Association of minimum dietary diversity with anaemia among 6-59 months' children from rural India: An evidence from a cross-sectional study.

Introduction: Anaemia is one of the micronutrient deficiency disorders that have global public health implications. The present study aims to determine the association of minimum dietary diversity (MDD) with anaemia among children aged 6-59 months in rural North India. Methods: In Rohtak (a north Indian city), a cross-sectional survey was conducted in 2018-19 (n = 266). Univariate and bivariate analyses were performed. The Chi-square test was used for assessing the significance level during bivariate analysis. Further, multivariable regression analysis was used for determining the factors for anaemia prevalence among children aged 6-59 months. Results: About 62.4% (n = 166) of the children aged 6-59 months were found to have anaemia in the study area. The prevalence of MDD was 35.3% (n = 94). It was found that children with no MDD have a higher prevalence of moderate (42% vs. 25.5%; P < 0.001) and severe (12.8% vs. 8.5%; P < 0.001) anaemia. It was revealed that the children with no MDD had a significantly higher likelihood of being anaemic than children with MDD in model-1 [aOR: 2.09; CI: 1.23, 3.55] and model-3 [aOR: 1.70; CI: 1.01, 3.01]. Children with mothers who never attended school had significantly higher odds for anaemia in reference to those children whose mothers ever attended school in model-2 [aOR: 3.62; CI: 2.07,6.34] and model-3 [aOR: 3.00; CI: 1.62,5.56]. Conclusion: Measures to alleviate under-five anaemia should include empowering and educating women, expanding access to supplementation, fortification programmes, and promoting and raising awareness about feeding diverse foods, while also considering the socioeconomic status.

Pre-exposure Prophylaxis (PrEP) Awareness, Willingness to Use, and Preferred Places for Access Among the Cambodian Female Entertainment Workers: A Cross-Sectional Study.

The aim of the study was to determine the awareness, desire to use, and preferred providers of pre-exposure prophylaxis (PrEP) among Female Entertainment Workers (FEWs) aged 18-35 years in Cambodia's Phnom Penh region. Of 1003 FEWs, 31.8% of them had heard of PrEP. When informed about PrEP, 67.4% said they would use PrEP and the most preferred location to access PrEP was a local non-governmental organization (NGO) (63.2%), followed by a government clinic/center (39.8%), ART clinic (26.5%), pharmacy (20.7%), and CBO (14.8%). FEWs who had heard about PrEP (aOR: 2.46; CI: 1.79-3.39) and those with no additional income source other than sex work (aOR: 1.53; CI: 1.16-2.02) were more likely to express their willingness to use PrEP. When the country is in the process of making provisions for PrEP, the study urges policymakers and programmers to take steps towards creating awareness about PrEP among key populations such as FEWs and its availability preferably through local NGOs and government clinics.

Awareness about Human Papillomavirus Vaccine and Its Uptake among Women from North India: Evidence from a Cross-Sectional Study.

OBJECTIVE: This study aims to estimate the prevalence of human papillomavirus (HPV) vaccine usage and determine the factors for awareness about HPV vaccine among women in reproductive age group. METHODS: This is a cross-sectional survey under a cervical cancer prevention study. The sample size was 1020 women, aged 15-49 years [550 in Delhi and 470 in Rohtak]. Bivariate analysis and Fisher exact test along with binary logistic regression analysis were used to determine the factors for awareness. RESULT: About 18.0 % [Delhi: 24.2 % and Rohtak: 10.9 %] of the respondents had heard about the vaccine against cervical cancer. The women aged more than 30 years [AOR: 1.35; CI: 0.94, 1.94] were more likely to be aware of cervical cancer vaccine as compare to women of 30 years and less. However, the women from Rohtak [AOR: 0.90; CI: 0.48, 1.66] were less likely to be aware of vaccine against cervical cancer in reference to women aged 30 years and more [AOR: 1.61; CI: 1.01, 2.56] from Delhi. About 0.6 % [Delhi: 1.1 % and Rohtak: 0.0 %] of the respondents had received HPV vaccine. CONCLUSION: Women tend to have limited knowledge about cervical cancer vaccine and immunisation practices. The women's demographic makeup varied significantly between the two sites, i.e , Rohtak and Delhi, which had an impact on how well they understood and utilised the cervical cancer vaccination. It is worth mentioning that none of the women from Rohtak had received the immunisation. The awareness of the cervical cancer vaccine among women from the Rohtak was lower than the Delhi women.

