DOI 10.1515/jbcpp-2013-0128 J Basic Clin Physiol Pharmacol 2014; 25(4): 351–358
Soumya Mishra*, Swasti Banerjee, Tridip Kumar Sengupta, Anugya Aparajita Behera, Magna Manjareeka and Jayanti Mishra
Association of diet and anthropometric measures as cardiovascular modifiable risk factors in young adults Abstract Background: Cardiovascular accidents are the major cause of death in the developing world, accounting for nearly 40% of deaths in adult men and women. Developed countries have already brought this under control, whereas India has to take a giant leap. Diet plays a pivotal role among the various modifiable cardiovascular risk factors. The sole objective of this study is to point at nutrition as being the main modulator of different anthropometric parameters and directly or indirectly has a tremendous impact on the blood pressure levels even during young age. Methods: In a cross-sectional study involving 223 young adults, the pattern of food habits and level of physical activity were determined from self-reported questionnaires, while blood pressure, weight, height, waist circumference (WC), and hip circumference were measured, and body mass index (BMI) and waist-to-hip ratio (WHR) were computed. The subjects were grouped as normotensives and prehypertensives and also were compared according to their BMI and other parameters. Results: Statistically significant, greater association of weight followed by WC with the prehypertensive levels of blood pressure compared to other parameters was seen. The subjects detected as prehypertensives had predilection for salty, fried, oily, sweet, and fast food; BMI > 25 kg/m2; and WC and WHR in high risk-categories per World Health Organization standards. More than 69% of subjects had high WHR, whereas only 9% of total subjects exercised regularly. Conclusions: Central obesity is associated with sedentary life and high intake of calories, leading to hypertension with advancing age. Early detection, awareness, and primary prevention would help reduce morbidity and mortality associated with cardiovascular diseases. Keywords: body mass index (BMI); cardiovascular modifiable risk factors; nutrition; prehypertensives; waist circumference; waist-to-hip ratio (WHR); young adults.
*Corresponding author: Dr. Soumya Mishra, Kalinga Institute of Medical Sciences, Department of Physiology, KIIT University, Bhubaneswar, Odisha-751024, India, E-mail: [email protected] Swasti Banerjee, Tridip Kumar Sengupta, Anugya Aparajita Behera, Magna Manjareeka and Jayanti Mishra: Kalinga Institute of Medical Sciences, Department of Physiology, KIIT University, Bhubaneswar, India
Introduction The major cardiovascular diseases affecting the developed countries have atherosclerosis and hypertension at their core, both of which can be curtailed at an early stage by primary prevention [1, 2]. Hypertension affects many cardiovascular diseases [3], such as coronary heart disease, renal disease, and stroke. In overweight individuals, the influence of hypertension on cardiovascular disease is more substantial than in normal-weight individuals [4]. Thus, an inevitable association between obesity and cardiovascular diseases is established on the “building blocks” of obesity, nutrition or diet, etc., of which nutrition plays a pivotal role. In other words, we can say that nutrition or diet is responsible for weight gain, increased body mass index (BMI), increased waist-to-hip ratio (WHR); salty and high-fat diet accelerates hypertension and atherogenic changes in the body. Our heart and health are on our food plates. If we monitor what we eat and how we eat, then we can maintain a healthy weight, avoid excess deposition of fat at undesirable parts of the body, and also keep a check on our blood pressure (BP) levels, which in turn is an indicator of the status of the blood vessels of our body. Globally, high BP is estimated to cause 7.1 million deaths, about 13% of the total deaths. About 62% of cerebrovascular disease and 49% of ischemic heart disease are attributable to suboptimal BP [systolic BP (SBP) > 115 mm Hg] [5]. Developing countries are increasingly faced with the double burden of hypertension and other cardiovascular diseases. Overweight and obesity
