Abstracts International Journal of Clinical Nutrition (IJCN) A publication of the International College of Nutrition 2001; Vol 1(1): 1-49 Utility and Necessity of the Results of the Indian Experiment of Infarct Survival for Prevention of Myocardial Infarction. RB Singh, SS Rastogi, MA Niaz, S Ghosh, H Mori. Medical Hospital and Research Center, Moradabad, India; Diabetes Research center, New Delhi, Aomori Prefectural Central Hospital, Japan Correspondence Prof Dr Ram B Singh, MD, FICN Medical Hospital and Research Center, Moradabad (UP)244001, India, Email: rbs@tsimtsoum.net Abstract. The Seven Country Study showed that diet rich in total and saturated fat and cholesterol is positively associated with increased risk of coronary artery disease (CAD). Apart from these nutrients, refined carbohydrates such as bread, biscuits, cakes, white chocolates and syrups as well as red and preserved meat are also known to increase the risk of cardiovascular diseases (CVDs). World Health Organization (1990) has advised that eating more than 400g/day of fruits, vegetables and legumes may be protective against CAD. The Indian Experiment of Infarct Survival was a randomized, controlled, intervention trial in which Indo-Mediterranean foods; vegetables, fruits, nuts (400g/day and another 400g/day of whole grains including legume, in conjunction with mustard oil were administered among patients with recent myocardial infarction (MI). After a follow up of one year, there was a significant decline in blood lipids and blood glucose along with significant decrease in body weight and blood pressures. Underlying these changes, there was a significant decline in cardiovascular events and cardiovascular mortality as well as total mortality. The findings indicate that all patients with CAD, including MI should be administered Indo-Mediterranean foods for prevention of CVDs. Key Words. Mediterranean diet, Japanese diet, nutrients, blood lipids. How to cite: Singh RB, Rastogi, SS, Niaz MA, Ghosh S, Mori H. Utility and Necessity of the Results of the Indian Experiment of Infarct Survival for Prevention of Myocardial Infarction. Int J Clin Nutr 2001; 1:1-5. 2.Traditional Mediterranean style diet and the Lyon Heart Study. Anuj Maheshwari, RK Singh, RB Singh, Serge Renaud. CODS, BBD University, Lucknow, India, K G Medical College, Lucknow, India; Halberg Hospital and Research Institute, Moradabad, India; Director of Research at INSERM, the French National Institute of Health and Medical Research, Paris, France. Correspondence Dr Serge Renaud, PhD Director of Research at INSERM, the French National Institute of Health and Medical Research, Paris, France Abstract. Mediterranean diet refers to dietary patterns observed in olive-growing areas of the regions of the Mediterranean countries, and described in the 1960s and beyond. Several variants of the traditional foods consumed in this area are included in the Mediterranean diet, but some common components can be identified. These are high monounsaturated/saturated fatty acid (MUFA) ratio (Olive oil, nuts); wine intake at moderate levels and mainly during the meals. High consumption of vegetables, nuts, fruits, legumes, and grains; moderate consumption of milk and dairy products, mostly in the form of cheese; and low consumption of refined carbohydrates, red meat and meat products. There is substantial evidence that the Mediterranean diet is beneficial in the prevention of cardiovascular diseases (CVDs). The evidence is stronger for coronary artery disease (CAD), compared to cancer. Further studies indicate a strong biomedical foundation for the beneficial effects of the Mediterranean diet against CVDs. In a prospective, randomized, single-blinded trial, in patients with recent myocardial infarction (MI), the effect of a Mediterranean alpha-linolenic acid-rich diet were compared to the usual post-infarct prudent diet. All the patients were randomly assigned to the intervention (n=302) or control group (n=303). The experimental group consumed significantly less lipids, saturated fat, cholesterol, and linoleic acid but more oleic and alpha-linolenic acids. After a mean follow up of 27 months, there were 16 cardiac deaths in the control and 3 in the intervention group; 17 non-fatal myocardial infarction (MI) in the control and 5 in the intervention groups: a risk ratio for these two main endpoints combined of 0·27 (95% Cl 0·12-0·59, p=0·001) after adjustment for prognostic variables. Total mortality was 20 in the control, 8 in the experimental group, an adjusted risk ratio of 0·30 (95% Cl 0·11-0·82, p=0·02). It is clear that an alpha-linolenic acid-rich Mediterranean style diet may be more effective than presently used diets in the secondary prevention of CVDs and death. Key Words. Healthy diet, mortality, blood lipids, cardiac events, fruits, vegetables. How to cite: Maheshwari A, Singh RK, Singh RB, Serge Renaud, Traditional Mediterranean style diet and the Lyon Heart Study. Int J Clin Nutr 2002; 1:6-10 3.PREVENTION OF CARDIOVASCULAR DISEASE AND DIABETES MELLITUS IN LOW AND MIDDLE INCOME COUNTRIES. TK Basu (1), SN Acharya(2), JP Sharma(3), Daniel Pella(4). 