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| ORIGINAL ARTICLE |
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| Year : 1999 | Volume
: 45
| Issue : 4 | Page : 110-3 |
Anthropometry, lipid profile and dietary pattern of patients with chronic ischaemic heart disease.
BU Vajifdar, VS Goyal, YY Lokhandwala, SR Mhamunkar, SP Mahadik, AK Gawad, SA Halankar, HL Kulkarni
Department of Cardiology, Seth G. S. Medical College and K.E.M. Hospital, Parel, Mumbai, India., India
Correspondence Address:
B U Vajifdar
Department of Cardiology, Seth G. S. Medical College and K.E.M. Hospital, Parel, Mumbai, India.
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 0010734348 
The anthropometry, lipid profile and dietary characteristics of 114 patients with chronic ischaemic heart disease (IHD) were evaluated. There were 91 (80%) men and the mean age was 56 +/- 9 years. The body mass index was near normal (24.4 +/- 3.4), but the waist: hip ratio was high (0.94 +/- 0.06) suggesting central obesity. This was well in accordance of the step II recommendations of the NCEP guidelines as regards their caloric intake and its break-up in terms of carbohydrate, protein and fat (including saturated, mono-unsaturated and poly-unsaturated fatty acids) content. Their daily cholesterol intake (31 +/- 32 mg/day, range 4-180) was very low. The total cholesterol (212 +/- 37 mg%) was marginally elevated, HDL cholesterol (33 +/- 7.5 mg%) was low, LDL cholesterol (148 +/- 39 mg%) was high and the total: HDL ratio (6.8 +/- 2.0) was significantly abnormal. The serum triglyceride level (154 +/- 68 mg%) was on the higher side of normal. These observations give further credence to the recently evolving view that there are different and hitherto unrecognised risk factors of IHD in Indians, who seem to have the highest incidence of IHD amongst all ethnic groups of the world despite consuming a diet low in fat and cholesterol content.
Keywords: Adult, Aged, Aged, 80 and over, Anthropometry, Female, Human, Lipoproteins, blood,Male, Middle Age, Myocardial Ischemia, blood,
How to cite this article:
Vajifdar B U, Goyal V S, Lokhandwala Y Y, Mhamunkar S R, Mahadik S P, Gawad A K, Halankar S A, Kulkarni H L. Anthropometry, lipid profile and dietary pattern of patients with chronic ischaemic heart disease. J Postgrad Med 1999;45:110 |
How to cite this URL:
Vajifdar B U, Goyal V S, Lokhandwala Y Y, Mhamunkar S R, Mahadik S P, Gawad A K, Halankar S A, Kulkarni H L. Anthropometry, lipid profile and dietary pattern of patients with chronic ischaemic heart disease. J Postgrad Med [serial online] 1999 [cited 2023 Mar 21];45:110. Available from: https://www.jpgmonline.com/text.asp?1999/45/4/110/336 |
The Indian population has a very high incidence of ischaemic heart disease (IHD) with lipid profiles and risk factors that are different from those seen in the western population[1]. Dietary patterns and anthropometric indices show racial and regional differences. There is scanty data from western India regarding these parameters. Hence we sought to analyse these in a group of patients having chronic IHD.
Study Population
Anthropometric, lipid profile and dietary parameters of 114 consecutive patients with chronic IHD, proven either by a coronary angiogram or an old myocardial infarction, were recorded. None of the patients were on any lipid lowering drugs. No dietary advice had been given to any of the patients prior to enrolment in this study
Parameters evaluated
The following parameters were evaluated: age, sex, weight, body mass index (BMI), waist (W) and hip (H) circumference and W:H ratio, complete lipid profile {viz. total, HDL, LDL and VLDL cholesterol, Apolipoprotein A-I (Apo A-I), Apolipoprotein B (Apo B) and serum triglycerides}. The patients also underwent detailed evaluation of their daily dietary intake as regards total calories, carbohydrates, proteins, fats, saturated fatty acids (SFA), mono-unsaturated fatty acids (MUFA), poly-unsaturated fatty acids (PUFA), cholesterol, and fibre.