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352 Mishra et al.: Diet and anthropometric measures as CV risk factors increase the risks of high BP, coronary heart disease, ischemic stroke, type II diabetes mellitus, certain cancers, and even normal lung functioning [6]. Worldwide, about 58% of diabetes mellitus and 21% of ischemic heart disease cases are attributable to BMI > 21 kg/m2 [7]. The rate of obesity is rising at an alarming pace mainly due to changes in lifestyle, advancing technology, and less attention to diet and nutrition. The process of atherosclerosis begins in youth but manifests itself clinically years later, allowing other risk factors to accelerate the process. Positive association between BMI and BP has also been reported among Asian populations [8–10] and is a wellestablished fact today. India, in a process of rapid economic development and modernization with changing lifestyle factors, has an increasing trend of hypertension, especially among the urban population [11]. Cardiovascular diseases in developing countries have an early age of onset and greater mortality as compared to those in developed countries [12]. Cardiovascular risk factors have been studied in the younger populations – children, adolescents, and youth – in different parts of the world. Previous studies have reported that the atherosclerosis factors start early in childhood and youth, and the risk factors tend to track and magnify with age [13]. The mean age at which the risk factors establish varies from 40 to 50 years [14–16]. Developed countries have already taken measures to keep hypertension and obesity under control, but India has to make substantial efforts in preventing premature mortality. Small but significant reduction in BP across a larger population would have a larger effect on heart disease and stroke rates than large reductions restricted to people with very high BPs. This can be attributed to the fact that a small reduction in risk for the majority of people translates to a greater reduction in disease rates than a large reduction in risk for a minority of people. As seen from several studies of developed countries, modifications introduced during youth bring about a significant decline in cardiovascular morbidity and mortality burden over society. Thus, an attempt could be made at preventing and eliminating modifiable lifestyle risk factors for cardiovascular disease if attended to at the initial years of adulthood. The present study is designed to determine the strongest association of prehypertensive levels of BP with the different anthropometric measures such as weight, BMI, waist circumference (WC), hip circumference (HC), and WHR. In predicting cardiovascular risks and the early development of obesity-related cardiovascular abnormalities in young adults, we can thus identify the need to prevent obesity early in life and to avoid its unfavorable
life-threatening consequences later in life. Diet is considered the “fulcrum” on which these above-mentioned parameters strike a balance with each other. Prevention means reducing the probability of disease, not eliminating an individual’s risk, and diet is only one aspect of any preventive strategy. This study targets the modifiable risk factors of cardiovascular disease and attempts to reveal diet and nutrition as an important determinant of cardiovascular disease around which other risk factors are interwoven.
Materials and methods Study design A cross-sectional study was undertaken in the Department of Physiology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, during September 2012 till January 2013. Approval of the institutional Ethics Committee was taken prior to the start of the study. A sample size of 302 was estimated from a study population of medical and dental students of the institute. Medical students were specifically chosen for this research, as creating awareness among them would be projected at a higher degree on society by the subjects themselves. Subjects were selected by random sampling, and informed written consent was taken for participation in the study after detailed explanation of the purpose and method of conducting this study. The students were given a pretested questionnaire regarding their food and exercise habits. This was followed by a simple anthropometric measurement of height (m), weight (kg), WC (cm), HC (cm), and BP recording. BMI and WHR were determined from the parameters measured.
Subjects The subjects were of the age group 18–22 years. This age group was chosen because they are at the junction of adolescence and adulthood, and this phase of life could help us track the future progression of hypertension. There is little evidence of data on research conducted in this age population. The subjects who were undergoing some sort of weight management program or training were excluded from this study because they had already undertaken preventive measures for cardiovascular morbidity, knowingly or unknowingly. The subjects who had an episode of gastrointestinal upset within the past month were also excluded from the study as their regular food pattern would have been disturbed, and this might lead to bias in our study. Subjects with a previous history of cardiovascular disease, those taking any drug that might affect the cardiovascular functioning in some way, or established cases of hypertension were also excluded from this study. History of any other systemic disease in the study subjects was considered as an exclusion criterion. Smokers and alcoholics were not included in the study. Young women who had a history of or presently taking hormonal treatment were excluded from this study as it can affect weight in some cases.
