radzhesh

Abstracts
2003; Vol 3(1): 1-25
 
1.EFFECTS OF LOW OMEGA-6/OMEGA-3 RATIO DIETS ON RISK OF CARDIOVAS - CULAR DISEASES  AND TYPE 2 DIABETES AMONG NIGHT SHIFT WORKERS.
RB Singh (1), Agnieszca Wilczynska (2), R K Agarval (3), A V Sotnikov(4), A V Gordienko(5), D V Nosovich (6).3Technomed Holdings LLC Publishing House, 
Moscow, Russian Federation, 4Military medical academy named after S.M. Kirov, St. Petersburg, Russian Federation,5International College of Cardiology, 
Thornhill, Canada,6Sechenov University, Ministry of Health, Moscow, Russian Federation.
Correspondence: Dr Agnieszka Wilkzynska,PhD, The Tsim Tsoum Institute, Krakow, Poland,  Email: <awk@tsimtsoum.net> 
Abstract. Nutritional transition from poverty to economic development is associated with emergence of non-communicable diseases (NCDs). The last 
decade of the last century offered us an opportunity to initiate action to counter growing epidemics of cardiovascular diseases (CVDs) and metabolic 
diseases in both developed and developing countries. The learning of the methods of prevention by the populations, was associated with a decrease in 
CVD in the western world but obesity continued to increase, resulting into an increase in the metabolic syndrome in both developed and developing economies. 
Western diet is characterized with energy dense, refined, ready prepared foods with a high glycemic index (e.g., refined starches; bread, biscuits, candies, 
cornflakes, potato chips, cola drinks and sugar) and unhealthy lipids (e.g., trans fats, high saturated fat) poor in w-3 fatty acids, phytochemicals and fiber. 
Such diets have been adopted by increased number of people and populations in the developed countries and in the urban populations of middle income 
countries in the last few decades. Apart from dietary factors, late night sleep and night shift working may be associated with risk of CVDs and diabetes. 
These diets and lifestyle factors are known to predispose inflammation and the epidemic of NCDs. CVDs, diabetes mellitus, obesity, cancer, autoimmune 
diseases, rheumatoid arthritis, asthma and depression are associated with increased production of thromboxane A2(TXA2), leucotrienes, prostacyclin, 
interleukins-1 and 6, tumor necrosis factor-alpha and C-reactive proteins. Increased dietary intake of w-6 fatty acids may have adverse effects on all 
these biomarkers as well as atherogenicity of cholesterol which have adverse pro-inflammatory effects resulting into NCDs. Mediterranean diet rich in fruits, 
vegetables, nuts, canola oil, olive oil characterized with low w-6/w-3 ratio in the diet, as well as physical activity, and meditation can modulate inflammation 
as well as body-mind interactions and may be protective against risk of CVD and all cause mortality.
Keywords. Polyunsaturated fatty acids, inflammation, western foods, night shift.
 How to cite: 
 