Nutritional assessment
Nutritional information regarding the general pattern of food intake of the patients was estimated from a general 24 hours recall and a food frequency chart. The frequency of intake of various foodstuffs was ascertained to calculate the actual consumption of food. Food frequency consumption data provides a clearer picture of consumption of nutrients by the patients over a period of time as compared to only a 24 hours recall. The amount of food consumed was calculated using standard bowls (wati/ katori), and teaspoons/ tablespoons. Food models for dough size and cardboard cuttings depicting the size of the chapatti consumed were used to check the size of the chapatti consumed. The cooked amounts were converted to raw weights in grams and were averaged out to give the value of daily consumption. The intake of various components was calculated by using the "Nutritive Value of Indian foods" given by Indian Council of Medical Research[1].
[Table - 1] summarizes the anthropometric evaluation. Of the 114 patients evaluated, 91 were males and 23 were females. Their age ranged from 35 - 84 years with a mean of 56 + 9 years. The mean weight was 62 + 10 kg (range 37 - 94 kg) with a mean BMI of 24.4 + 3.4 (range 17 - 39). The W and H circumferences were 36.7 + 3.7 (range 26 - 45) and 38.9 + 3.2 (range 25 - 49) cm respectively. The W:H ratio was 0.94 + 0.06 (range 0.74 - 1.16).
The dietary evaluation [Table - 2] revealed a mean caloric daily consumption of 1885 kilocalories. Though the range was from 876 to 4977, only 2.5% patients consumed more than 3000 kcal/day. The mean dietary fat consumption was only 22% of total calories. Of this, SFA was 7.5%, MUFA was 7.5% and PUFA was 7%. Only 14% patients were consuming more than 30% percent calories in the form of fats. The mean cholesterol intake was only 31 mg/day. No patient was taking more than 200 mg of cholesterol per day. Only 7% of patients were consuming more than 100 mg/day of cholesterol. The daily fibre intake was 48 + 32 grams.
Detailed evaluation of the lipid profile is summarized in [Table - 3]. The total cholesterol level was 212 + 37 mg% (range 138 - 329). HDL, LDL and VLDL cholesterol levels were 33 + 7.5 (range 20 - 55), 148 + 39 (range 62 - 267) and 31 + 14 (10 - 85) mg% respectively and the total: HDL cholesterol ratio was 6.8 + 2.0 (3.5 - 11.8). Serum triglycerides showed a wide range from 52 - 425 mg% with a mean of 154 + 68 mg%. Apo A-I and Apo B levels were 105 + 24 (range 52 - 218) and 100 + 32 (range 59 - 308) mg% respectively.
The popular misconception that coronary atherosclerosis is a disease of affluence and indulgence, needs to be critically re-examined. Despite the lower body weights and higher prevalence of vegetarianism in India as compared to the West, coronary atherosclerosis is widely present in our country. In fact, immigrant Asian Indians in the USA and UK have the highest incidence of coronary artery disease[1]. Clearly coronary atherosclerosis is affected by many factors in addition to the well-known ones like smoking, diabetes and hypertension. Diet, exercise and genetic influences are prominent among them.
The male female ratio in our study was 4:1, which probably reflects the referral pattern at a tertiary care hospital rather than the true prevalence. Most patients were middle-aged. The standard criteria used to define obesity in the western literature is a BMI greater than 27.8 for men and greater than 27.3 for women[3]. Recommended W: H ratios are less than 0.9 in men and less than 0.8 in middle-aged and elderly women[4]. High BMI[5] and high W: H ratios[6] are associated with higher incidence of CAD. An Indian study reports the occurrence of IHD even in patients with lower BMI[7]. Similarly, most of our patients did not fall in the standard obese category, but still had an abnormal W: H ratio.
