathad JS. Screening and diagnosis of gestational diabetes in India: a systematic review and meta-analysis. Acta Diabetol 2018; 55:613-625. [PMID: 29582160 PMCID: PMC5999405 DOI: 10.1007/s00592-018-1131-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/14/2018] [Indexed: 02/06/2023]
Abstract
AIMS Although diabetes is rapidly increasing in India, there is no national consensus on best practices for screening, diagnosis, and management of gestational diabetes mellitus (GDM). The goal of this study was to systematically review the literature for studies reporting the prevalence and screening and diagnostic methods for gestational diabetes in India. METHODS We searched MEDLINE, Embase, and POPLINE for studies on screening for GDM in India. We included English-language full reports and conference abstracts of cross-sectional studies, prospective, and retrospective cohorts that reported the screening method and prevalence of GDM. We performed descriptive analysis on all studies and meta-analysis, meta-regression, and subgroup meta-analysis on studies with medium or low risk of bias. RESULTS We included 64 studies reporting 90 prevalence estimates. Prevalence estimates ranged from 0 to 41.9%. Subset meta-analyses showed that the IADPSG diagnostic criteria found significantly more GDM cases (prevalence = 19.19% [15.5, 23.6], p < 0.05) than the WHO 1999 criteria (10.13% [8.17, 12.50]) and DIPSI criteria (7.37% [5.2, 10.16]). Studies that compared the IADPSG and WHO 1999 criteria showed poor positive agreement (33-79%). Studies specifying time of GDM diagnosis showed that patients (11-60%) develop GDM as early as the first trimester, but many GDM cases (16-40%) are missed if screened only at first visit. CONCLUSIONS In India, prevalence estimates of GDM vary substantially by diagnostic criteria. When evaluating screening and diagnostic criteria for GDM, providers should consider their patients' needs and correlate screening criteria with pregnancy outcomes.
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Affiliation(s)
- Katherine T Li
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA.
| | - Shilpa Naik
- Department of OB-GYN, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Mallika Alexander
- Johns Hopkins University Clinical Trials Unit, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Jyoti S Mathad
- Departments of Medicine and OB-GYN, Weill Cornell Medicine, New York, NY, USA
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Alter JS, Sharma C. Nature cure treatment in the context of India's epidemiological transition. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2018; 14:245-54. [PMID: 27417171 DOI: 10.1016/s2095-4964(16)60265-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Scholars have argued that theoretical insights of critical medical anthropology should be applied to the analysis of complementary and alternative medicine in order to develop more critically engaged integrative medicine. In this essay we focus on nature cure in the context of India's contemporary epidemiological transition as an example of why engaged integrative medicine is important for public health, and how the institutionalization of nature cure treatment in India provides a critical framework for the development of programs focused on holistic treatment and prevention. After providing an overview of the epidemiological transition in contemporary India, we develop this argument through an examination of illustrative cases in a clinic that operates within the structure of India's Central Council for Research on Yoga and Naturopathy. Based on a review of recent history and contemporary practice we describe how a system of medicine that makes use exclusively of air, earth, sunlight, water and food has been institutionalized and professionalized in India. Whereas biomedical treatment for chronic non-communicable diseases is focused on the problem of curing individual diseases, nature cure establishes a regimen of personalized public healthcare for the integrated management of symptoms. We argue that nature cure is based on an ecological understanding of health, thus providing treatment that reflects a broad appreciation for the risk factors that characterize India's current crises of public health.
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Debnath S. Preliminary studies on the inhibition potential of Indian domestic curd against coliforms, an emerging periodontal pathogen. J Indian Soc Periodontol 2018; 21:357-365. [PMID: 29491580 PMCID: PMC5827501 DOI: 10.4103/jisp.jisp_223_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Coliforms colonize in dental plaques via oral route and may lead to systemic complications. Escherichia coli and its lipopolysaccharide-induced periodontitis is an emerging threat. Clinical management necessitates antibiotic regimens with risk of resistance and upsetting the gut. There is urgent need for better, sustainable, and economical alternative. Aim: To investigate the inhibition of coliforms, a potential periodontopathogen directly by Indian domestic curd (IDC) “in situ". Materials and Methods: Coliforms from natural habitat (Municipal sewage in Agartala, Tripura), a source of infection through food and water, were used as target organism. Domestically prepared curd without any fortification is used to explore its true inhibition potential. Assays of agar well diffusion performed with IDC (ultraviolet sterilized and pH adjusted 6.5) against isolated pure cultures of coliforms. The study protocol nullified effect of organic acids, volatile compounds, bacteriophages, and peroxides in IDC. Peptide nature of inhibitory ingredient was studied by Sodium Dodecyle Sulphate Polyacrylamide Gel Electrophoresis (SDS-PAGE), urea treatment. Computational phylogenetics revealed structural features of inhibitory ingredient. Statistical comparisons were done by analysis of variance. Second-order polynomial regression was done to evaluate the effect of IDC dilution on coliform inhibition. Mann–Whitney U-test performed to analyze different sample treatments. Results: Agar well diffusion (sealed bottom wells) shows inhibition of catalase-negative coliforms (confirmed by Gram staining and triple sugar iron agar assay) in pure culture (MacConkey agar). Activity diminished in urea, potentiated in ethylene diamine tetra acetic acid, remains unchanged by heat treatment (121°C, 15 min). SDS-PAGE revealed three distinct peptides (>10–15KDa). Hence, thermostable inhibitory peptides attached to target cell lead to observed activity (titer up to 1204.82 AU/ml with minimum 8 mm inhibition). Conclusions: IDC adequately inhibits sewage coliforms and may prevent dental plaques coliform colonization and its associated risks.
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Affiliation(s)
- Surajit Debnath
- Head, Department of Medical Laboratory Technology, Women's Polytechnic, Agartala, Tripura, India
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Shridhar K, Satija A, Dhillon PK, Agrawal S, Gupta R, Bowen L, Kinra S, Bharathi AV, Prabhakaran D, Srinath Reddy K, Ebrahim S. Association between empirically derived dietary patterns with blood lipids, fasting blood glucose and blood pressure in adults - the India migration study. Nutr J 2018; 17:15. [PMID: 29422041 PMCID: PMC5806276 DOI: 10.1186/s12937-018-0327-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 01/19/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Dietary patterns (DPs) in India are heterogenous. To date, data on association of indigenous DPs in India with risk factors of nutrition-related noncommunicable diseases (cardiovascular disease and diabetes), leading causes of premature death and disability, are limited. We aimed to evaluate the associations of empirically-derived DPs with blood lipids, fasting glucose and blood pressure levels in an adult Indian population recruited across four geographical regions of India. METHODS We used cross-sectional data from the Indian Migration Study (2005-2007). Study participants included urban migrants, their rural siblings and urban residents and their urban siblings from Lucknow, Nagpur, Hyderabad and Bangalore (n = 7067, mean age 40.8 yrs). Information on diet (validated interviewer-administered, 184-item semi-quantitative food frequency questionnaire), tobacco consumption, alcohol intake, physical activity, medical history, as well as anthropometric measurements were collected. Fasting-blood samples were collected for estimation of blood lipids and glucose. Principal component analysis (PCA) was used to identify major DPs based on eigenvalue> 1 and component interpretability. Robust standard error multivariable linear regression models were used to investigate the association of DPs (tertiles) with total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), triglycerides, fasting-blood glucose (FBG), systolic and diastolic blood pressure (SBP and DBP) levels. RESULTS Three major DPs were identified: 'cereal-savoury' (cooked grains, rice/rice-based dishes, snacks, condiments, soups, nuts), 'fruit-vegetable-sweets-snacks' (Western cereals, vegetables, fruit, fruit juices, cooked milk products, snacks, sugars, sweets) and 'animal food' (red meat, poultry, fish/seafood, eggs) patterns. High intake of the 'animal food' pattern was positively associated with levels of TC (β = 0.10 mmol/L; 95% CI: 0.02, 0.17 mmol/L; p-trend = 0.013); LDL-C (β = 0.07 mmol/L; 95% CI: 0.004, 0.14 mmol/L; p-trend = 0.041); HDL-C (β = 0.02 mmol/L; 95% CI: 0.004, 0.04 mmol/L; p-trend = 0.016), FBG: (β = 0.09 mmol/L; 95% CI: 0.01, 0.16 mmol/L; p-trend = 0.021) SBP (β = 1.2 mm/Hg; 95% CI: 0.1, 2.3 mm/Hg; p-trend = 0.032); DBP: (β = 0.9 mm/Hg; 95% CI: 0.2, 1.5 mm/Hg; p-trend = 0.013). The 'cereal-savoury' and 'fruit-vegetable-sweets-snacks' patterns showed no association with any parameter except for a positive association with diastolic blood pressure for high intake of 'fruits-vegetables-sweets-snacks' pattern. CONCLUSION Our results indicate positive associations of the 'animal food' pattern with cardio-metabolic risk factors in India. Further longitudinal assessments of dietary patterns in India are required to validate the findings.