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Mishra et al.: Diet and anthropometric measures as CV risk factors 353
Measurements Using a standard height measuring rod, the height of each subject was determined in meters and rounded off to two decimal places. Weight (kg) was recorded using a digital weighing machine, and BMI was calculated as weight (kg)/[height (m)]2. WC was taken at the end of a normal expiration to the nearest 0.1 cm at the midpoint between the last floating rib and the top of the iliac crest [17, 18]. HC was measured at the level of the symphysis pubis and the greatest gluteal protuberance [18]. WHR was calculated as WC (cm) divided by HC (cm). Based on cut points recommended by the World Health Organization, Health Canada, and Obesity Canada, the respondents included in this analysis were divided into four health risk categories based on BMI (kg/m2): –– Underweight (
Soumya Mishra*, Swasti Banerjee, Tridip Kumar Sengupta, Anugya Aparajita Behera, Magna Manjareeka and Jayanti Mishra
Association of diet and anthropometric measures as cardiovascular modifiable risk factors in young adults Abstract Background: Cardiovascular accidents are the major cause of death in the developing world, accounting for nearly 40% of deaths in adult men and women. Developed countries have already brought this under control, whereas India has to take a giant leap. Diet plays a pivotal role among the various modifiable cardiovascular risk factors. The sole objective of this study is to point at nutrition as being the main modulator of different anthropometric parameters and directly or indirectly has a tremendous impact on the blood pressure levels even during young age. Methods: In a cross-sectional study involving 223 young adults, the pattern of food habits and level of physical activity were determined from self-reported questionnaires, while blood pressure, weight, height, waist circumference (WC), and hip circumference were measured, and body mass index (BMI) and waist-to-hip ratio (WHR) were computed. The subjects were grouped as normotensives and prehypertensives and also were compared according to their BMI and other parameters. Results: Statistically significant, greater association of weight followed by WC with the prehypertensive levels of blood pressure compared to other parameters was seen. The subjects detected as prehypertensives had predilection for salty, fried, oily, sweet, and fast food; BMI > 25 kg/m2; and WC and WHR in high risk-categories per World Health Organization standards. More than 69% of subjects had high WHR, whereas only 9% of total subjects exercised regularly. Conclusions: Central obesity is associated with sedentary life and high intake of calories, leading to hypertension with advancing age. Early detection, awareness, and primary prevention would help reduce morbidity and mortality associated with cardiovascular diseases. Keywords: body mass index (BMI); cardiovascular modifiable risk factors; nutrition; prehypertensives; waist circumference; waist-to-hip ratio (WHR); young adults.
*Corresponding author: Dr. Soumya Mishra, Kalinga Institute of Medical Sciences, Department of Physiology, KIIT University, Bhubaneswar, Odisha-751024, India, E-mail: [email protected] Swasti Banerjee, Tridip Kumar Sengupta, Anugya Aparajita Behera, Magna Manjareeka and Jayanti Mishra: Kalinga Institute of Medical Sciences, Department of Physiology, KIIT University, Bhubaneswar, India
Introduction The major cardiovascular diseases affecting the developed countries have atherosclerosis and hypertension at their core, both of which can be curtailed at an early stage by primary prevention [1, 2]. Hypertension affects many cardiovascular diseases [3], such as coronary heart disease, renal disease, and stroke. In overweight individuals, the influence of hypertension on cardiovascular disease is more substantial than in normal-weight individuals [4]. Thus, an inevitable association between obesity and cardiovascular diseases is established on the “building blocks” of obesity, nutrition or diet, etc., of which nutrition plays a pivotal role. In other words, we can say that nutrition or diet is responsible for weight gain, increased body mass index (BMI), increased waist-to-hip ratio (WHR); salty and high-fat diet accelerates hypertension and atherogenic changes in the body. Our heart and health are on our food plates. If we monitor what we eat and how we eat, then we can maintain a healthy weight, avoid excess deposition of fat at undesirable parts of the body, and also keep a check on our blood pressure (BP) levels, which in turn is an indicator of the status of the blood vessels of our body. Globally, high BP is estimated to cause 7.1 million deaths, about 13% of the total deaths. About 62% of cerebrovascular disease and 49% of ischemic heart disease are attributable to suboptimal BP [systolic BP (SBP) > 115 mm Hg] [5]. Developing countries are increasingly faced with the double burden of hypertension and other cardiovascular diseases. Overweight and obesity