Dietary evaluation revealed that the daily intake of total calories, fats, SFA, MUFA, and PUFA was well in accordance of the step II recommendations of the NCEP guidelines[8]. The total cholesterol intake was much below the recommended level of 200 mg/day. Even the daily dietary fiber intake was better than that recommended by the American Heart Association[9]. High levels of total and LDL cholesterol are the established risk factors of IHD. High triglyceride and low HDL cholesterol are also reported as important and independent risk factors for IHD[10] and show a high prevalence in the Indian population[1]. We observed a similar pattern in our patients. The total cholesterol was marginally elevated, HDL cholesterol was low, LDL cholesterol was high and the total: HDL ratio was significantly abnormal. Also most patients had a high level of serum triglyceride level. Though, one study on Indian men in South Africa stated that Apo B is one of the best indicators of IHD amongst al lipid parameters[11], Apo A-I and Apo B levels have not been extensively studied or charted in the Indian population.
The results of our study should be viewed with the background that the study population consisted of patients with established and chronic IHD, who were already on medical treatment for at-least a few months prior to inclusion in this study.
We acknowledge the support of the 'Human Resource Development Group, Council for Scientific and Industrial Research, New Delhi' for recruiting Dr. Bhavesh U. Vajifdar as a 'Senior Research Associate' under their 'Scientific Pool Scheme' at the 'Department of Cardiology, King Edward Memorial Hospital, Mumbai'
| :: References | |  |
| 1. | Enas EA, Mehta J. Malignant coronary artery disease in young Asian Indians: thoughts on pathogenesis, prevention, and therapy. Coronary Artery Disease in Asian Indians (CADI) Study. Clin Cardiol 1995; 18:131-135  |
| 2. | Narsinga Rao BS, Deosthale YG, Pant KC. Nutritive value of Indian Foods. National Institute of Nutrition, Indian Council of Medical Research, 1989. |
| 3. | Kuczmarski RJ, Flegal KM, Campbell SM. Increasing prevelance of overweight among US adults: The National Health and Nutrition Examination Surveys, 1960 to 1991. JAMA 1994; 272: 205-208 |
| 4. | Freedman DS, Jacobsen SJ, Barboriak JJ. Body Fat Distribution and male/ female differences in lipids and lipoproteins. Circulation 1990; 81:1498-1500. |
| 5. | Willett WC, Manson JAE, Stampfer MJ. Weight, weight change and coronary heart disease in women: Risk within the 'normal' weight range. JAMA 1995; 273:461-464. |
| 6. | Larsson B, Bengtsson C, Bjorntop P. Is abdominal body fat distribution a major explanation for the sex difference in the incidence of myocardial infarction? The study of men born in 1913 and the study of women. Am J Epidemiol 1992; 135:266-273. |
| 7. | Thomas CS, Krishnaswami S. Distribution of Body Mass Index in Indian patients with coronary artery disease. Indian Heart J 1995; 47:134-137. |
| 8. | National Cholesterol Education Program. Second report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). Circulation 1994; 89:1333-1445. |
| 9. | The Nutrition Committee, American Heart Association. Dietary guidelines for healthy American adults. Circulation 1996; 94:1795-1800. |
| 10. | Jeppesen J, Madsbad S. High triglyceride, low HDL-cholesterol and risk of coronary heart disease. Ugeskr Laeger 1996; 25:158:6896-6901. |
| 11. | Sewdarsen M, Desai RK, Vythilingum S. Serum lipoproteins and apolipoproteins in young normo-cholesterolaemic, non-diabetic Indian men with myocardial infarction. Postgrad Med J 1991; 67:159-164. |
Tables
[Table - 1], [Table - 2], [Table - 3]
| This article has been cited by | | 1 |
Waist circumference correlates better with body mass index than waist-to-hip ratio in Asian Indians |
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| Kurpad SS, Tandon H, Srinivasan K | | NATIONAL MEDICAL JOURNAL OF INDIA. 2003; 16 (4): 189-192 | | [Pubmed] | |
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