2.NUTRITIONAL MODULATORS OF EPIGENETIC INHERITANCE.
Mahmood Moshiri, Sara Sarrafi-Zadeh, Mahsa Jalili; Halberg Hospital and Research Institute, Moradabad, Department of Foods Sciences, 
University of Mysore, Mysore, India
Correspondence:  Dr Mahmood Moshiri, MD, International College of Nutrition, Thornhill, On, Canada,<moshiri@nextpharmainc.com> 
Abstract. The example for epigenetic inheritance is the yellow Agouti mouse, an epigenetic biosensor for nutritional and environmental changes. These 
fat and yellow mice owe their appearance to epigenetic modification that removes methyl groups from the normally methylated agouti gene. In a 
developing mouse fetus, if the above modification occurs shortly after fertilization, the baby mouse may exhibit the yellow fur and obese phenotype 
with greater risk of developing metabolic syndrome, cardiovascular disease (CVD) and diabetes. Since, epigenome is limited to the surface of the gene, 
the genetic sequence remains unchanged from normal mice. It has been observed that alteration of the nutrient intake to serve as methyl group donors 
in mouse mothers, was associated with methylation or demethylation of the agouti gene. Increased supplementation of choline, betaine, folic acid and 
vitamin B12 in the diet of pregnant yellow agouti mice was able to decrease the incidence of deleterious phenotypes in offspring, by donating methyl group 
and allowing for the re-methylation of the agouti gene. If these mice be born with the agouti phenotype, they can pass that deleterious epigenetic trait 
in their offspring, regardless of their diet during pregnancy. This landmark study indicates   that nutrients can cause phenotypic changes which can pass on 
through cell division and mating to the offspring due to their possible influence on (natural) selection. It is possible therefore to say; that we are what we 
eat and what our parents ate, and potentially what our grand parents ate which would be modification of the old Sanskrit saying ‘Aham Annam’   from the 
ancient Vedas (5000BCE). There is a need to study the effects of low ω-6/ω-3 fatty acid ratio diet, and other nutrients; arginine, taurine, cysteine, 
coenzyme Q10 on the re-methylation of the agouti gene and their effects on phenotypic variations. However this mode of inheritance needs to penetrate 
more than a few generations before it earns a place in evolutionary concept.
Keywords. DNS methylation, chromatids, hypomethylation, hypermethylation.
How to cite: Moshiri M, Sarrafi-Zadeh S, Jalili M. Nutritional modulators of epigenetic inheritance. Int J Clin Nutrition 2004; 4: 6-10. 
 
3.METABOLIC SYNDROME: A DYSFUNCTION OF THE BRAIN.
RB Singh(1), Lekh Juneja(2), Ghizal Fatima(3), Poonam Tiwari (4) 1Halberg Hospital and Research Institute; Moradabad, India. 2Tayo Kagaku, Japan; 
3Era Medical College, Lucknow, India, 4RML Hospital, Lucknow, India
Association between brain dysfunction and pathogenesis of metabolic syndrome leading to cardiovascular diseases (CVDs), type 2 diabetes (T2DM) 
is an interesting hypothesis.
Increased intake of  refined carbohydrates, linoleic acid, saturated and total fat and low dietary n-3 fatty acids and other long chain polyunsarurated 
fatty acids(PUFA) in conjunction with sedentary behaviour and mental stress and various personality traits can predispose inflammation in the adipocytes 
leading to obesity and  central obesity. There may be increased sympathetic activity with increased secretion of catecholamine, cortisol and serotonin and 
pro-inflammatory cytokines that appear to be underlying mechanisms of metabolic syndrome. Apart from these alterations, these is an underlying long 
chain PUFA deficiency, which may increase the susceptibility of the neurons to damage, in the ventromedial hypothalamus and insulin receptors in the 
brain, especially during fetal life, infancy and childhood, resulting into their dysfunction. Since 30-50% of the fatty acids in the brain are long chain 
PUFA, especially omega-3 fatty acids, which are incorporated in the cell membrane phospholipids, it is possible that the treatment with these may 
be protective. Omega-3 fatty acids are also known to enhance parasympathetic activity and increase the secretion of anti-inflammatory cytokines IL-4 
and IL-10, as well as acetyle- choline in the hippocampus. It is possible that marginal deficiency of long chain PUFA, especially n-3 fatty acids, due to 
poor dietary intake during the critical period of brain growth and development in the fetus and infant, and also possibly in the child, adolescents and 
adults, may also enhance the release of tumor necrosis factor-alpha, interleukin-1,2 and 6 and cause neuronal dysfunction. However, supplementation 
of these fatty acids may prevent the brain damage leading to prevention of CVDs and T2DM in the concerned subjects.
Keywords. Diet, polyunsaturated fatty acids, inflammation, western diet.
How to cite.  RB Singh (1), Lekh Juneja(2), Ghizal Fatima(3), Poonam Tiwari (4) Metabolic syndrome: a dysfunction of the brain. 
Int J Clin Nutrition 2003; 3: 11-15.

