Genetic variation and nutrition in relation to coronary artery disease.

There is evidence that coronary artery disease (CAD), hypertension, diabetes mellitus (DM) and hyperlipidemia develop due to interaction of genetic and environmental factors during transition from poverty to affluence. Rapid transition in diet and lifestyle factors may influence heritability of the variant phenotypes that are dependent on the nutrient environment for their expression. We are beginning to recognize the interaction of specific nutrients with the genetic code possessed by all nucleated cells. In the next millennium, the physician may be able to make nutrient intake recommendations not on physical characteristics but on the basis of the individual's phenotypic expression for health while suppressing his phenotypic expression for disease. We have demonstrated an increased susceptibility to CAD, diabetes, central obesity, hyperinsulinemia and lipoprotein(a) excess in Indians in younger age groups indicating a genetic predisposition to these problems due to interaction of gene and environment. Lipoprotein(a) is a genetic risk factor for CAD, diabetes and stroke and it is higher in South Indians than North Indians. Antioxidant vitamins, coenzyme Q10 and n-3 fatty acids may have a beneficial influence whereas linoleic acid, saturated fat and sugars may have adverse effects on phenotypic expression. There is significant evidence that genes are involved in determining enzymes, receptors, cofactors, structural components involved in regulation of blood pressure, the metabolism of lipids, lipoproteins and inflammatory and coagulation factors that are involved in determining an individual's risk. Majority of these genes are polymorphic. While some genes respond to nutritional modulation, others may not indicate any response.

Validation of tobacco and alcohol intake questionnaire in relation to food intakes for the Five City Study and a proposed classification for Indians.

Cross-sectional survey was conducted among 1806 subjects (904 men and 902 women) between 25-64 years of age. The survey instruments were questionnaires according to guidelines of WHO and other Indian studies and based on scores of various attributes of tobacco and alcohol consumption. All subjects with tobacco and alcohol consumption were classified separately into mild, moderate and heavy consumption and previous consumptions were also recorded. The overall prevalence of tobacco consumption was significantly higher in men compared to women (27.5 vs 11.6%), while mild tobacco intakes were comparable (2.0 vs 1.6%), moderate (22.2 vs 7.7%) and heavy (3.3 vs 2.2%) tobacco consumptions were significantly higher in men compared to women. The overall prevalence of alcohol consumption was 10.4% in men without any subject among women. The prevalence of moderate (6.6%) alcohol intakes was significantly higher compared to mild (1.2%) and heavy (2.5%) alcohol consumption. Whisky and country liquor were most commonly consumed alcoholic beverages. Smoking (20.7 vs 1.6%) and tobacco chewing (13.3 vs 10.7%) in men and women respectively were common modes of tobacco consumption. Tobacco consumption was significantly associated with lower consumption of vitamin C and beta-carotene and lower body mass index. These findings suggest that tobacco and alcohol consumption assessed by scores constructed on the basis of various attributes appear to be accurate and the questionnaires may be used with precision for classification and assessment in other population groups.

Coenzyme Q in cardiovascular disease.

Coenzyme Q10 or ubiquinone normally present in many plant and animal cells is an antioxidant. Coenzyme Q10 deficiency has been observed in patients with congestive heart failure, angina pectoris, coronary artery disease, cardiomyopathy, hypertension, mitral valve prolapse and after coronary revascularization. Coenzyme Q10 is involved in the synthesis of ATP and hence is useful in preventing cellular damage during ischaemia-reperfusion injury. The clinical benefits are mainly due to its ability to improve energy production, antioxidant activity, and membrane stabilizing properties. Several studies showed that coenzyme Q could be useful in patients with congestive heart failure, angina pectoris, cardiomyopathy, coronary artery disease and in the preservation of myocardium. Coenzyme Q10 is normally present in the low density lipoprotein cholesterol fraction and inhibits its oxidation. It can also regenerate vitamin E. Coenzyme Q10 is known for producing minor gastrointestinal discomfort and elevation in SGOT and LDH when used.