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Affiliation(s)
- Krithiga Shridhar
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Ambika Satija
- Harvard T. H. Chan School of Public Health, Boston, USA
| | - Preet K Dhillon
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India.
| | - Sutapa Agrawal
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Ruby Gupta
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Liza Bowen
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sanjay Kinra
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - D Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India.,London School of Hygiene and Tropical Medicine, London, UK.,Centre for Chronic Disease Control, Gurgaon, Haryana, India
| | | | - Shah Ebrahim
- London School of Hygiene and Tropical Medicine, London, UK
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Borges CA, Rinaldi AE, Conde WL, Mainardi GM, Behar D, Slater B. Dietary patterns: a literature review of the methodological characteristics of the main step of the multivariate analyzes. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 18:837-57. [PMID: 26982299 DOI: 10.1590/1980-5497201500040013] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/14/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To describe the solutions adopted in the multiple steps of the use of multivariate techniques to obtain a dietary pattern (DP) concerning: the objective of the studies, the selection of the method for measuring food intake, the criteria for grouping the foods, the number of food groups used, the number of DP obtained, and the nomenclature criteria. METHODS The articles were selected from MEDLINE and Lilacs scientific databases using the following keywords: "dietary patterns" versus "factor analysis"; "principal components analysis"; "cluster analysis" and "reduced regression rank." The initial search resulted in 1,752 articles. After inclusion and exclusion criteria, 189 publications were selected. RESULTS The following aspects were relevant among the studies: the prevalence of the principal component analysis (PCA); the prevalence of the use of 4 to 5 DPs in the studies of association with health outcomes; the use of 30 or more food groups from the food frequency questionnaire (FFQ); the prevalence of studies that associated DPs with health outcomes and socioeconomic factors; and the heterogeneity of criteria used throughout the analytical stages of the multivariate techniques. CONCLUSION The heterogeneity between the publications concentrates on the criteria for food grouping, the nomenclature, and the number of dietary patterns calculated, which varied depending on the number of food groups present in these analyses. To understand, apply, and explore in full, the multivariate techniques has become necessary in order to improve the reliability of the results and, consequently, to improve the relationships with health outcomes and socioeconomic factors.
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Affiliation(s)
| | - Ana Elisa Rinaldi
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Wolney Lisboa Conde
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Dora Behar
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Betzabeth Slater
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
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Dietary patterns and non-communicable disease risk in Indian adults: secondary analysis of Indian Migration Study data. Public Health Nutr 2017; 20:1963-1972. [PMID: 28367791 PMCID: PMC5560196 DOI: 10.1017/s1368980017000416] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective Undernutrition and non-communicable disease (NCD) are important public health issues in
India, yet their relationship with dietary patterns is poorly understood. The current
study identified distinct dietary patterns and their association with micronutrient
undernutrition (Ca, Fe, Zn) and NCD risk factors (underweight, obesity, waist:hip ratio,
hypertension, total:HDL cholesterol, diabetes). Design Data were from the cross-sectional Indian Migration Study, including semi-quantitative
FFQ. Distinct dietary patterns were identified using finite mixture modelling;
associations with NCD risk factors were assessed using mixed-effects logistic regression
models. Setting India. Subjects Migrant factory workers, their rural-dwelling siblings and urban non-migrants.
Participants (7067 adults) resided mainly in Karnataka, Andhra Pradesh, Maharashtra and
Uttar Pradesh. Results Five distinct, regionally distributed, dietary patterns were identified, with
rice-based patterns in the south and wheat-based patterns in the north-west. A
rice-based pattern characterised by low energy consumption and dietary diversity (‘Rice
& low diversity’) was consumed predominantly by adults with little formal
education in rural settings, while a rice-based pattern with high fruit consumption
(‘Rice & fruit’) was consumed by more educated adults in urban settings. Dietary
patterns met WHO macronutrient recommendations, but some had low micronutrient contents.
Dietary pattern membership was associated with several NCD risk factors. Conclusions Five distinct dietary patterns were identified, supporting sub-national assessments of
the implications of dietary patterns for various health, food system or environment
outcomes.
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Green R, Milner J, Joy EJM, Agrawal S, Dangour AD. Dietary patterns in India: a systematic review. Br J Nutr 2016; 116:142-8. [PMID: 27146890 PMCID: PMC4890343 DOI: 10.1017/s0007114516001598] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/09/2016] [Accepted: 03/19/2016] [Indexed: 11/15/2022]
Abstract
Dietary patterns analysis is an emerging area of research. Identifying distinct patterns within a large dietary survey can give a more accurate representation of what people are eating. Furthermore, it allows researchers to analyse relationships between non-communicable diseases (NCD) and complete diets rather than individual food items or nutrients. However, few such studies have been conducted in developing countries including India, where the population has a high burden of diabetes and CVD. We undertook a systematic review of published and grey literature exploring dietary patterns and relationships with diet-related NCD in India. We identified eight studies, including eleven separate models of dietary patterns. Most dietary patterns were vegetarian with a predominance of fruit, vegetables and pulses, as well as cereals; dietary patterns based on high-fat, high-sugar foods and more meat were also identified. There was large variability between regions in dietary patterns, and there was some evidence of change in diets over time, although no evidence of different diets by sex or age was found. Consumers of high-fat dietary patterns were more likely to have greater BMI, and a dietary pattern high in sweets and snacks was associated with greater risk of diabetes compared with a traditional diet high in rice and pulses, but other relationships with NCD risk factors were less clear. This review shows that dietary pattern analyses can be highly valuable in assessing variability in national diets and diet-disease relationships. However, to date, most studies in India are limited by data and methodological shortcomings.