4.EFFECTS OF DIETARY OMEGA-6/OMEGA-3 FATTY ACID RATIO ON INFL AMMATION AND RISK OF HIP FRACTURE.
Kumar Kartikey (1), Brajesh Kidyore(2), Y A Somsunder(3); Howarth P.(4) , Viola Vargova (5), Zelmira Macejova (6); 1,2,3Department of Orthopedics, 
Sidhartha Medical College, Tumkur (AP), India; 4,5,6Faculty of Medicine,  PJ Safaric University, Slovakia
Correspondence:  Dr Kumar Kartikey,MBBS,MS(Orthopedics),FICN, Senior Resident, Teerthankar Medical College, Halberg Hospital and Research Institute, 
Civil Lines, Moradabad- 10 (UP) 244001, India, email,  <spark10_us@yahoo.com>
Abstract: There is evidence that calcium, magnesium, vitamin D, proteins,  antioxidants and w-3 fatty acids intakes are inversely associated with risk of 
osteoporosis and hip fractures. This study aims to examine the association of food consumption pattern and w-6/w-3 fatty acid ratio of the diet with 
inflammation and hip joint fractures. After written informed consent and approval from ethic committee of the college, 60 patients, having fracture 
neck of femur  and 95 control subjects above 50 years of age were included in this case control study. The results revealed that the fracture was  more 
common in male than female. Fruits, vegetables and legume (165  ±12.6 vs. 205±15.8g/day, P<0.03) as well as milk products (milk, curd, butter etc) 
consumption (205+25.8 vs.  318±31.5g/day,P<0.05) were significantly lower and w-6 rich oils and saturated fat intake was significantly higher among 
patients with fractures compared to control subjects, respectively. Omega-3 fatty acids intakes were significantly lower among patients with fractures 
(0.45± 0.74 g/day, P<0.05).Osteoporosis (92.0%), trivial trauma (92.0%), physical inactivity (80.0%), diabetes mellitus(21.6%) were common among patients 
with hip fracture. Multivariate logistic regression analysis showed that the intakes of fruit, vegetable and legume( odds ratio 1.12, confidence interval 
(CI) 1.02-1.21, P<0.05), physical activity(OR 1.36, CI 1.22-1.52, P<0.05), w-3 fatty acids (OD1.05, 0.92-1.17, P<0.01) intake were inversely associated 
with fracture, whereas w-6/w-3 ratio (OD 1.33, CI 1.18-1.47,P<0.01) interleukin-6, (OD1.11, CI 1.02-1.19, P<0.01), tumor necrosis factor-alpha
(OD,1.09, CI 1.01-1.17, P<0.01)  were positively associated with fracture. The findings showed that increased consumption of fruit, vegetable and legume, 
milk products and w-3 fatty acid and low w-6/w-3 ratio diet as well as physical activity may be protective against hip joint fractures. 
Key words:  Nutrition, dietary pattern, fatty acids, inflammation, bone disease, cytokines.
How to cite: Kartikey K,  Kidyore B, Somsunde YA; Howarth P, Vargova V, Zelmira Macejova Z.  Effects of dietary omega-6/omega-3 fatty acid ratio on 
inflammation and risk of hip fracture. Int J Clin Nutrition 2003; 3: 16-20.

