Effect of low energy diet and weight loss on major risk factors, central obesity and associated disturbances in patients with essential hypertension.

Obesity, especially central, increases the risk of hypertension, hypertriglyceridaemia and diabetes to a significant extent. To determine whether dietary weight reduction can reduce blood pressure (BP) and other cardiovascular risk factors, 217 hypertensives were randomised to receive either 1600 Kcal/day diet (group A, n = 108) or the usual 2100 Kcal/day diet (group B, n = 109). Sodium intake and physical activity were kept similar in both groups. After 16 weeks of follow-up, patients in group A received significantly less energy leading to a 2.8 kg net reduction in mean weight in association with a significant net decrease in mean SBP and DBP (7.5/6.5 mm Hg) compared with nonsignificant changes in group B. There was a significant net decrease in mean total cholesterol (7.0%), low-density lipoprotein (LDL)-cholesterol (7.9%) and triglycerides (8.0%), with a significant net increase in high-density lipoprotein (HDL)-cholesterol (4.0%) in group A compared with group B. New risk factors such as glucose intolerance (8.0%) and central obesity (waist-hip girth ratio, 0.021) showed a significant net reduction compared with group B. Patients with central obesity and other associated disturbances showed maximal reduction in BP and other cardiovascular risk factors with a significantly greater increase in HDL-cholesterol. Mean doses of drugs were similar at entry to the study as well as after 16 weeks in both groups. It is possible that weight reduction due to a low caloric diet can moderate central obesity and associated disturbances in hypertensive subjects.

Epidemiologic study of diet and coronary risk factors in relation to central obesity and insulin levels in rural and urban populations of north India.

In a population survey of 162 rural and 152 urban subjects aged 26-65 years at Moradabad, the findings are compared with existing data on Indian immigrants to Britain and United States. In comparison with rural subjects, urban subjects had a higher prevalence of coronary artery disease (8.6 vs. 3.0%) and diabetes (7.9 vs 2.5%), higher blood pressures, total and low density lipoprotein cholesterol, triglycerides and postprandial 2-h blood glucose and plasma insulin similar to observations made in UK in immigrants compared to Europeans. Fasting plasma insulin and high density lipoprotein cholesterol levels in urban subjects were comparable with rural subjects. Mean body weights were significantly higher in urban women, but not in men, than in rural subjects. However the body mass index (22.9 +/- 4.2 vs. 21.6 +/- 2.4 kg/m2) and waist-hip girth ratio (0.89 +/- 0.10 vs. 0.86 +/- 0.07) were significantly higher in urban men compared to rural men without such differences in women. Underlying these differences in risk factors, urban subjects had three times better socioeconomic status than rural subjects and were eating higher total and saturated fat, cholesterol and refined carbohydrates and lower total and complex carbohydrates compared to rural men and women. Energy expenditure during routine and spare time physical activity was significantly higher in rural compared to urban subjects. Those patients who had risk factors, showed lesser physical activity and had greater adverse factors in the diet compared to subjects without risk factors. Body mass index and waist-hip girth ratio in patients with risk factors were significantly higher than in subjects without risk factors. The findings suggest that decreased consumption of total and saturated fat and increased physical activity may be useful for prevention of coronary artery disease among urbans as well as in immigrants.

Plasma levels of antioxidant vitamins and oxidative stress in patients with acute myocardial infarction.

Of 138 patients with suspected acute myocardial infarction (AMI), 29 were excluded. Remaining 109 patients and 182 healthy controls of similar age and sex and same population were studied in detail for demographic variables, clinical and biochemical data for comparison. Mean age, sex, body weight, body mass index and blood pressures were comparable in the two groups whereas blood lipids, blood glucose and cardiac enzymes were raised in AMI patients compared to controls. Mean levels of vitamin C, E, A and beta-carotene were significantly less in AMI patients than controls whereas the lipid peroxides were significantly higher in AMI patients. The reduction in vitamin C and beta-carotene was more marked than decrease in other vitamins. With in AMI patients, those 28 patients who had cardiac arrhythmias showed greater decrease in vitamins compared to rest of the patients. Within both groups, smokers and diabetes patients had greater reduction in vitamin C and beta-carotene than other patients and subjects without confounding factors. Smokers also had higher lipid peroxides level than non-smokers. The inverse relation between AMI and low plasma vitamin levels remained significant after exclusion of patients with smoking and diabetes. These findings suggest that vitamin deficiency may be a risk factor of AMI and these patients may benefit by administration of these antioxidant vitamins for primary and secondary prevention of coronary artery disease.

Diet, antioxidant vitamins, oxidative stress and risk of coronary artery disease: the Peerzada Prospective Study.

The prevalence of coronary artery (CAD) disease in the Indian urban population is comparable to British population. Dietary intakes, antioxidant vitamins, prevalence of risk factors and CAD, were studied in a random sample of 152 adult urban subjects between 26-65 years of age (80 males, 72 females) from Peerzada street, Moradabad and compared with Indian immigrants to U.K. and a British comparison group. There was no significant relation with vitamin A. Smoking and diabetes were the confounding factors. Plasma antioxidant vitamin C (21.6 +/- 3.3 vs 42.5 +/- 4.5 mumol/L), vitamin E (15.2 +/- 2.8 vs 21.4 +/- 3.2 mumol/L) and beta-carotene (0.33 +/- 0.6 vs 0.55 +/- 0.08 mumol/L) were significantly lowered and lipid peroxides higher (2.82 +/- 0.22 vs 1.3 +/- 0.20 nmol/ml) in patients with CAD compared to subjects without any risk factors. The relation between low plasma level of vitamin C and E levels and carotene remained independently and inversely related after adjustment for smoking, diabetes and other risk factors. Regression analysis showed that after adjustment. Odd's ratio for carotene (1.82, 95% C.I. 0.50 to 3.72), vitamin C (2.23, 95% C.I. 1.14 to 5.26) and vitamin E (2.35, 95% C.I. 1.29 to 5.30) were significantly related to CAD. Underlying these changes, dietary intake of vitamin A, E, C and beta-carotene was significantly less in patients with CAD. Vitamin C and beta-carotene intake were less in smokers and diabetes. Compared with British population, the Indian urbans consumed less total and saturated fat and cholesterol and more polyunsaturated fat and complex carbohydrates. The plasma total and low density lipoprotein cholesterol levels were less in Indian urbans compared to Britons and so were mean body weight, body mass index and waist-hip ratio. Plasma insulin levels were comparable. The fatty acid composition of the diet, blood lipids, central obesity and insulin levels do not appear to account for high rates of CAD among Indians. The findings suggest that urban population in India may benefit from eating diets rich in antioxidant vitamin C, E and beta-carotene.