1,2University of Alberta, Edmonton, Canada, 3Halberg Hospital and Research Institute, Moradabad (UP),India, 4PJ Safaric University, Kosice, Slovakia. Correspondence Prof Dr Tapan K Basu, PhD, FICN Department of Agriculture, University of Alberta Edmonton, Canada, Email: <Tapan.Basu@ualberta.ca Abstract. Despite a moderate increase in fat intake and low rates of obesity, the risk of coronary artery disease (CAD) and diabetes is rapidly increasing in most of the developing economies. It is a paradox that in some of these countries the increased risk of people to diabetes and CAD, especially at a younger age, is difficult to explain by conventional risk factors. It is possible that the presence of new risk factors especially higher lipoprotein(a) (Lpa), insulin resistance, low HDL cholesterol and poor nutrition in fetus, infancy and childhood may explain at least in part, the cause of this paradox. The prevalence of obesity, central obesity, smoking, physical inactivity and stress are rapidly increasing in low and middle income populations, due to economic development. In high income populations, there is a decrease in tobacco consumption, increase in physical activity and dietary restrictions, due to learning of the message of prevention, resulting into reduction in CVDs. In cross-sectional surveys, hypertension(5-10%) diabetes(3-5%) and CAD(3-4%) are very low in the adult, rural populations (n=1750) of India, which has less economic development. However, in urban (n=1810) and possibly in the immigrant populations of India and China, the prevalence of hypertension (>140/90, 25-30%), diabetes (6-18%) and CAD (7-14%) are significantly higher than they are in some of the high income populations. Mean serum cholesterol (180-200 mg/dl), obesity (5-8%) and dietary fat intake (25-30% en/day) are paradoxically not very high and do not explain the cause of increased susceptibility to CAD and diabetes. The force of lipid- related risk factors and refined starches and sugar appears to be greater in these populations due to the presence of the above factors and results into CVD and diabetes at a younger age. These findings may require modification of the existing American and European guidelines, proposed for prevention of CAD, in high income populations. Key words. Risk factor, inflammation, fruit, vegetable, diet. How to cite: Basu TK, Acharya SN, Sharma JP, Pella D. Prevention of cardiovascular disease and diabetes mellitus In low and middle income countries. Int J Clin Nure 2001; 1: 11-15.
4.2001 Guidelines of the International College of Nutrition for prevention of hypertension and coronary artery diseases. The Indian Consensus Group: Narsingh Verma (1), Anuj Maheshwari (2), RB Singh(3), RK Singh(4), RG Singh(5), KK Tripathi (6), Saibal Chakravorty (7), Shallendra Vajpayee(8); ,4KG Medical College, Lucknow; 2CODS, BBD University, Lucknow; 3,5,6,7Institute of Medical Sciences, BHU, Varanasi, India; 8Government Medical college, Surat, India Correspondence Dr Narsingh Verma, MD, FICN King,s George Medicalk College, Lucknow, India, <narsinghverma@gmail.com> Abstract. Rapid changes in diet and lifestyle combined with high levels of lipoprotein (a) are the main genetic causes of coronary artery disease (CAD) in Indians. CAD and hypertension have become a public health problem in India, however, there is no consensus on diet and lifestyle guidelines and desirable levels of risk factors for prevention. In the urban adult population, the prevalence of CAD appears to be about 90/1000 and of hypertension about 250/1000. Both hypertension and CAD are 3-4 fold less common in the rural population compared with urban subjects. In view of the lower fat intake in the low-risk rural population compared with those in urban areas (13.8% vs 25% kcal/day), the limit for total energy from fat intake should