5.COENZYME  Q10 AND CARNITINE IN CARDIOMYOPATHY.
Adarsh Kumar(1), RB Singh(2), Manoj Saxena(3), MA Niaz (4), Pronobesh Chattopadhyay(5). 1Government Medical College, Amritser, India; 
2,3Medical Hospital and Research Institute, Moradabad, 5IFTM College of Pharmacy, Moradabad, India
Correspondence:  Dr Adarsh Kumar,MD,DM, FICN, Department of Medicine, Government College, Amritsar(Punjab), India
Abstract. Environmental risk factors are known to cause mitochondrial dysfunction which enhances the generation of radical oxygen species (ROS), 
leading to damage mtDNA, nDNA, proteins, and lipid membranes. Experimental studies indicate that lacking the mitochondrial antioxidant enzyme 
manganese-superoxide dismutase (SOD) develop dilated cardiomyopathy. Treatment with L-acetyl-carnitine and coenzyme Q10 improves cardiac 
function in patients with cardiomyopathy. CoQ10 which is a potent antioxidant is important in OXPHOS as well as in mitochondrial function. L-Carnitine 
also regulates mitochondrial function and may have synergistic effects, when combined with CoQ10. In a clinical study, including 18 patients with dilated 
cardiomyopathy diagnosed by 2-D echocardiography, 10 patients were randomized to CoQ10+ L-carnitine and 8 patients to placebo group. Carni Q-gel 9 
softgels (3 with each meal thrice daily), which provide a total of 270 mg ubiquinol and 2250 mg L-carnitine daily, or 9 matching placebos were administered 
daily to each patient during the 12-week period.TNF-alpha, IL-6, TBARS, MDA and diene conjugates were raised in both the groups at base line. Both groups 
had significant CoQ10 deficiency in the plasma (normal range 0.5 to 1.5 ug/ml). However, after 12week treatment with this combination, there was a 
significant improvement in the clinical and biochemical parameters of these patients. Serum concentration of CoQ10 (0.21±0.11 vs 0.19±0.10  ug/ml, 
normal 0.5 to 1.5 ug/ml) were deficient but comparable at baseline. However, after 12week treatment, there was a significant increase in CoQ10 in 
the intervention group without any rise in the placebo group. (2.7±1.2 vs 0.76±0.14 ug/ml, P<0.001). Further studies are necessary to confirm our results.
Key Words. Cardiac, antioxidant, mitochondrial, oxidative stress,
How to cite: Kumar A, Singh RB, Saxena M, Niaz MA, Chattopadhyay P. Coenzyme  Q10 and carnitine in cardiomyopathy. Int J Clin Nutrition 2003; 3: 21-25.

ASSOCIATION OF MAGNESIUM, DEFICIENCY AND LARGE BREAKFAST WITH RISK OF ACUTE CORONARY SYNDROMES.
Ram B Singh (1), ,Jagdish P Sharma (2)Viola Vargova (3), M Moshiri (4) ,Fabien De Meester (5)  Kuniaki Otsuka (6); 1,2Halberg Hospital and Research Center, 
Moradabad, P J 3Safaric University2, Kosice, Slovakia, 4Center of Nutrition Research, Toronto, Canada ,
 5The Tsim Tsoum Institute, Krakow, Poland; 6Tokyo Womens Medical University,Tokyo,Japan
Correspondence:
Dr. R.B. Singh, MD
Professor of Medicine, Medical Hospital and Research Center, Civil Lines, Moradabad-10(UP) 244001, India email: rbs@tsimtsoum.net
Abstract: Acute coronary syndrome (ACS) is a highly dynamic event, which is associated with marked biochemical dysfunction apart from cardiac damage. 
There is a marked increase in sympathetic activity, oxidative stress, inflammation, dyslipidemia, increase in free fatty acids and deficiency of magnesium and 
potassium as well as antioxidants during ACS. Clinical studies have reported an increased incidence of re-infarction, sudden death, coronary constriction, 
myocardial ischemia and angina, during first quarter of the day when there is rapid withdrawal of vagal activity and increase in sympathetic tone. 
This study included 54 patients of ACS and 85 age and sex matched control subjects. The incidence of subjects consuming large breakfast was significantly greater 
among patients with ACS compared to control subjects (40.7 vs 23.5%, P<001). There was a significant greater incidence of cardiac events in the second quarter 
of the day compared to 4thquarter. Mean serum levels of magnesium, and coenzyme Q10, were significantly lower and mean total cholesterol, triqlycerides,
 were significantly higher in the study group compared to control group. Lp(a), triglycerides, blood glucose, plasma insulin, TBARS, malondialdehyde, 
diene conjugates and TNF-alpha and IL-6 which were significantly greater during acute phase, showed a significant decline, and coenzyme Q, an increase, 
at 4 weeks of follow up, when the acute reactions evoked by MI were controlled. Large breakfast was a predisposing factor of cardiac events in between 
8.00 to 11.00 hours of the day, and it was significantly associated with metabolic reactions. The findings indicate that acute reactions as a result or as 
circadian rhythms appear to be important in the pathogenesis of complications in ACS and that a large breakfast in association with and magnesium deficiency, 
may further trigger the circadian rhythms. However more studies in a large number of subjects would be necessary to confirm our findings.
Key Words: Myocardial infarction, cytokines, inflammation, coenzyme Q10,
How to cite: Singh RB, Sharma, JP, Vargova V, Moshiri M, De Meester F, Otsuka K. Association of magnesium, deficiency and large breakfast with risk of 
acute coronary syndromes. Int J Clin Nutrition 2002; 2: 1-5.
 