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352 Mishra et al.: Diet and anthropometric measures as CV risk factors increase the risks of high BP, coronary heart disease, ischemic stroke, type II diabetes mellitus, certain cancers, and even normal lung functioning [6]. Worldwide, about 58% of diabetes mellitus and 21% of ischemic heart disease cases are attributable to BMI > 21 kg/m2 [7]. The rate of obesity is rising at an alarming pace mainly due to changes in lifestyle, advancing technology, and less attention to diet and nutrition. The process of atherosclerosis begins in youth but manifests itself clinically years later, allowing other risk factors to accelerate the process. Positive association between BMI and BP has also been reported among Asian populations [8–10] and is a wellestablished fact today. India, in a process of rapid economic development and modernization with changing lifestyle factors, has an increasing trend of hypertension, especially among the urban population [11]. Cardiovascular diseases in developing countries have an early age of onset and greater mortality as compared to those in developed countries [12]. Cardiovascular risk factors have been studied in the younger populations – children, adolescents, and youth – in different parts of the world. Previous studies have reported that the atherosclerosis factors start early in childhood and youth, and the risk factors tend to track and magnify with age [13]. The mean age at which the risk factors establish varies from 40 to 50 years [14–16]. Developed countries have already taken measures to keep hypertension and obesity under control, but India has to make substantial efforts in preventing premature mortality. Small but significant reduction in BP across a larger population would have a larger effect on heart disease and stroke rates than large reductions restricted to people with very high BPs. This can be attributed to the fact that a small reduction in risk for the majority of people translates to a greater reduction in disease rates than a large reduction in risk for a minority of people. As seen from several studies of developed countries, modifications introduced during youth bring about a significant decline in cardiovascular morbidity and mortality burden over society. Thus, an attempt could be made at preventing and eliminating modifiable lifestyle risk factors for cardiovascular disease if attended to at the initial years of adulthood. The present study is designed to determine the strongest association of prehypertensive levels of BP with the different anthropometric measures such as weight, BMI, waist circumference (WC), hip circumference (HC), and WHR. In predicting cardiovascular risks and the early development of obesity-related cardiovascular abnormalities in young adults, we can thus identify the need to prevent obesity early in life and to avoid its unfavorable
life-threatening consequences later in life. Diet is considered the “fulcrum” on which these above-mentioned parameters strike a balance with each other. Prevention means reducing the probability of disease, not eliminating an individual’s risk, and diet is only one aspect of any preventive strategy. This study targets the modifiable risk factors of cardiovascular disease and attempts to reveal diet and nutrition as an important determinant of cardiovascular disease around which other risk factors are interwoven.
Materials and methods Study design A cross-sectional study was undertaken in the Department of Physiology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, during September 2012 till January 2013. Approval of the institutional Ethics Committee was taken prior to the start of the study. A sample size of 302 was estimated from a study population of medical and dental students of the institute. Medical students were specifically chosen for this research, as creating awareness among them would be projected at a higher degree on society by the subjects themselves. Subjects were selected by random sampling, and informed written consent was taken for participation in the study after detailed explanation of the purpose and method of conducting this study. The students were given a pretested questionnaire regarding their food and exercise habits. This was followed by a simple anthropometric measurement of height (m), weight (kg), WC (cm), HC (cm), and BP recording. BMI and WHR were determined from the parameters measured.
Subjects The subjects were of the age group 18–22 years. This age group was chosen because they are at the junction of adolescence and adulthood, and this phase of life could help us track the future progression of hypertension. There is little evidence of data on research conducted in this age population. The subjects who were undergoing some sort of weight management program or training were excluded from this study because they had already undertaken preventive measures for cardiovascular morbidity, knowingly or unknowingly. The subjects who had an episode of gastrointestinal upset within the past month were also excluded from the study as their regular food pattern would have been disturbed, and this might lead to bias in our study. Subjects with a previous history of cardiovascular disease, those taking any drug that might affect the cardiovascular functioning in some way, or established cases of hypertension were also excluded from this study. History of any other systemic disease in the study subjects was considered as an exclusion criterion. Smokers and alcoholics were not included in the study. Young women who had a history of or presently taking hormonal treatment were excluded from this study as it can affect weight in some cases.
Brought to you by | Penn State - The Pennsylvania State University Authenticated Download Date | 5/22/15 7:16 PM
Mishra et al.: Diet and anthropometric measures as CV risk factors 353
Measurements Using a standard height measuring rod, the height of each subject was determined in meters and rounded off to two decimal places. Weight (kg) was recorded using a digital weighing machine, and BMI was calculated as weight (kg)/[height (m)]2. WC was taken at the end of a normal expiration to the nearest 0.1 cm at the midpoint between the last floating rib and the top of the iliac crest [17, 18]. HC was measured at the level of the symphysis pubis and the greatest gluteal protuberance [18]. WHR was calculated as WC (cm) divided by HC (cm). Based on cut points recommended by the World Health Organization, Health Canada, and Obesity Canada, the respondents included in this analysis were divided into four health risk categories based on BMI (kg/m2): –– Underweight (