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Affiliation(s)
- Rosemary Green
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London WC1H 0PD, UK
| | - James Milner
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Edward J. M. Joy
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London WC1H 0PD, UK
| | - Sutapa Agrawal
- Public Health Foundation of India, Delhi NCR, Plot No. 47, Sector 44, Institutional Area Gurgaon 122002, India
| | - Alan D. Dangour
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London WC1H 0PD, UK
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Singh A, Gupta V, Ghosh A, Lock K, Ghosh-Jerath S. Quantitative estimates of dietary intake with special emphasis on snacking pattern and nutritional status of free living adults in urban slums of Delhi: impact of nutrition transition. BMC Nutr 2015; 1:22. [PMID: 26918196 PMCID: PMC4763040 DOI: 10.1186/s40795-015-0018-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The nutritional landscape of India is experiencing the fallout of urbanization and globalization. The changes are manifest in dietary patterns as well as health outcomes. The study aimed at assessing household dietary intake pattern with special emphasis on snacking pattern, anthropometric and lipid profiles in low socio-economic status households in an urban slum of Delhi. METHODS Community based cross-sectional study in 260 households of a purposively selected urban slum in North-East district of Delhi, India. Family dietary surveys including consumption pattern of commercial food products rich in Partially Hydrogenated Vegetable Oils (PHVOs), 24 h dietary recall and assessment of dietary diversity using Household Diet Diversity Scores (HDDS) were done. Assessment of nutritional status using anthropometric and lipid profile on a subsample (n =130) were also conducted. RESULTS Median energy and fat intake were adequate. Micronutrient intake was found to be inadequate for vitamin A, riboflavin, calcium and folate. PHVO usage was low (<20 % households). Milk (39 %), green leafy vegetables (25 %) and fruits (25 %) intake were below recommendations. Mean HDDS was 7.87. Prevalence of overweight/obesity was high (66.7 %). Lipid profile showed mean HDL-C levels lower than recommendations for females. CONCLUSION Community based awareness programs for prevention of non-communicable diseases should incorporate healthy diet and lifestyle practices with emphasis on quantity and quality of nutrient intake. This must be considered as an integral part of chronic disease prevention strategy for underprivileged communities in urban India.
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Affiliation(s)
- Archna Singh
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Plot No. 47, Sector-44, Gurgaon 122002 Haryana, India ; All India Institute of Medical Sciences, Delhi, India
| | - Vidhu Gupta
- Public Health Foundation of India, Haryana, India
| | - Arpita Ghosh
- Public Health Foundation of India, Haryana, India
| | - Karen Lock
- London School of Hygiene and Tropical Medicine and Leverhulm Centre for Integrative Research on Agriculture and Health, London, UK
| | - Suparna Ghosh-Jerath
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Plot No. 47, Sector-44, Gurgaon 122002 Haryana, India
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Naicker A, Venter CS, MacIntyre UE, Ellis S. Dietary quality and patterns and non-communicable disease risk of an Indian community in KwaZulu-Natal, South Africa. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2015; 33:12. [PMID: 26825059 PMCID: PMC5025990 DOI: 10.1186/s41043-015-0013-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 06/26/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Limited data exist on the South African Indian diet despite their high prevalence of non-communicable diseases. This study attempted to determine the dietary quality and patterns of an Indian population in KwaZulu-Natal with reference to the high prevalence of non-communicable disease METHODS Two-hundred-and-fifty apparently healthy Indians, aged 35-55 years participated in a cross-sectional study where diet was assessed using a validated quantitative food frequency questionnaire. Mean intakes were compared to the World Health Organization goals. Dietary quality was determined by index construction and dietary patterns by factor analysis. RESULTS The mean daily percentage of energy (%E) from n-3 fatty acids (0.24 %E), dietary fibre (18.4 g/day) and fruit and vegetable intakes (229.4 g/day) were below the World Health Organization goals. Total fat (36.1 %E), polyunsaturated fatty acids (11.8 %E), n-6 fatty acids (11 %E) and free sugars (12.5 %E) exceeded the goals. The means for the deficient index reflected a moderate diet quality whereas, the excess index reflected good diet quality. The Pearson partial correlation coefficients between the deficient index and risk markers were weak whilst, the excess index was inversely correlated with waist circumference for the whole sample. Two factors were identified, based on the percentage of fat that contributed to each food group: factor 1 (meat and fish versus legume and cereal pattern), which accounted for added fat through food preparation; and Factor 2 (nuts and seeds versus sugars and visible fat pattern), which accounted for obvious fat. The medians for waist circumference, blood glucose, cholesterol and triglyceride levels showed significant decreasing trends for factor 1 (p < 0.05). The medians for blood glucose and cholesterol showed significant decreasing trends for factor 2 (p < 0.01). CONCLUSION A shortfall of fruit and vegetable, fibre and n-3 fatty acid intake in the diet is highlighted. When assessing the diet quality and patterns, guidance on the prudent use of added fats may lead to a healthier lifestyle reducing the prevalence of non-communicable diseases.
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Affiliation(s)
- A Naicker
- Department of Food and Nutrition Consumer Sciences, Durban University of Technology, Kwa-Zulu Natal, South Africa.
| | - C S Venter
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, North West Province, South Africa
| | - U E MacIntyre
- Department of Human Nutrition, University of Pretoria, Gauteng, South Africa
| | - S Ellis
- Statistical Consultation Services, North-West University, North West Province, South Africa
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Gupta R, Sharma KK, Gupta BK, Gupta A, Saboo B, Maheshwari A, Mahanta T, Deedwania PC. Geographic epidemiology of cardiometabolic risk factors in middle class urban residents in India: cross-sectional study. J Glob Health 2015; 5:010411. [PMID: 25969733 PMCID: PMC4416330 DOI: 10.7189/jogh.05.010411] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective To determine epidemiology of cardiovascular risk factors according to geographic distribution and macrolevel social development index among urban middle class subjects in India. Methods We performed cross-sectional surveys in 11 cities in India during years 2005–2009. 6198 subjects aged 20–75 years (men 3426, women 2772, response 62%) were evaluated for cardiovascular risk factors. Cities were grouped according to geographic distribution into northern (3 cities, n = 1321), western (2 cities, n = 1814), southern (3 cities, n = 1237) and eastern (3 cities, n = 1826). They were also grouped according to human social development index into low (3 cities, n = 1794), middle (5 cities, n = 2634) and high (3 cities, n = 1825). Standard definitions were used to determine risk factors. Differences in risk factors were evaluated using χ2 test. Trends were examined by least squares regression. Findings Age–adjusted prevalence (95% confidence intervals) of various risk factors was: low physical activity 42.1% (40.9–43.3), high dietary fat 49.9% (47.8–52.0), low fruit/vegetables 26.9% (25.8–28.0), smoking 10.1% (9.1–11.1), smokeless tobacco use 9.8% (9.1–10.5), overweight 42.9% (41.7–44.1), obesity 11.6% (10.8–12.4), high waist circumference 45.5% (44.3–46.7), high waist–hip ratio 75.7% (74.7–76.8), hypertension 31.6% (30.4–32.8), hypercholesterolemia 25.0% (23.9–26.9), low HDL cholesterol 42.5% (41.3–43.7), hypertriglyceridemia 36.9% (35.7–38.1), diabetes 15.7% (14.8–16.6), and metabolic syndrome 35.7% (34.5–36.9). Compared with national average, prevalence of most risk factors was not significantly different in various geographic regions, however, cities in eastern region had significantly lower prevalence of overweight, hypertension, hypercholesterolemia, diabetes and metabolic syndrome compared with other regions (P < 0.05 for various comparisons). It was also observed that cities with low human social development index had lowest prevalence of these risk factors in both sexes (P < 0.05). Conclusions Urban middle–class men and women in eastern region of India have significantly lower cardiometabolic risk factors compared to northern, western and southern regions. Low human social development index cities have lower risk factor prevalence.
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Affiliation(s)
| | | | - Bal Kishan Gupta
- SP Medical College and Associated Group of Hospitals, Bikaner, India
| | | | - Banshi Saboo
- Diabetes Care and Hormone Clinic, Ahmedabad, India
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Abstract
OBJECTIVE Obesity is a growing problem in India, the dietary determinants of which have been studied using an 'individual food/nutrient' approach. Examining dietary patterns may provide more coherent findings, but few studies in developing countries have adopted this approach. The present study aimed to identify dietary patterns in an Indian population and assess their relationship with anthropometric risk factors. DESIGN FFQ data from the cross-sectional sib-pair Indian Migration Study (IMS; n 7067) were used to identify dietary patterns using principal component analysis. Mixed-effects logistic regression was used to examine associations with obesity and central obesity. SETTING The IMS was conducted at four factory locations across India: Lucknow, Nagpur, Hyderabad and Bangalore. SUBJECTS The participants were rural-to-urban migrant and urban non-migrant factory workers, their rural and urban resident siblings, and their co-resident spouses. RESULTS Three dietary patterns were identified: 'cereals-savoury foods' (cooked grains, rice/rice-based dishes, snacks, condiments, soups, nuts), 'fruit-veg-sweets-snacks' (Western cereals, vegetables, fruit, fruit juices, cooked milk products, snacks, sugars, sweets) and 'animal-food' (red meat, poultry, fish/seafood, eggs). In adjusted analysis, positive graded associations were found between the 'animal-food' pattern and both anthropometric risk factors. Moderate intake of the 'cereals-savoury foods' pattern was associated with reduced odds of obesity and central obesity. CONCLUSIONS Distinct dietary patterns were identified in a large Indian sample, which were different from those identified in previous literature. A clear 'plant food-based/animal food-based pattern' dichotomy emerged, with the latter being associated with higher odds of anthropometric risk factors. Longitudinal studies are needed to further clarify this relationship in India.