Outdoor Physical Activity in an Air Polluted Environment and Its Effect on the Cardiovascular System-A Systematic Review.

Air pollution is a global public health threat. Evidence suggests that increased air pollution leads to increased cardiovascular morbidity and mortality. The aim of this review was to systematically review and synthesize scientific evidence to understand the effect of performing outdoor physical activity (PA) in a polluted environment on cardiovascular outcomes. This review was developed and reported in accordance with the PRISMA guidelines. Electronic searches in Embase, Web of Science, and PubMed were undertaken through March 2021 initially, and later updated through to 31st January 2022, for observational studies published in peer-reviewed journals that report cardiovascular mortality or morbidity due to outdoor PA in air polluted environment. These searches yielded 10,840 citations. Two reviewers independently reviewed each citation for its eligibility. Seven studies were found to be eligible. Of these, five were cohort studies and two were cross-sectional studies. Pollutants measured in the selected studies were Particulate Matter (PM)-PM10, PM2.5, nitrogen oxides (NOx), and ozone (O3). The most common study outcome was myocardial infarction, followed by cardiovascular mortality, hypertension and heart rate variability. Six studies emphasized that the PA has beneficial effects on cardiovascular outcomes, though air pollutants attenuate this effect to an extent. Two studies showed that walking, even in the polluted environment, significantly reduced the heart rate and heart rate variability indices. The beneficial effects of outdoor PA outweigh the harmful effects of air pollution on cardiovascular health, though the benefits reduce to an extent when PA is carried out in a polluted environment. Because a limited number of studies (n = 7) were eligible for inclusion, the review further emphasizes the critical need for more primary studies that differentiate between outdoor and indoor PA and its effect on cardiovascular health.

Prevalence and Predictors of Cervical Cancer Screening among Reproductive Age Group Women: Evidence from Cross-Sectional Study in Rohtak and Delhi.

BACKGROUND: The present study aims to estimate the prevalence and determine the factors for cervical cancer screening among women in the reproductive age group in Delhi and Rohtak, India. METHODS: The data were utilized from a survey conducted as part of a larger study to increase the access to cervical cancer screening and care by MAMTA-Health Institute for Mother and Child in collaboration with the Health Departments of Palam, New Delhi, and Rohtak, Haryana between 2015 and 2017. Data pertaining to the socio-economic and demographic information along with the information related to cervical cancer screening were utilized for the present study. The sample size was 1020 women in reproductive age group. Descriptive statistics (percentage and frequency distribution), bivariate analysis along with multivariable analysis were done to represent the results.  The Fisher exact test was used to test the level of significance during bivariate analysis. RESULTS: About 35.2% [Delhi: 44.9% and Rohtak: 23.8%] of the respondents had heard about cervical cancer screening. Further about 3.9% [Delhi-2.9% and Haryana-5.1%] had screened for cervical cancer. Women who had heard about cervical cancer were five times more likely to go for screening [aOR: 5.27; CI: 2.53,10.96]. It was found that women over 30 years of age had 12.04 significantly higher  odds of going for cervical cancer screening in reference to women aged 30 years and less [aOR: 12.04; CI: 3.01,53.20]. Women from households with a monthly income of more than 15000 had 2.98  significantly higher odds of going for cervical cancer screening in reference to women from households with an income of 5000 and less [aOR : 2.98; CI: 1.12,9.09]. CONCLUSION: Findings suggest that awareness about cervical cancer screening test along with its thorough knowledge about its benefits would be an effective intervention to increase the uptake of cervical cancer screening.

Women's Knowledge on Cervical Cancer Risk Factors and Symptoms: A Cross Sectional Study from Urban India.

