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| GUEST EDITORIAL |
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| Year : 2011 | Volume
: 57
| Issue : 1 | Page : 1-2 |
Chronic disease burden in rural India attributable to diet, obesity, and tobacco use
PN Singh
Department of Epidemiology and Global Health, Loma Linda University, Loma Linda, CA 92350, USA
| Date of Web Publication | 31-Jan-2011 |
Correspondence Address:
P N Singh
Department of Epidemiology and Global Health, Loma Linda University, Loma Linda, CA 92350
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0022-3859.76349
How to cite this article:
Singh P N. Chronic disease burden in rural India attributable to diet, obesity, and tobacco use. J Postgrad Med 2011;57:1-2 |
During the past decade, the number of diabetics in India increased from 32 million to 50 million. [1] The recent Global Burden of Disease study reported that in 2003, there were 32 million coronary heart disease (CHD) cases in India. [2] This figure represents about a twofold increase in CHD prevalence in rural areas and a sixfold increase in CHD prevalence in urban areas relative to 40 years ago. [2],[3] Recent mortality data from 180,000 adults of the Andra Pradhesh Rural Health Initiative indicate that death rates (32 deaths per 1000 persons) from CHD, stroke, and other circulatory system disease now exceed both accidental death (13 per 1000 persons) or deaths from infectious and parasitic disease (12 per 1000 persons) in rural India. [4] This substantial increase in the prevalence of diabetes, CHD, and stroke in India points to the occurrence of an epidemiologic transition due to a higher prevalence of traditional cardiovascular disease risk factors such as diet (higher saturated fat and meat intake), physical inactivity, obesity and tobacco use. The increased prevalence of these risk factors is a likely consequence of the change in lifestyle pattern from the rapid urbanization (30% urban inhabitants with a projected rise to 43% by 2021) of the Indian population.
Is there evidence for such changes in lifestyle pattern in India? Recent trends in diet patterns in India deserve scrutiny. The longstanding practice of faith-based vegetarianism that has been present in India for more than 3000 years may be on the decline. Data from the National Sample Survey of India indicate that between 1988 and 2000, there was a 77% increase in animal product consumption in rural areas and a 45% increase in urban areas. [5] Also, recent national consumption data indicate that from 2000 to 2006, broiler meat availability has increased by about 10% per year. [6] There are extensive data implicating nutritional (macronutrients, micronutrients) and other components of ingested meat products as risk factors for fatal disease. [7] In the studies of the Indian population, Pais et al. found that the Indian non-vegetarian diet pattern was associated with a significant 82% increase in the risk of CHD. [8] Rastogi showed an inverse relation between vegetable intake (excluding potatoes) and ischemic heart disease that was especially evident for green leafy vegetables. [9] Our group at Loma Linda University found that faith-based vegetarians who changed their diet pattern from zero meat intake to weekly meat intake during a 17-year period, then experienced weight gain, obesity, an increased risk of diabetes, and a 3.6 year decrease in life expectancy. [10],[11]
It also important to note that the more recent harmful trends in diet and obesity in India are occurring in combination, and probably in synergism, with other longstanding chronic disease risk factors. The rate of tobacco use in India remains quite high, especially in the rural areas. In addition to cigarettes, smokeless tobacco use, particularly in women, remains a persistent problem. This latter form of tobacco is found throughout South Asia, Southeast Asia, and Asia-Pacific regions and in rural areas and is part of a cultural, familial, and traditional medicine practices. Genetic factors in South Asians have also long been a suspected contributor to increased cardiovascular disease risk. CHD appears to be occurring in Asian Indians 5-10 years earlier than in other populations, with the mean age at first presentation of an acute myocardial infarction being about 53 years. Some of this effect has been attributed to an "Asian Indian Phenotype" which produces a high-risk metabolic profile that includes increased insulin resistance, metabolic syndrome, elevated concentrations of lipoprotein(a) and homocysteine, greater abdominal adiposity, lower adiponectin level, and higher sensitivity to C-reactive protein. [13] Razak et al. recently reported that the glucose, lipid, and blood pressure levels found in obese (≥30 kg/m2) European adults were evident in Asian Indians at a body mass index that was 6 kg/m2 lower - an effect suggesting Asian Indians need a lower cutpoint for clinical obesity due to their greater sensitivity diabetogenic and atherogenic effects of excess adipose tissue. [14]