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Wang H, Qu M, Yang P, Yang B, Deng F. Dietary patterns and cardio-cerebrovascular disease in a Chinese population. Nutr Res Pract 2015; 9:313-8. [PMID: 26060544 PMCID: PMC4460064 DOI: 10.4162/nrp.2015.9.3.313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/OBJECTIVES Dietary pattern and its association with cardio-cerebrovascular disease have not been studied in Baoji city by now. This study was aimed to identify the dietary patterns among Chinese adults in Baoji, and explore the association between these dietary patterns and cardio-cerebrovascular disease. SUBJECTS/METHODS A total of 4,968 participants were included in this study at 12 counties. With multistage stratified random sampling and semi quantitative food frequency questionnaire, the prevalence of cardio-cerebrovascular disease and dietary intake were investigated in 2013. We used factor analysis to establish dietary patterns. RESULTS A total of 4,968 participants over 15 years old were included in this study. Five dietary patterns were identified in Baoji: protein, balanced, beans, prudent, and traditional patterns. The protein dietary pattern mainly included animal and plant proteins and was negatively associated with hypertension as well as stroke. The balanced pattern included carbohydrates, protein, and fat and was negatively associated with hypertension as well as stroke. The beans pattern was mainly beans and beans products and was negatively associated with hypertension. The prudent pattern only included staple foods and pickled vegetables and was positively associated with hypertension as well as coronary heart disease. The traditional pattern was representative of local Baoji traditional recipes and was positively associated with hypertension. CONCLUSIONS The protein, balanced, and beans dietary patterns showed many protective effects on cardio-cerebrovascular disease. Based on these results, Baoji city residents should be encouraged to choose protein, balanced, and beans dietary patterns and abandon prudent and traditional patterns to prevent incidence of hypertension, coronary heart disease, and stroke.
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Affiliation(s)
- Honglin Wang
- Baoji Center for Disease Control and Prevention, XiBao Road No. 68, Baoji, Shaanxi, China
| | - Meng Qu
- Baoji Center for Disease Control and Prevention, XiBao Road No. 68, Baoji, Shaanxi, China
| | - Peirong Yang
- Baoji Center for Disease Control and Prevention, XiBao Road No. 68, Baoji, Shaanxi, China
| | - Biao Yang
- Baoji Center for Disease Control and Prevention, XiBao Road No. 68, Baoji, Shaanxi, China
| | - Feng Deng
- Baoji Center for Disease Control and Prevention, XiBao Road No. 68, Baoji, Shaanxi, China
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McEvoy CT, Cardwell CR, Woodside JV, Young IS, Hunter SJ, McKinley MC. A posteriori dietary patterns are related to risk of type 2 diabetes: findings from a systematic review and meta-analysis. J Acad Nutr Diet 2014; 114:1759-75.e4. [PMID: 25001435 DOI: 10.1016/j.jand.2014.05.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 05/01/2014] [Indexed: 11/18/2022]
Abstract
Our review and meta-analysis examined the association between a posteriori-derived dietary patterns (DPs) and risk of type 2 diabetes mellitus. MEDLINE and EMBASE were searched for articles published up to July 2012 and data were extracted by two independent reviewers. Overall, 19 cross-sectional, 12 prospective cohort, and two nested case-control studies were eligible for inclusion. Results from cross-sectional studies reported an inconsistent association between DPs and measures of insulin resistance and/or glucose abnormalities, or prevalence of type 2 diabetes. A meta-analysis was carried out on nine prospective cohort studies that had examined DPs derived by principle component/factor analysis and incidence of type 2 diabetes risk (totaling 309,430 participants and 16,644 incident cases). Multivariate-adjusted odds ratios were combined using a random-effects meta-analysis. Two broad DPs (Healthy/Prudent and Unhealthy/Western) were identified based on food factor loadings published in original studies. Pooled results indicated a 15% lower type 2 diabetes risk for those in the highest category of Healthy/Prudent pattern compared with those in the lowest category (95% CI 0.80 to 0.91; P<0.0001). Compared with the lowest category of Unhealthy/Western DP, those in the highest category had a 41% increased risk of type 2 diabetes (95% CI 1.32 to 1.52; P<0.0001). These results provide evidence that DPs are consistently associated with risk of type 2 diabetes even when other lifestyle factors are controlled for. Thus, greater adherence to a DP characterized by high intakes of fruit, vegetables, and complex carbohydrate and low intakes of refined carbohydrate, processed meat, and fried food may be one strategy that could have a positive influence on the global public health burden of type 2 diabetes.
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The association between a vegetarian diet and cardiovascular disease (CVD) risk factors in India: the Indian Migration Study. PLoS One 2014; 9:e110586. [PMID: 25343719 PMCID: PMC4208768 DOI: 10.1371/journal.pone.0110586] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 09/23/2014] [Indexed: 11/21/2022] Open
Abstract
Background Studies in the West have shown lower cardiovascular disease (CVD) risk among people taking a vegetarian diet, but these findings may be confounded and only a minority selects these diets. We evaluated the association between vegetarian diets (chosen by 35%) and CVD risk factors across four regions of India. Methods Study participants included urban migrants, their rural siblings and urban residents, of the Indian Migration Study from Lucknow, Nagpur, Hyderabad and Bangalore (n = 6555, mean age-40.9 yrs). Information on diet (validated interviewer-administered semi-quantitative food frequency questionnaire), tobacco, alcohol, physical history, medical history, as well as blood pressure, fasting blood and anthropometric measurements were collected. Vegetarians ate no eggs, fish, poultry or meat. Using robust standard error multivariate linear regression models, we investigated the association of vegetarian diets with blood cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides, fasting blood glucose (FBG), systolic (SBP) and diastolic blood pressure (DBP). Results Vegetarians (32.8% of the study population) did not differ from non-vegetarians with respect to age, use of smokeless tobacco, body mass index, and prevalence of diabetes or hypertension. Vegetarians had a higher standard of living and were less likely to smoke, drink alcohol (p<0.0001) and were less physically active (p = 0.04). In multivariate analysis, vegetarians had lower levels of total cholesterol (β = −0.1 mmol/L (95% CI: −0.03 to −0.2), p = 0.006), triglycerides (β = −0.05 mmol/L (95% CI: −0.007 to −0.01), p = 0.02), LDL (β = −0.06 mmol/L (95% CI: −0.005 to −0.1), p = 0.03) and lower DBP (β = −0.7 mmHg (95% CI: −1.2 to −0.07), p = 0.02). Vegetarians also had decreases in SBP (β = −0.9 mmHg (95% CI: −1.9 to 0.08), p = 0.07) and FBG level (β = −0.07 mmol/L (95% CI: −0.2 to 0.01), p = 0.09) when compared to non-vegetarians. Conclusion We found beneficial association of vegetarian diet with cardiovascular risk factors compared to non-vegetarian diet.