2.NUTRITIONAL MODULATORS OF INFLAMMATION, OSTEOPOROSIS AND ATHEROSCLEROSIS.
Kumar Kartikey (1), NR Hadi(2),. Bassim M(3), Osama Elmaraghi (4), Medical Hospital and Research Center, Faculty of Medicine, University of Kufa, Kufa, 
Faculty of Medicine, University of AlQadisiyah, Diwaniyah, Iraq, Diabetes Clinic, Kuwait.
Correspondence
Dr NR Hadi, MD,PhD
Faculty of Medicine, University of Kufa, Najaf, Iraq, <drnajahhadi@yahoo.com>
 
Abstract: There is evidence that the high intake of some of the nutraceuticals or dietary salt, trans fat and sugar and low intake of fish oil or fish in the diet are 
risk factors for the development of atherosclerosis as well as osteoporotic and hip fractures. Increased intake of fish oil, fish, low fat dairy products, fruits, 
vegetables, legumes and nuts that are rich in ω3 fatty acids (alpha-linolenic acid) have recently been found to be protective against atherosclerosis and osteoporosis. 
This finding raises the possibility that these foods and their nutrients may protect against CVD and hip fracture, and may provide better quality of life. Increased 
risks in co-twins without an index diagnosis suggest that genetic factors and genes/diet interactions may explain the association of CVD with osteoporotic fractures. 
There is evidence that Western diet rich in refined carbohydrates (coke drinks, biscuits, cakes, ice creams), trans fat, high ω6 / low ω3 fats, deficiencies in soluble 
fibers and antioxidants can enhance the expression of about 125 genes, the majority of which are pro-inflammatory. There is increase in AP-1, Egr-1 and NFkB, 
that are transcription factors for inflammation. It is possible that these pro-inflammatory factors can increase the risk of osteoporosis as well 
as of athero-thrombosis, resulting into hip fractures and CVD, respectively. Calcification of vascular walls shares similarities with bone formation and resorption 
processes; in particular, bisphosphonates are known to decrease the progression of osteoporosis, as well as to prevent the development of atherosclerosis, 
thereby reducing total mortality. On the other hand, statins, the cholesterol-lowering drugs are anti-inflammatory and reduce risk of CVD and osteoporotic fractures.
Kew words:  hip fractures, coronary heart disease, chronic diseases, diet.
How to cite: Kartikey K, Hadi NR., Bassim IM, Elmarghi E. Nutritional modulators of inflammation, osteoporosis and atherosclerosis. Int J of Clin Nutrition 2002; 2: 6-10.