In this issue of the Journal, Kaur et al[15]. have clearly documented the prevalence of several potent chronic disease risk factors in a large cross-sectional study of 10,500 adults in the rural areas of Tamil Nadu. In studying the effect of overweight and obesity, they have aptly eschewed the global cutpoint for overweight/obesity at≥25 kg/m2 and instead focused on a more sensitive indicator of ≥23 kg/m2 for Asian populations. This classifies 32.8% of males and 38.2% of females as overweight or obese. Women also exceeded men in rates of abdominal adiposity. The relation between high rates of abdominal adiposity and higher education may be reflecting effects of a sedentary lifestyle. The high prevalence of use of cooking oils (palm oils) that have a more atherogenic profile is noteworthy. Future surveys that measure diet, cooking methods, and physical activity (work, leisure time) in detail should prove useful in the design of interventions and health promotion campaigns. The authors have also shown with alarming prevalence statistics how the high rate of obesity in this community is occurring in addition to high rates of current smoking, smokeless tobacco use, alcohol use, and family history of chronic disease. Taken together, the community risk factor profile for rural Tamil Nadu predicts a major chronic disease burden both presently and in the coming decade. Since this is occurring in a rural population, much of the chronic disease that manifests from this community's risk factor profile will likely be diagnosed at a later stage. Thus, in addition to health promotion and education efforts that are targeting prevention, efforts to educate rural adults about early symptoms of chronic disease are also needed.
| :: References | |  |
| 1. | Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res 2007;125:217-30. 
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| 2. | Gupta R. Burden of coronary heart disease in India. Indian Heart J 2005;57:632-8.
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| 3. | Gupta R. Coronary heart disease in India: Absolute numbers and economic burden. Rapid response to Ghaffar A, Reddy KS, Singhi M. Burden of non-communicable diseases in South Asia. BMJ 2004;328:807-10.
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| 4. | Joshi R, Cardona M, Iyengar S, Sukumar A, Raju CR, Raju KR, et al. Chronic diseases now a leading cause of death in rural India--mortality data from the Andhra Pradesh Rural Health Initiative. Int J Epidemiol 2006;35:1522-9.
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| 5. | Amarasinghe UA, Shah T, Singh OP. Changing consumption patterns: Implications for food and water demand in India (Research Report 119), Colombo, Sri Lanka. International Water Management Institute, 2007. p. 1-43.
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| 6. | Meat Production in India (1971-2009). Available from: http://www.indiastat.com/agriculture/2/animalhusbandrylivestock/48/meatproductioninindia/449517/stats.aspx [last cited in 2011].
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| 7. | Fraser GE. "Diet, Chronic Disease, and Longevity: Studies of Adventists and Other Vegetarians" Oxford University Press, 2003.
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| 8. | Pais P, Pogue J, Gerstein H, Zachariah E, Savitha D, Jayprakash S, et al. Risk factors for acute myocardial infarction in Indians: a case-control study. Lancet 1996;348:358-63.
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| 9. | Rastogi T, Reddy KS, Vaz M, Spiegelman D, Prabhakaran D, Willett WC, et al. Diet and risk of ischemic heart disease in India. Am J Clin Nutr 2004;79:582-92.
[PUBMED] [FULLTEXT] |
| 10. | Vang A, Singh PN, Lee JW, Haddad EH, Brinegar CH. Meats, processed meats,obesity, weight gain and occurrence of diabetes among adults: findings from dventist Health Studies. Ann Nutr Metab 2008;52:96-104.
[PUBMED] [FULLTEXT] |
| 11. | Singh PN, Sabaté J, Fraser GE. Does low meat consumption increase life expectancy in humans? Am J Clin Nutr 2003;78:526S-32S.
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| 12. | Available from: http://www.tobaccoatlas.org/ [last cited in 2011].
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| 13. | Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res 2007;125:217-30.
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| 14. | Razak F, Anand SS, Shannon H, Vuksan V, Davis B, Jacobs R, et al, McQueen M, Yusuf S. Defining obesity cut points in a multiethnic population. Circulation 2007;115:2111-8.
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| 15. | Kaur P, Rao SR, Radhakrishnan E, Ramachandran R, Venkatachalam R, Gupte MD. High prevalence of tobacco use, alcohol use and overweight in a rural population in Tamil Nadu, India. J Postgrad Med 2011;57:9-15.
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