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Association between Dietary Patterns and Chronic Diseases among Chinese Adults in Baoji. Int J Chronic Dis 2014; 2014:548269. [PMID: 26464858 PMCID: PMC4590925 DOI: 10.1155/2014/548269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/12/2014] [Accepted: 08/31/2014] [Indexed: 02/07/2023] Open
Abstract
Objective. This study was aimed to identify the dietary patterns among Chinese adults in Baoji and explore the association between these dietary patterns and chronic diseases. Methods. With multistage stratified random sampling and semiquantitative food frequency questionnaire, the prevalence of chronic disease and dietary intake was investigated in 2013. We used factor analysis to establish dietary patterns. Results. A total of 5020 participants over 15 years old were included in this study. Five dietary patterns were identified in Baoji named as protein, balanced, beans, prudent, and traditional patterns. There are many protective effects with protein, balanced, and beans dietary patterns on chronic diseases. Conclusions. We should encourage Baoji city residents to choose protein, balanced, and beans dietary patterns and abandon prudent and traditional patterns.
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Cross-regional analysis of multiple factors associated with childhood obesity in India: a national or local challenge? Indian J Pediatr 2014; 81 Suppl 1:5-16. [PMID: 25139390 DOI: 10.1007/s12098-014-1550-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/22/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate obesogenic co-causing factors, promoting rise of weight in children, associated to local differences in India. METHODS Overall 1,680 children, aged 3-11 and balanced by gender, were recruited in school contexts distributed in seven major Indian cities. All children were weighted and measured in order to calculate their BMI. A validated cultural specific questionnaire was administered to children's parents for assessing socio-demographic data, eating habits, physical activity, etc. Furthermore children's brand awareness scores were computed in order to analyze their affiliation towards food-based advertisement. Descriptive statistics of frequencies, duration and intensity of the various factors were performed. Chi-square tests or Wilcoxon signed rank test were used for evaluating significance of differences in factors distribution across Indian cities. RESULTS Four factors, promoting rise of children's weight, were individuated as associated to urban differences, namely meal times consumed in the family, parents' BMI, brand awareness and physical activity. These aspects exercised a significant impact on children's body size in Kolkata and Chennai. Hyderabad and Mumbai, instead, were the cities where religion played some role in influencing children's weight gain. CONCLUSIONS Such findings underline the need to frame obesity as a situated phenomenon rather than a national problem. Health policies, implemented in treating and preventing obesity, should be therefore specifically focused on locally situated peculiarities.
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Hochdorn A, Baldi I, Paramesh EC, Kumar M, Gulati A, Gregori D. Is my kid out of size? Indian mothers' desirability bias in evaluation of their children's weight. Indian J Pediatr 2014; 81 Suppl 1:39-46. [PMID: 24916133 DOI: 10.1007/s12098-014-1464-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 04/17/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To quantify mothers' social desirability bias with respect to their children's weight in a cross-regional Indian setting. METHODS The OBEY-AD was a cross-sectional study which has been realized in 7 Indian cities (Bengaluru, Mumbai, Chennai, Hyderabad, Kolkata, New Delhi and Surat), enroling 1,680 children aged 3-11 y of which 50% were females. Children's BMI scores were computed, standardized according to WHO growth charts and categorized as Normal, Overweight, Obese and Underweight. Mothers were asked to judge the weight status of their children through an iconographic test, indicating the shape, which better mirrors the size of their kids. Socio-demographic data, especially employment, income and education, was accessed by administrating a cross-sectional questionnaire to the mothers, involved for the study. RESULTS Overall, 369 children resulted as obese or overweight (23.5%). Out of them, 75% (278) were not recognized as such by their mothers. Such figures range from up to 76% in Chennai and Surat down to 72% in Hyderabad, Kolkata, New Delhi and Mumbai. Overall agreement between perceived and desired weight status of children was very poor (p < 0.001). Surprisingly, overall 10% of overweight/obese children were considered as even too lean by their mothers. Misperception of children's weight status seemed to be significantly related to urban differences and socio-economic status. CONCLUSIONS This study quantifies the extent of the so-called social desirability bias, namely mother's unconscious attitude to adapt empirical evidence to more culturally legitimized ideal-types of what their children's weight status is expected to be. Its association with westernized representations of leanness as evaluation criteria for beauty has important policy implications.
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Affiliation(s)
- Alexander Hochdorn
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Loredan, 18, 35121, Padova, Italy
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Vecchio MG, Paramesh EC, Paramesh H, Loganes C, Ballali S, Gafare CE, Verduci E, Gulati A. Types of food and nutrient intake in India: a literature review. Indian J Pediatr 2014; 81 Suppl 1:17-22. [PMID: 24928105 DOI: 10.1007/s12098-014-1465-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/17/2014] [Indexed: 12/31/2022]
Abstract
Nowadays India is undergoing an impressive economic growth accompanied by a very slow decline, almost stagnation, in malnutrition levels. In developing countries, studies on dietary patterns and their relationship with nutritional status are scarce. Over the years some nutritional studies have been performed to explore different types of food consumed in various Indian regions, among different social samples. The aim of the present paper is to review and describe trends in food and nutrition intake patterns in the different states of India. The review was carried out in PubMed, using the advanced research criteria: [food* OR ("meal pattern*") OR ("eating pattern*")] AND ("nutrient intake") AND India*. PubMed research gave back 84 results and out of these, 7 papers due to their focus on food intake and consumption levels in India have been included in this study. Food intake patterns showed that most of the Indians are vegetarians and that food items rich in micronutrients (pulses, other vegetables, fruits, nuts, oilseeds and animal foods) are generally consumed less frequently. Poor and monotonous cereals-based diet may promote inadequate nutrition intakes according to Recommended Daily Allowance (RDA) standards.
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Trichopoulou A, Martínez-González MA, Tong TYN, Forouhi NG, Khandelwal S, Prabhakaran D, Mozaffarian D, de Lorgeril M. Definitions and potential health benefits of the Mediterranean diet: views from experts around the world. BMC Med 2014; 12:112. [PMID: 25055810 PMCID: PMC4222885 DOI: 10.1186/1741-7015-12-112] [Citation(s) in RCA: 340] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 06/10/2014] [Indexed: 02/07/2023] Open
Abstract
The Mediterranean diet has been linked to a number of health benefits, including reduced mortality risk and lower incidence of cardiovascular disease. Definitions of the Mediterranean diet vary across some settings, and scores are increasingly being employed to define Mediterranean diet adherence in epidemiological studies. Some components of the Mediterranean diet overlap with other healthy dietary patterns, whereas other aspects are unique to the Mediterranean diet. In this forum article, we asked clinicians and researchers with an interest in the effect of diet on health to describe what constitutes a Mediterranean diet in different geographical settings, and how we can study the health benefits of this dietary pattern.