3.EFFECTS OF LIPOSOMAL COENZYME Q10 (LI-Q-Sorb) INHIBIT HMG- CoA-REDUCTASE ENZYME IN HYPERLIPIDEMIA IN RATS.
P Chattopadhya (1), R B Singh (2), NR Hadi (3), Galal Elkilany (4). 1College of Pharmacy, IFTM, Moradabad, India; 2Medical Hospital and Research Center, 
Moradabad, India; 3University of Kufa, Najaf, Iraq; 4Global Health Care Division, La Place, USA. 
Correspondence
Dr P Chattopadhyay, PhD, FICN, IFTM, College of Pharmacy, IFTM, Moradabad, India
Abstract: There is evidence that coenzyme Q10 (CoQ10) effect in mitigating experimental atherosclerosis in rabbits and rats.The effects of the administration 
of CoQ10 liposomal solution (LI-QSorb, Tishcon, NY,USA) (10 mg/kg per day) group A, n= 8) and placebo (peanut oil 10 mg/kg per day) (group B, n=8) were
 compared over 24 weeks in a randomized, single-blind, controlled trial. In particular rats, after reaching an age of 16 weeks or over, and a weight of 
200-250 grams, received the trans fatty acid rich diet. Baseline total cholesterol (TC, 112+15mg/dl) and HMG CoA reductase (1.98+0.54 IU) enzymes 
were within normal range. After 12 weeks feeding with TFA, there was a significant increase in T-C (407.6+48 vs 410.5+51.7mg/dl) and HMG-CoA 
reductase (5.13+1.6 vs 5.22+1.8 IU) enzyme, TBARS, and MDA in both groups. Intervention with LI-Q-Sorb, after having been fed an experimental 
diet for 24 weeks, was associated with a significant decline in all the parameters of oxidative stress and an increase in plasma levels of vitamin E 
and CoQ in the CoQ group compared to placebo group. These adverse effects were independent of lipid lowering. After 24 weeks, plasma levels of 
HMG-CoA reductase (2.48+1.1 vs 5.51+1.4 IU, P<0.01) showed significant decline in the CoQ group compared to placebo group. Liver cholesterol and T-C 
in blood also showed modest decline in the CoQ group than placebo group (381.3+27 vs 448.5+54mg/dl,).It seems that oxidative stress may be an 
independent cause of increase in HMG-CoA reductase enzyme, and CoQ may be a potential HMG-CoA reductase inhibitor. Cholesterol lowering may 
be a separate action of HMG-CoA reductase inhibitors such as statins.The findings suggest that antioxidant therapy with LI-Q-Sorb  may be used as 
an adjunct to lipid lowering for additional beneficial effects related to HMG-CoA reductase enzyme which may be protective against atherosclerosis and thrombosis.
Key Words. Cholesterol, lipids, oxidative stress, nutraceutical.
How to cite: Chattopadhya P, Singh RB, Hadi NR, Elkilany G. Effects of liposomal coenzyme Q10 (li-q-sorb) on HMG-Coa-reductase enzyme in hyperlipidemic  rats. 
Int J Clin Nutrition 2002; 2: 11-15.

4.NUTRITIONAL RISK FACTORS OF HYPERTENSION AND PREHYPERTENSION: THE FUTIRE OF CARDIOVASCULAR PROTECTION.
Daniel Pella (1), Viola Vargova (2), MA Niaz (3); OA Bawareed (4), Sergey Chibisov (6), Osama Elmarghi. 1,2Faculty of Medicine, PJ Safari University, 
Kosice, Slovakia; 3Medical Hospital and Research Center, Moradabad, India; 5,6Peoples Friendship University of Russia; Diabetes Care Center, Jahraa, Kuwait.
Correspondence
Dr Osama Elmarghi MD, PhD, Diabetes Care Center, Jahraa, Kuwait, Email: <dr-osamaam@hotmail.com>
Abstract: Rapid changes in diet and lifestyle with increase in salt, sugar and refined food intake have been associated with a marked increase in the prevalence 
of hypertension as well as mean systolic and diastolic blood pressures in the last three decades, among most of the developing populations of the world . 
Increased intake of alcohol and sedentary behavior may have predisposed obesity which is a major risk factors of pre-hypertension and hypertension causing 
increased burden of hypertension in most countries of the world. The absolute number of hypertensives (>140/90) in India, would be 31.5 million rural and 
34 million urbans, (total=65.5 million). Stage 1, hypertension (>140-159/90-99) 45.5 million and prehypertension (130-139/85-89) with 20% prevalence; 50 million. 
Almost half of the population of the world above 25 years have either prehypertension or hypertension. The Five City Study shows a high prevalence of 
prehypertension and hypertension among Indian urban population from five different regions of India.  The prevalence of prehypertension shows greater rates 
in south (women 31.5%, men 35.1%) and west India (women 30.0%, men 34.7%) compared to north (women 24.6%, men 26.7%) and east India (women 20.9%, 
men 23.5%) as well as central India (women 25.8%, men 28.3%). The overall prevalence of prehypertension (27.2 vs 30.0%, P<0.02) and hypertension (27.2 vs 
30.6%, P<0.02) after pooling of data from the five cities, were significantly greater among men compared to women. Among total number of subjects (n=6940), 
the prevalence of prehypertension and hypertension, respectively were similar (28.6 vs 28.9%). The increased burden of hypertension in the developing countries 
are due to increased intake of western type foods; refined rice, ready prepared foods with increased content of salt, sugar and trans fat and total fat which 
are risk factors of hypertension.
Key Words: western diet, sedentary behavior, salt, alcoholism, obesity.
How to cite: Pella D, Vargova V, Niaz MA, Bawareed OA, Sergey Chibisov S, Elmarghi O. Nutritional risk factors of hypertension and prehypertension: 
the future of cardiovascular protection.Int J Clin Nutrition 2002; 2: 16-20.