be < 21% kcal/day (7% each from saturated, polyunsaturated and monounsaturated fatty acids). The carbohydrate intake should be > 65% kcal/day, mainly from complex carbohydrates. A body mass index of 21 kg m−2 should be considered safe for Indians, but the range may be 18.5–23kg m−2 and > 23kg m−2 should be considered as overweight. A waist-hip ratio of > 0.88 in males and > 0.85 in females should be considered as central obesity because the prevalence of risk factors and CAD beyond these limits is higher. Despite this there is a general international consensus that the desirable level of serum cholesterol should be < 170mg dl−1 (5.20 mmol l−1); in Indians the optimal limit should be < 170mg dl−1 (4.42 mmol l−1). The values between 170 and 200mg dl−1 (4.42–5.20 mmol l−1) should be considered as borderline. The critical values for LDL cholesterol may be <90mg dl−1 (2.32 mmol l−1), 90–110mg dl−1 (2.32–2.84 mmol l−1) and >110mg dl−1 (2.84 mmol l−1). Fasting serum triglycerides should be <150mg dl−1 and HDL cholesterol > 40 mg dl−1. Eating 400 g/day fruits, vegetables and legumes and mustard or soya bean oil (25-50 g/day) in place of hydrogenated fat, coconut oil or ghee, in conjunction with a low-salt diet (< 6 g/day), moderate physical activity (300 kcal/day) and cessation of tobacco consumption may protect against CAD in Indians. Key Words: Total fat, saturated fat, refined CHO, blood lipids, blood pressure. How to cite: 2001 Indian Consensus Group. Guidelines of the International College of Nutrition for prevention of hypertension and coronary artery diseases. The Indian Consensus Group: Narsingh Verma (1), Anuj Maheshwari (2), RB Singh(3), RK Singh(4), RG Singh(5), KK Tripathi (6), Saibal Chakravorty (7), Shallendra Vajpayee(8); ,4KG Medical College, Lucknow; 2CODS, BBD University, Lucknow; 3,5,6,7Institute of Medical Sciences, BHU, Varanasi, India; 8Government Medical college, Surat, India. Int J Clin Nutr 2001; 1: 16-20. 5.Prevention of coronary artery disease in Asians: a scientific statement of the International. College of Nutrition. Zhou Shoumin (China), Wan Abdul Manan (Malaysia), Singh RB(India), Mori H (Japan), Chen J (China), Shanthi Mendi(Sri Lanka), Mahmood Moshiri (Iran), Sook He Kim (Korea), Rody G. Sy (Phillippines),, Azhar M.A. Faruqui (Pakistan). Correspondence Prof Dr Zhu Shoumin, PhD, FICN Zhejiang Medical University, Huangzhou, China Abstract. The rapid increase in coronary artery disease (CAD) in most Asian countries in association with economic development may be due to rapid increase in harmful diet and lifestyle. However, there is no consensus of opinion on diet and lifestyle guidelines and desirable levels of risk factors for prevention of CAD in these countries. The proportion of deaths due to cardiovascular diseases(CVDs) in Asians, may be about 15% but there are wide variations. In view of the lower fat intake of the low-risk rural populations of India, China, Indonesia, Korea, Thailand and Japan compared with that of urban subjects, the limit for total energy from fat intake in an average should be 21% (7% each from saturated, polyunsaturated and mono-unsaturated fatty acids). The carbohydrates intake should be > 60% and mainly from complex carbohydrates. A body mass index of 21 kg/m2 may be safe but the range may be 18.5-23.0 kg/m2 and a body mass index > 23 kg/m2 should be considered overweight. A waist: hip ratio > 0.88 for men and >0.85 for women should be considered to define central obesity. The desirable limit for blood lipoproteins should also be lower. Fasting serum triglycerides may be < 150 mg/dl and HDL cholesterol > 40 mg/dl, which are close to the levels in low-risk rural populations. Fasting blood glucose > 110 mg/dl and postprandial blood glucose > 200 mg/dl may be considered conditions for diabetes, and 140-200 mg/dl, glucose intolerance. An intake of 400 g/day fruit, vegetables and legumes, mustard or soybean oil (25-50 g/day) in conjunction with moderate physical activity (1255 kJ/day), cessation of tobacco consumption and moderation of alcohol intake may be an effective package of remedies for prevention of CAD in Asians. Key Words. total fat, body mass index, waist: Hip ratio, serum cholesterol How to cite : Shoumin Z, Vargova V, Singh RB, Mori H, Chen J, Mendis S, Moshiri M, Kim SH, Sy RG, Faruqui AMA. Recommendations for the prevention of coronary artery disease in Asians: a scientific statement of the International. College of Nutrition. Int J Clin Nutr 2001; 1: 21-25.