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Affiliation(s)
- Antonia Trichopoulou
- />Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Greece; Hellenic Health Foundation, Athens, Greece
| | - Miguel A Martínez-González
- />Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
- />CIBER-OBN, Instituto de Salud Carlos III, Madrid, Spain
| | - Tammy YN Tong
- />MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Nita G Forouhi
- />MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Shweta Khandelwal
- />Public Health Foundation of India (PHFI), New Delhi; Centre for Chronic Disease Control (CCDC), New Delhi, India
| | - Dorairaj Prabhakaran
- />Public Health Foundation of India (PHFI), New Delhi; Centre for Chronic Disease Control (CCDC), New Delhi, India
| | - Dariush Mozaffarian
- />Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
| | - Michel de Lorgeril
- />Laboratoire TIMC-IMAG CNRS UMR 5525, PRETA Cœur & Nutrition, and Faculté de Médecine, Université Joseph Fourier, Grenoble, France
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Development of a field-friendly automated dietary assessment tool and nutrient database for India. Br J Nutr 2014; 111:160-71. [PMID: 23796477 DOI: 10.1017/s0007114513001864] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Studies of diet and disease risk in India and among other Asian-Indian populations are hindered by the need for a comprehensive dietary assessment tool to capture data on the wide variety of food and nutrient intakes across different regions and ethnic groups. The nutritional component of the India Health Study, a multicentre pilot cohort study, included 3908 men and women, aged 35-69 years, residing in three regions of India (New Delhi in the north, Mumbai in the west and Trivandrum in the south). We developed a computer-based, interviewer-administered dietary assessment software known as the 'NINA-DISH (New Interactive Nutrition Assistant - Diet in India Study of Health)', which consisted of four sections: (1) a diet history questionnaire with defined questions on frequency and portion size; (2) an open-ended section for each mealtime; (3) a food-preparer questionnaire; (4) a 24 h dietary recall. Using the preferred meal-based approach, frequency of intake and portion size were recorded and linked to a nutrient database that we developed and modified from a set of existing international databases containing data on Indian foods and recipes. The NINA-DISH software was designed to be easily adaptable and was well accepted by the interviewers and participants in the field. A predominant three-meal eating pattern emerged; however, patterns in the number of foods reported and the primary contributors to macro- and micronutrient intakes differed by region and demographic factors. The newly developed NINA-DISH software provides a much-needed tool for measuring diet and nutrient profiles across the diverse populations of India with the potential for application in other South Asian populations living throughout the world.
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Shridhar K, Dhillon PK, Bowen L, Kinra S, Bharathi AV, Prabhakaran D, Reddy KS, Ebrahim S. Nutritional profile of Indian vegetarian diets--the Indian Migration Study (IMS). Nutr J 2014; 13:55. [PMID: 24899080 PMCID: PMC4055802 DOI: 10.1186/1475-2891-13-55] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 05/23/2014] [Indexed: 12/31/2022] Open
Abstract
Background The cardiovascular and other health benefits and potential harms of protein and micronutrient deficiency of vegetarian diets continue to be debated. Methods Study participants included urban migrants, their rural siblings and urban residents (n = 6555, mean age - 40.9 yrs) of the Indian Migration Study from Lucknow, Nagpur, Hyderabad and Bangalore. Information on diet (validated interviewer-administered semi-quantitative food frequency questionnaire), tobacco, alcohol, physical activity, medical histories, as well as blood pressure, fasting blood and anthropometric measurements were collected. Nutrient databases were used to calculate nutrient content of regional recipes. Vegetarians ate no eggs, fish, poultry and meat. Using multivariate linear regression with robust standard error model, we compared the macro- and micro-nutrient profile of vegetarian and non-vegetarian diets. Results Vegetarians, (32.8% of the population), consumed greater amounts of legumes, vegetables, roots and tubers, dairy and sugar, while non-vegetarians had a greater intake of cereals, fruits, spices, salt (p < 0.01), fats and oils. Vegetarians had a higher socioeconomic status, and were less likely to smoke, drink alcohol (p < 0.0001) and engage in less physical activity (p = 0.04). On multivariate analysis, vegetarians consumed more carbohydrates (β = 7.0 g/day (95% CI: 9.9 to 4.0), p < 0.0001), vitamin C (β = 8.7 mg/day (95% CI: 4.3 to13.0), p < 0.0001) and folate (β = 8.0 mcg/day (95% CI: 3.3 to 12.7), p = 0.001) and lower levels of fat (β = −1.6 g/day (95% CI: −0.62 to −2.7), p = 0.002), protein (β = −6.4 g/day (95% CI: −5.8 to −7.0), p < 0.0001), vitamin B12 (β = −1.4 mcg/day (95% CI: −1.2 to −1.5), p < 0.0001) and zinc (β = −0.6 mg/day (95% CI: −0.4 to −0.7), p < 0.0001). Conclusion Overall, Indian vegetarian diets were found to be adequate to sustain nutritional demands according to recommended dietary allowances with less fat. Lower vitamin B12 bio-availability remains a concern and requires exploration of acceptable dietary sources for vegetarians.
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Affiliation(s)
- Krithiga Shridhar
- South Asia Network of Chronic Disease, Public Health Foundation of India, Building 47, Sector 44 Gurgaon, New Delhi, Haryana 122002, India.
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Gadgil MD, Anderson CAM, Kandula NR, Kanaya AM. Dietary patterns in Asian Indians in the United States: an analysis of the metabolic syndrome and atherosclerosis in South Asians Living in America study. J Acad Nutr Diet 2014; 114:238-243. [PMID: 24295929 PMCID: PMC3947024 DOI: 10.1016/j.jand.2013.09.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 09/10/2013] [Indexed: 11/18/2022]
Abstract
Dietary patterns contribute to cardiovascular disease (CVD) risk. Asian Indians have earlier onset, more severe, and more prevalent CVD than many other racial/ethnic groups. We aimed to characterize dietary patterns in Asian Indians living in the United States and examine associations with cardiometabolic risk factors. One hundred fifty Asian Indians, aged 45 to 84 years, without known CVD, living in the San Francisco Bay, CA, area between August 2006 and October 2007 were enrolled into the Metabolic syndrome and Atherosclerosis in South Asians Living in America study. A food frequency questionnaire validated in Asian Indians, fasting blood samples, and computed tomography scans were obtained for all participants. Principal component analysis with varimax rotation was used to determine prevalent dietary patterns. Linear regression analyses were performed for associations between dietary patterns and metabolic factors, adjusting initially for age and sex, then additionally for BMI, income, education, metabolic equivalent of task-minutes of exercise, alcohol consumption, and smoking. Two distinct dietary patterns were identified that we termed "Western," and "Vegetarian." Compared with the Western diet, the Vegetarian diet was associated with lower homeostasis model of assessment-insulin resistance (-1.12 mmol/L × mU/L; P=0.05) and lower high-density lipoprotein cholesterol (-4.77 mg/dL; P=0.09). Given that the Western and Vegetarian dietary patterns were each associated with adverse metabolic changes, healthful diet choices may help Asian Indians improve risk factors for CVD.
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Ko BJ, Park KH, Mantzoros CS. Diet patterns, adipokines, and metabolism: where are we and what is next? Metabolism 2014; 63:168-77. [PMID: 24360751 DOI: 10.1016/j.metabol.2013.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 11/08/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Byung-Joon Ko
- Division of Endocrinology, Diabetes, and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA; Department of Family Medicine, College of Medicine, Korea University, Seoul 136-705, South Korea
| | - Kyung Hee Park
- Division of Endocrinology, Diabetes, and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA; Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do, South Korea.