5.ASSOCIATION OF WESTERN TYPE DIET WITH OBESITY AND INCREASED MORTALITY AMONG URBAN DECEDENTS IN NORTH INDIA.
Viola Vargova (1), SK Kulshrestha (2), Ram B Singh (3); Vijendra Singh (4), Jan Fedacko,(5),  Daniel Pella, (6), MA Niaz (7).;1,5,6 PJ Safaric University, 
Kosice, Slovakia; 2,4Hindu College, Moradabad, India; 3,7Medical Hospital and Research Center, Moradabad,
Correspondence: 
Dr MA Niaz, PhD, FICN Medical Hospital and Research Center,Civil Lines, Moradabad-10 (UP)244001, India, Email:<mohdarifniaz@yahoo.com>
Abstract: There is evidence that western type diet, overweight and obesity are important risk factors of death due to cardiovascular disease(CVD) and diabetes. 
However, undernutrition and underweight predispose deaths due to infections. In a previous study, the association of western type diet, body mass index(BMI) 
with causes of deaths among urban decedents. We studied the randomly selected records of death of 2222 (1385 men and 837 women) decedents, aged 25-64 years, 
out of 3034 death records overall from the records at Municipal board. Western type food intake was considered when one fourth of the foods were bread, biscuits, 
cakes, syrups and refined rice (500-600 K Cal/day). Majority of the decedents (n=792,35.6%) (men 31.1%,n=431; and women 43.1%,n=361) had normal BMI of 
18.5-22.9 Kg/m2.The prevalence of underweight victims was 14.2%(n=315), overweight 29.4%(n=654)and obese 20.8%(n=461).There was an overall increase 
in risk factors; western food intake, diabetes mellitus, hypertension, and CAD among overweight and obese victims based on BMI criteria, and the trend 
was significant. BMI and western type food intake were positively associated with significant rising trend in the prevalence of circulatory causes of death, 
both among men and women. Infections and cancers as the cause of death were inversely associated with increase in BMI and western type food intake, 
among both men and women. Among circulatory causes of death, 25.0%(n=108) of the victims had normal BMI (18.5-22.9Kg/m2), which was because of 
victims dying due to rheumatic heart diseases and heart failure. Overweight (>23Kg/m 2) and obesity(>25Kg/m 2) in conjunction with western type food
 intake, are important determinant of mortality due to  CAD and underweight due to infections. Larger studies would be necessary to demonstrate the 
association of BMI with causes of death in India.
Kew words: Diet, body weight, cardiovascular diseases, undernutrition.
How to cite: Vargova V, Kulshrestha SK, Singh RB; Singh V, Fedacko, J,  Association of western type diet with increased mortality and and obesity among 
urban decedents in India. Int J Clin Nutrition 2002; 2: 21-25.

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.