Title: Correlation of Dietary Pattern and Risk Factors in Patients with Coronary Artery Disease in Rural Population of Tamil Nadu- Pilot Study

Authors: Dr A. G. Narayanaswamy, Dr P. Vinodh Kumar, Dr S. Porchelvan, S. Pavithra

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i11.128

Abstract

Worldwide studies have reported increase in the incidence of CAD in illiterate & people with lower socio economic status1. Based on cross sectional morbidity surveys incidence of coronary heart disease has increased two fold, (2.06% is 1970’s to 4.04% in 1990’s) in rural India3. There is no published data correlating dietary pattern & risk factors in patient with CAD in rural Tamil Nadu.

Aim: Correlation of dietary pattern and risk factors in patient with CAD in rural Tamil Nadu.

Study Design: Retrospective case control study. All patients residing in rural areas who underwent CAG in our centre with evidence of CAD were enrolled for the study after informed consent.

Methodology: All the patients with CAD were interviewed by the dietician of our hospital regarding their diet pattern, using a 7days dietary recall questionnaire. This was analysed & daily intake fat, carbohydrates, protein & total calories of each patient was tabulated & compared with recommended dietary allowance 2010 guidelines for Indian (ICMR).

Results: A total of 148 patients who underwent CAG 39.9% (59 patients) had normal CAG, 29.1% (43 patients) had SVD, 17.6% (26 patients) had DVD and 13.5% (20 patients) had TVD. Male & Female patients were equally distributed in CAD & normal group (P=0.24). Patients with Hypertension (OR 1.4, 95% CI: 0.6 – 2.9), Diabetes (OR 1.85, 95% CI: 0.91 – 3.71) tended to have CAD, however it did not reach statistical significance. The mean intake of carbohydrates, protein, and fat did not reach statistically significance between the 2 groups. There was a significant difference in carbohydrate intake in patients with single vessel disease, but did not reach statistical significance in patients with double / triple vessel disease when compared with normal coronaries.

Conclusion: Risk of CAD in rural population of Tamil Nadu is not related to total carbohydrates or fat intake. Coronary artery disease could be related poor intake of vegetables and fruits.

Keywords: Coronary Artery Disease, Dietary Pattern, rural population.

References

  1. World Health Organization. Preventing chronic disease: a vital investment. Geneva. World Health Organization 2005.
  2. Gupta R, Joshi P, Mohan V, Reddy KS, Yosuf S. Epidemiology and causation of coronary heart disease and stroke in India. Heart 2008; 94:16 – 26.
  3. Gupta R,Misra A, Pais P, Rastogi P,  Gupta VP. Correlation of regional cardiovascular disease mortality in India with lifestyle and nutritional factors. Int J Cardiol. 2006 Apr 14; 108(3):291-300.
  4. Kinra S, Bowen LJ et al. Sociodemographic patterning of non – communicable disease factors in rural India: a cross sectional study. BMJ. 2010;341:c4974.
  5. Chow C, Cardona M, Raju PK, Iyengar S, Sukumar A, Raju R, et al. Cardiovascular disease and risk factors among 345 adults in rural India—the Andhra Pradesh Rural Health Initiative. Int J Cardiol 2007;116:180-5.
  6. Chadha SL, Gopinath N, Shekhawat S et al. Urban-rural differences in the prevalence of coronary heart disease and its risk factors in Delhi Bull World Health Organ. 1997; 75(1):31-8.
  7. Zachariah G, Harikrishnan S, Krishnan MN et al. Prevalence of coronary artery disease and coronary risk factors in Kerala, South India: a population survey - design and methods. Indian Heart J. 2013 May-Jun; 65(3):243-9
  8. Ajay VS, Prabhakaran D. Coronary heart disease in Indians: Implications of the INTERHEART study.The Indian Journal of Medical Research. 2010;132(5):561-566. doi:10.4103/0971-5916.73396.
  9. Hu F, Stampfer MJ, Manson JE et al. Dietary fat intake and the risk of coronary heart disease in women.NEngl J Med1997;337: 1491–9.
  10. Jakobsen MU, O’Reilly EJ, Heitmann BL et al. Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J ClinNutr 2009; 89: 1425–32.
  11. Multiple Risk Factor Intervention Trial Research Group. Multiple risk factor intervention trial: risk factor changes and mortality results.JAMA1982;248:1465–77.
  12. Howard BV, Van Horn L, Hsia J Et al. Low-fat dietary pattern and risk of cardiovascular disease: The Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA 2006; 295:655–66.
  13. Hjermann I, Velve Byre K, Holme I, Leren P. Effect of diet and smoking intervention on the incidence of coronary heart disease. Report from the Oslo Study Group of a randomised trial in healthymen. Lancet1981;2:1303–10.
  14. Sacks F. Dietary fats and coronary heart disease. Overview. J CardiovascRisk1994; 1:3–8.
  15. de Lorgeril M, Renaud S, Mamelle N et al. Mediterranean alphalinolenic acid-rich diet in secondary prevention of coronary heart disease [Erratum in: Lancet 1995; 345: 738]. Lancet 1994; 343:1454–9.
  16. Mensink RP,Zock PL, Katan MB,  Hornstra G. Effect of dietary cis and trans fatty acids on serum lipoprotein [a] levels in humans. J Lipid Res 1992; 33: 1493–501.
  17. Dehghan, MahshidDiaz, R et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. The Lancet Aug 29, 2017. DOI: 1016/S0140-6736(17)32252-3
  18. Luc Dauchet, Philippe Amouyel, Serge Hercberg, and Jean Dallongeville. Fruit and Vegetable Consumption and Risk of Coronary Heart Disease: A Meta-Analysis of Cohort Studies. Nutr.October 2006 136: 10 2588-2593.
  19. Tanuja Rastogi, K Srinath Reddy, Mario Vaz, Donna Spiegelman, D Prabha-karan, Walter C Willett, Meir J Stampfer, and Alberto Ascherio. Diet and risk of ischemic heart disease in India. Am J ClinNutr 2004 79: 4 582-592

Corresponding Author

Dr A. G. Narayanaswamy

Department of Cardiology, Saveetha Medical College, Thandalam, Chennai – 602105

Telephone No: 9444054861, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.