| | - Christos S Mantzoros
- Division of Endocrinology, Diabetes, and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA 02130, USA
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Frankenfeld CL, Poudrier J, Waters N, Gillevet PM. Past residence outside of the United States is associated with diet quality in adults currently residing in the United States. Am J Hum Biol 2014; 26:64-72. [DOI: 10.1002/ajhb.22477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Cara L. Frankenfeld
- Department of Global and Community HealthGeorge Mason UniversityFairfax Virginia22030
| | - Jill Poudrier
- Department of Global and Community HealthGeorge Mason UniversityFairfax Virginia22030
| | - Nigel Waters
- Department of Geography and Geinformation ScienceGeorge Mason UniversityFairfax Virginia22030
| | - Patrick M. Gillevet
- Department of Environmental Science and PolicyGeorge Mason UniversityFairfax Virginia22030
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Bhojani U, Beerenahalli TS, Devadasan R, Munegowda CM, Devadasan N, Criel B, Kolsteren P. No longer diseases of the wealthy: prevalence and health-seeking for self-reported chronic conditions among urban poor in Southern India. BMC Health Serv Res 2013; 13:306. [PMID: 23938172 PMCID: PMC3751059 DOI: 10.1186/1472-6963-13-306] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 08/09/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The burden of chronic conditions is high in low- and middle-income countries and poses a significant challenge to already weak healthcare delivery systems in these countries. Studies investigating chronic conditions among the urban poor remain few and focused on specific chronic conditions rather than providing overall profile of chronic conditions in a given community, which is critical for planning and managing services within local health systems. We aimed to assess the prevalence and health- seeking behaviour for self-reported chronic conditions in a poor neighbourhood of a metropolitan city in India. METHODS We conducted a house-to-house survey covering 9299 households (44514 individuals) using a structured questionnaire. We relied on self-report by respondents to assess presence of any chronic conditions, including diabetes and hypertension. Multivariable logistic regression was used to analyse the prevalence and health-seeking behaviour for self-reported chronic conditions in general as well as for diabetes and hypertension in particular. The predictor variables included age, sex, income, religion, household poverty status, presence of comorbid chronic conditions, and tiers in the local health care system. RESULTS Overall, the prevalence of self-reported chronic conditions was 13.8% (95% CI = 13.4, 14.2) among adults, with hypertension (10%) and diabetes (6.4%) being the most commonly reported conditions. Older people and women were more likely to report chronic conditions. We found reversal of socioeconomic gradient with people living below the poverty line at significantly greater odds of reporting chronic conditions than people living above the poverty line (OR = 3, 95% CI = 1.5, 5.8). Private healthcare providers managed over 80% of patients. A majority of patients were managed at the clinic/health centre level (42.9%), followed by the referral hospital (38.9%) and the super-specialty hospital (18.2%) level. An increase in income was positively associated with the use of private facilities. However, elderly people, people below the poverty line, and those seeking care from hospitals were more likely to use government services. CONCLUSIONS Our findings provide further evidence of the urgent need to improve care for chronic conditions for urban poor, with a preferential focus on improving service delivery in government health facilities.
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Affiliation(s)
- Upendra Bhojani
- Institute of Public Health, 250, 2 C Cross, 2 C Main, Girinagar, First Phase, Bangalore 560085, Karnataka, India
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Department of Public Health, Ghent University, De Pintelaan 185, Block A, B- 9000 Ghent, Belgium
| | - Thriveni S Beerenahalli
- Institute of Public Health, 250, 2 C Cross, 2 C Main, Girinagar, First Phase, Bangalore 560085, Karnataka, India
| | - Roopa Devadasan
- Institute of Public Health, 250, 2 C Cross, 2 C Main, Girinagar, First Phase, Bangalore 560085, Karnataka, India
| | - CM Munegowda
- Institute of Public Health, 250, 2 C Cross, 2 C Main, Girinagar, First Phase, Bangalore 560085, Karnataka, India
| | - Narayanan Devadasan
- Institute of Public Health, 250, 2 C Cross, 2 C Main, Girinagar, First Phase, Bangalore 560085, Karnataka, India
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Patrick Kolsteren
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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Agrawal S, Ebrahim S. Association between legume intake and self-reported diabetes among adult men and women in India. BMC Public Health 2013; 13:706. [PMID: 23915141 PMCID: PMC3735389 DOI: 10.1186/1471-2458-13-706] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 08/01/2013] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is postulated that a diet high in legumes may be beneficial in preventing diabetes. However, little empirical evidence on this association exists in developing countries. We aimed to examine the association between legume intake and self-reported diabetes status in adult men and women in India. METHODS The analysis is based on a population-based cross sectional study of 99,574 women and 56,742 men aged 20-49 years included in India's third National Family Health Survey conducted in 2005-06. Association of legume intake, determined by the frequency of consumption of pulses and beans (daily, weekly and occasionally or never), with the reported prevalence of diabetes were estimated using multiple logistic regression after adjusting for frequency of consumption of other food items, BMI status, tobacco smoking, alcohol drinking, watching television, age, education, living standard of the household, residence and geographic regions. RESULTS Daily (OR: 0.71; 95% CI: 0.59-0.87; p=0.001) and weekly (OR: 0.66; 95% CI: 0.54-0.80; p<0.001) legumes intake were associated with a significantly reduced prevalence of diabetes among adult Indian women even after controlling for the effects of potentially confounding factors, whereas non-significant inverse associations were observed in men. CONCLUSION Daily or weekly intake of legumes was inversely associated with presence of diabetes in the Indian population. However, this is an observational finding and uncontrolled confounding cannot be excluded as an explanation for the association. More epidemiological research with better measures of legumes intake and clinical measures of diabetes is needed to clarify this relationship.
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Affiliation(s)
- Sutapa Agrawal
- South Asia Network for Chronic Disease, Public Health Foundation of India, C1/52, First floor, Safdurjung Development Area, New Delhi, India
| | - Shah Ebrahim
- South Asia Network for Chronic Disease, Public Health Foundation of India, C1/52, First floor, Safdurjung Development Area, New Delhi, India
- London School of Hygiene and Tropical Medicine, London, UK
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Daivadanam M, Wahlstrom R, Sundari Ravindran TK, Sarma PS, Sivasankaran S, Thankappan KR. Design and methodology of a community-based cluster-randomized controlled trial for dietary behaviour change in rural Kerala. Glob Health Action 2013; 6:20993. [PMID: 23866917 PMCID: PMC3715653 DOI: 10.3402/gha.v6i0.20993] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/08/2013] [Accepted: 06/08/2013] [Indexed: 11/25/2022] Open
Abstract
Background Interventions targeting lifestyle-related risk factors and non-communicable diseases have contributed to the mainstream knowledge necessary for action. However, there are gaps in how this knowledge can be translated for practical day-to-day use in complex multicultural settings like that in India. Here, we describe the design of the Behavioural Intervention for Diet study, which was developed as a community-based intervention to change dietary behaviour among middle-income households in rural Kerala. Methods This was a cluster-randomized controlled trial to assess the effectiveness of a sequential stage-matched intervention to bring about dietary behaviour change by targeting the procurement and consumption of five dietary components: fruits, vegetables, salt, sugar, and oil. Following a step-wise process of pairing and exclusion of outliers, six out of 22 administrative units in the northern part of Trivandrum district, Kerala state were randomly selected and allocated to intervention or control arms. Trained community volunteers carried out the data collection and intervention delivery. An innovative tool was developed to assess household readiness-to-change, and a household measurement kit and easy formulas were introduced to facilitate the practical side of behaviour change. The 1-year intervention included a household component with sequential stage-matched intervention strategies at 0, 6, and 12 months along with counselling sessions, telephonic reminders, and home visits and a community component with general awareness sessions in the intervention arm. Households in the control arm received information on recommended levels of intake of the five dietary components and general dietary information leaflets. Discussion Formative research provided the knowledge to contextualise the design of the study in accordance with socio-cultural aspects, felt needs of the community, and the ground realities associated with existing dietary procurement, preparation, and consumption patterns. The study also addressed two key issues, namely the central role of the household as the decision unit and the long-term sustainability through the use of existing local and administrative networks and community volunteers.
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Affiliation(s)
- Meena Daivadanam
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
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Weng LC, Steffen LM, Szklo M, Nettleton J, Chambless L, Folsom AR. A diet pattern with more dairy and nuts, but less meat is related to lower risk of developing hypertension in middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) study. Nutrients 2013; 5:1719-33. [PMID: 23698164 PMCID: PMC3708346 DOI: 10.3390/nu5051719] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/22/2013] [Accepted: 05/09/2013] [Indexed: 02/07/2023] Open
Abstract
Dietary intake among other lifestyle factors influence blood pressure. We examined the associations of an “a priori” diet score with incident high normal blood pressure (HNBP; systolic blood pressure (SBP) 120–139 mmHg, or diastolic blood pressure (DBP) 80–89 mmHg and no antihypertensive medications) and hypertension (SBP ≥ 140 mmHg, DBP ≥ 90 mmHg, or taking antihypertensive medication). We used proportional hazards regression to evaluate this score in quintiles (Q) and each food group making up the score relative to incident HNBP or hypertension over nine years in the Atherosclerosis Risk of Communities (ARIC) study of 9913 African-American and Caucasian adults aged 45–64 years and free of HNBP or hypertension at baseline. Incidence of HNBP varied from 42.5% in white women to 44.1% in black women; and incident hypertension from 26.1% in white women to 40.8% in black women. Adjusting for demographics and CVD risk factors, the “a priori” food score was inversely associated with incident hypertension; but not HNBP. Compared to Q1, the relative hazards of hypertension for the food score Q2–Q5 were 0.97 (0.87–1.09), 0.91 (0.81–1.02), 0.91 (0.80–1.03), and 0.86 (0.75–0.98); ptrend = 0.01. This inverse relation was largely attributable to greater intake of dairy products and nuts, and less meat. These findings support the 2010 Dietary Guidelines to consume more dairy products and nuts, but suggest a reduction in meat intake.
