Major dietary patterns and risk of acute myocardial infarction in young, urban Pakistani population

To investigate the role of dietary intake in the development of premature acute myocardial infarction [AMI] in a hospital-based Pakistani population in Karachi. In a case control study, 203 consecutive patients [146 males and 57 females] with their first AMI and age below 45 years were enrolled with informed consent. Similarly, 205 gender and age matched [within 3 years] healthy adults were also included as controls. Dietary intake of both cases and controls was assessed by using a simple 14-item food frequency questionnaire. Using factor analysis, 3 major dietary patterns- prudent dietary pattern, combination dietary pattern and western dietary pattern were identified. Fasting plasma/serum of both cases and controls were analyzed for homocysteine, folate, vitamin B[12], blood Pb, ferritin, cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides. ANOVAand conditional logistic regression were used to predict the association of dietary patterns with AMI. Consumption of prudent diet, characterized by high consumption of legumes, vegetables, wheat, chicken and fruits, is protective against the risk of premature AMI. Moderate to high consumption of combination diet, characterized by high intake of eggs, fish, fruits, juices and coffee was associated with decreased risk of AMI. No association was observed between western diet, characterized by high intake of meat, fish and tea with milk and risk of AMI. Consumption of a prudent dietary pattern and a combination dietary pattern is protective against the risk of AMI in a Pakistani population

High blood lead levels compromise the total antioxidant status of normal healthy adults in a population in Karachi

To find out the total antioxidant status [TAS] and its relationship to blood lead [Pb] in apparently healthy adults in a population in Karachi. In a cross-sectional study, a cohort of 132 healthy adults [67 having blood Pb levels below 7 micro g/dl and 65 having blood Pb levels above 11 micro g/dl] were randomly selected from 872 healthy adults [age 18-60 years] recruited from a low-income population in Karachi. TAS in serum was analyzed using spectrophotometric assay based kit, while blood Pb levels were determined using Atomic Absorption Spectrometric method. Mean serum TAS levels were significantly less in subjects with high blood Pb concentration compared to those with low blood Pb concentration [1.05 +/- 0.27 mmol/l vs 1.16 +/- 0.24 mmol/l; P=0.01]. In a correlation analysis adjusted for age and gender, TAS levels were found to be modestly associated with blood Pb [Pearson's r=-0.2; P=0.02]. Mean TAS levels were significantly decreased in apparently healthy adults with high blood Pb in a general population in Karachi. Exposure to Pb pollution could be compromising antioxidant ability of individuals in the study population

High prevalence of mild hyperhomocysteinemia and folate, B12 and B6 deficiencies in an urban population in Karachi, Pakistan

To find out the prevalence of hyperhomocysteinemia, and deficiencies of folate, vitamin B6 and vitamin B12 in an urban population in Karachi, Pakistan. In a pre and post experimental study, eight hundred and seventy-two apparently healthy adults [aged 18-60 years; 355 males and 517 females] were recruited from a low-income urban locality in East of Karachi from February 2006 to March 2007. Fasting venous blood was obtained. Serum was analyzed for folate and vitamin B12. Plasma was analyzed for pyridoxal phosphate [PLP, coenzymic form of B6] and total homocysteine. A group of vitamin-deficient individuals [n=194] was given 3-week supplementation with folic acid [5mg/day], methycobalamin [0.5mg/day] and pyridoxine hydrochloride [vitamin B6, 50 mg/day]. After supplementation, serum/plasma levels of folate, vitamin B12, PLP and homocysteine were again determined. Prevalence of hyperhomocysteinemia [>15micromol/l] was 32%. Similarly percent values of folate deficiency [<3.5ng/ml], vitamin B6 deficiency [PLP<20 nmol/l] and vitamin B12 deficiency [<200pg/ml] in the study population were 27.5%, 33.7% and 9.74%, respectively. Hyperhomocysteinemia was associated with male sex, folate deficiency, vitamin B12 deficiency [OR [95%CI], 8.3[5.7-12.1]; 2.5[1.76-3.58]; 2.6[1.5-4.5], respectively]. A 3-week supplementation with folic acid, methycobalamin and pyridoxine hydrochloride in vitamin-deficient subjects decreased plasma homocysteine levels by 37%. High prevalence estimates of folate, vitamin B12, and vitamin B6 deficiencies appear to be the major determinants of hyperhomocysteinemia in a low income general population in Karachi