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Affiliation(s)
- Lu-Chen Weng
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454, USA; E-Mails: (L.-C.W.); (A.R.F.)
| | - Lyn M. Steffen
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454, USA; E-Mails: (L.-C.W.); (A.R.F.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-612-625-9307; Fax: +1-612-624-0315
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA; E-Mail:
| | - Jennifer Nettleton
- Department of Epidemiology and Disease Control, University of Texas Health Science Center-Houston, 1200 Herman Pressler, Houston, TX 77030, USA; E-Mail:
| | - Lloyd Chambless
- Department of Biostatistics, University of North Carolina-Chapel Hill, 3101 McGavran-Greenberg Hall, CB #7420, Chapel Hill, NC 27599, USA; E-Mail:
| | - Aaron R. Folsom
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454, USA; E-Mails: (L.-C.W.); (A.R.F.)
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Chopra SM, Misra A, Gulati S, Gupta R. Overweight, obesity and related non-communicable diseases in Asian Indian girls and women. Eur J Clin Nutr 2013; 67:688-96. [PMID: 23612512 DOI: 10.1038/ejcn.2013.70] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 02/14/2013] [Accepted: 02/15/2013] [Indexed: 01/09/2023]
Abstract
The prevalence of obesity is rising globally and in India. Overweight, obesity and related diseases need to be delineated in Asian Indian women. A literature search was done using key words like 'obesity', 'Asian Indian women', 'body fat distribution', 'type 2 diabetes', 'fertility', 'polycystic ovarian disease', metabolic syndrome', 'cardiovascular disease', 'non-alcoholic fatty liver disease', 'gender', 'sex' and 'prevalence' up to September 2012 in Pubmed and Google Scholar search engines. This review highlights the Asian Indian body composition with regards to obesity and provides a collated perspective of gender-specific prevalence of the co-morbidities. Recent data show that women (range of prevalence of overweight and obesity from different studies 15-61%) have higher prevalence of overweight and obesity as compared with men (range of prevalence of overweight and obesity from different studies 12-54%) in India and that obesity is increasing in the youth. The prevalence of overweight and obesity in both men and women steeply rose in a Punjabi community from Jaipur. Importantly, prevalence of abdominal obesity has been consistently higher in women than in men. The lowest prevalence (6.0%) of type 2 diabetes mellitus in women is reported from South India (rural Andhra Pradesh; 2006) and the highest (14.0%) by the National Urban Diabetes Survey (2001). Although the clustering of cardiovascular disease risk factors was generally high, it increased further in post-menopausal women. There are a number of factors that predispose Indian women to obesity; sedentary behaviour, imbalanced diets, sequential and additive postpartum weight gain and further decrease in physical activity during this period and cultural issues. In view of these data, preventive measures should be specifically targeted to Indian women.
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Affiliation(s)
- S M Chopra
- National Diabetes Obesity and Cholesterol Foundation, New Delhi, India
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Aloia CR, Gasevic D, Yusuf S, Teo K, Chockalingam A, Patro BK, Kumar R, Lear SA. Differences in perceptions and fast food eating behaviours between Indians living in high- and low-income neighbourhoods of Chandigarh, India. Nutr J 2013; 12:4. [PMID: 23289746 PMCID: PMC3546030 DOI: 10.1186/1475-2891-12-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 12/30/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND Increased density of fast food restaurants is associated with increased prevalence of obesity in developed countries. However, less is known about this relationship in developing countries undergoing rapid urbanization and how differences in neighbourhood income affect the patronage of fast food outlets. The purpose of the study is to explore the differences in fast food preferences, perceptions, and patronage between Indians living in high- and low-income neighbourhoods. METHODS This cross-sectional study recruited 204 men and women (35 to 65 years in age) from high- and low-income neighbourhoods who completed a questionnaire on fast food consumption. The questionnaire asked participants to define fast food and to provide reasons for and frequency of visits to fast food restaurants. The differences were analyzed using Chi square and t-tests for categorical and continuous variables, respectively. RESULTS Participants from a high-income neighbourhood were more likely to perceive Western -style fast food as fast food, while people from the low-income neighbourhood were more likely to identify food sold by street vendors as fast food (p <0.001). Furthermore, compared to participants from the high-income neighbourhood, people from the low-income neighbourhood were more likely to report buying food from street vendors while less likely to dine out at both fast food and non-fast food restaurants (p<0.001). Although the high-income neighbourhood group was more likely to report enjoying eating at fast food restaurants than their low-income neighbourhood counterparts, there were no significant differences in the reasons for visiting fast food restaurants (convenience, price, social enjoyment, and quality of meals) between the two groups. Both groups preferred home cooked over restaurant meals, and they recognized that home cooked food was healthier. CONCLUSIONS Overall, consumption of fast food was low. People from a high-income neighbourhood dined out more frequently and were more likely to perceive Western-style food as fast food compared to their counterparts from the low-income neighbourhood.
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Moore SC, Gunter MJ, Daniel CR, Reddy KS, George PS, Yurgalevitch S, Devasenapathy N, Ramakrishnan L, Chatterjee N, Chanock SJ, Berndt SI, Mathew A, Prabhakaran D, Sinha R. Common genetic variants and central adiposity among Asian-Indians. Obesity (Silver Spring) 2012; 20:1902-8. [PMID: 21799482 PMCID: PMC3429696 DOI: 10.1038/oby.2011.238] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recent studies have identified common genetic variants that are unequivocally associated with central adiposity, BMI, and/or fasting plasma glucose among individuals of European descent. Our objective was to evaluate these associations in a population of Asian-Indians. We examined 16 single-nucleotide polymorphisms (SNPs) from loci previously linked to waist circumference, BMI, or fasting glucose in 1,129 Asian-Indians from New Delhi and Trivandrum. Trained medical staff measured waist circumference, height, and weight. Fasting plasma glucose was measured from collected blood specimens. Genotype-phenotype associations were evaluated using linear regression, with adjustments for age, gender, religion, and study region. For gene-environment interaction tests, total physical activity (PA) during the past 7 days was assessed by the International Physical Activity Questionnaire (IPAQ). The T allele at the FTO rs3751812 locus was associated with increased waist circumference (per allele effect of +1.58 cm, P(trend) = 0.0015) after Bonferroni adjustment for multiple testing (P(adj) = 0.04). We also found a nominally statistically significant FTO-PA interaction (P(interaction) = 0.008). Among participants with <81 metabolic equivalent (MET)-h/wk of PA, the rs3751812 variant was associated with increased waist size (+2.68 cm; 95% confidence interval (CI) = 1.24, 4.12), but not among those with 212+ MET-h/wk (-1.79 cm; 95% CI = -4.17, 0.58). No other variant had statistically significant associations, although statistical power was modest. In conclusion, we confirmed that an FTO variant associated with central adiposity in European populations is associated with central adiposity among Asian-Indians and corroborated prior reports indicating that high PA attenuates FTO-related genetic susceptibility to adiposity.
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Affiliation(s)
- Steven C Moore
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland, USA.
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