BACKGROUND: Early-stage cervical cancer diagnoses may be the consequence of timely medical care in the presence of symptoms which can be linked to awareness of the symptoms and risk factors. This study aims to determine the knowledge about risk factors and symptoms of cervical cancer and associated factors among women aged 20-49 years. METHODS: Data were utilized from the survey under the intervention "Increasing access to cervical cancer screening and care through the community-centric continuum of care initiative in India" (2015). The sample size was 1,020 women in the age group of 20-49 years. Descriptive statistics, along with bivariate analysis, was done to represent the preliminary results. Multivariable regression analysis was used to represent the estimates. RESULTS: About 40.1% [Delhi: 56.9% and Rohtak: 20.4%] and 45.5% [Delhi: 52.2% and Rohtak: 37.7%] of respondents had good knowledge about risk factors and symptoms of cervical cancer, respectively. Respondents with primary educational status had an 86% significantly higher likelihood for good knowledge about identified risk factors of cervical cancer [ adjusted odds ratio (aOR): 1.86; CI: 1.12-3.10]. Respondents who were married or widowed/divorced/separated had significantly higher odds for good knowledge about identified risk factors and symptoms of cervical cancer in reference to respondents who were never married. Respondents from Rohtak had 72% and 35% significantly higher odds for good knowledge about identified risk factors [aOR:0.28; CI: 0.21,0.39] and symptoms [aOR:0.65; CI: 0.48,0.88] of cervical cancer, respectively, in reference to respondents from Delhi. CONCLUSION: Overall awareness about cervical cancer and Human papillomavirus (HPV) as the causative agent was low, more so in Rohtak. This is extremely worrisome as blocking HPV infection is one of the most effective ways to prevent cervical cancer. Moreover, the knowledge about the risk factors and symptoms of cervical cancer is also inadequate, particularly in women from Rohtak.

Association of air pollution and homocysteine with global DNA methylation: A population-based study from North India.

BACKGROUND: Anthropogenic air pollution has been implicated in aberrant changes of DNA methylation and homocysteine increase (>15µM/L). Folate (<3 ng/mL) and vitamin B12 (<220 pg/mL) deficiencies also reduce global DNA methylation via homocysteine increase. Although B-vitamin supplements can attenuate epigenetic effects of air pollution but such understanding in population-specific studies are lacking. Hence, the present study aims to understand the role of air pollution, homocysteine, and nutritional deficiencies on methylation. METHODS: We examined cross-sectionally, homocysteine, folate, vitamin B12 (chemiluminescence) and global DNA methylation (colorimetric ELISA Assay) among 274 and 270 individuals from low- and high- polluted areas, respectively, from a single Mendelian population. Global DNA methylation results were obtained on 254 and 258 samples from low- and high- polluted areas, respectively. RESULTS: Significant decline in median global DNA methylation was seen as a result of air pollution [high-0.84 (0.37-1.97) vs. low-0.96 (0.45-2.75), p = 0.01]. High homocysteine in combination with air pollution significantly reduced global DNA methylation [high-0.71 (0.34-1.90) vs. low-0.93 (0.45-3.00), p = 0.003]. Folate deficient individuals in high polluted areas [high-0.70 (0.37-1.29) vs. low-1.21 (0.45-3.65)] showed significantly reduced global methylation levels (p = 0.007). In low polluted areas, despite folate deficiency, if normal vitamin B12 levels were maintained, global DNA methylation levels improved significantly [2.03 (0.60-5.24), p = 0.007]. Conversely, in high polluted areas despite vitamin B12 deficiency, if normal folate status was maintained, global DNA methylation status improved significantly [0.91 (0.36-1.63)] compared to vitamin B12 normal individuals [0.54 (0.26-1.13), p = 0.04]. CONCLUSIONS: High homocysteine may aggravate the effects of air pollution on DNA methylation. Vitamin B12 in low-polluted and folate in high-polluted areas may be strong determinants for changes in DNA methylation levels. The effect of air pollution on methylation levels may be reduced through inclusion of dietary or supplemented B-vitamins. This may serve as public level approach in natural settings to prevent metabolic adversities at community level.

Mobile Health App for Self-Learning on HIV Prevention Knowledge and Services Among a Young Indonesian Key Population: Cohort Study.

BACKGROUND: Indonesia is the only country in the Asia Pacific region where the incidence of HIV is still on the rise, and its prevalence is extremely high among the key populations such as men who have sex with men, transgender women, and people who inject/use drugs. Mobile health (mHealth) apps provide an innovative platform for delivering tailored HIV prevention and care among these populations more efficiently than possible through the direct face-to-face approach. OBJECTIVE: The aim of this study was to assess the role of a peer-customized mobile app based on the principle of self-learning for improving HIV prevention knowledge and access to health services among men who have sex with men, transgender women (known as Waria in Indonesia), and people who use drugs in Indonesia. METHODS: A prospective intervention cohort study was conducted among the key populations in five provinces of Indonesia (Jakarata, West Java, East Java, Special Region of Yogyakarta, and Bali). The data were evaluated using a pre-post assessment survey conducted on a sample of 200 unique users, including 50 men who have sex with men and transgender women each, and 100 people who use drugs, with a follow-up response rate of 98% and 70%, respectively. An mHealth app named RUMAH SELA was developed and implemented among the key populations. RESULTS: From baseline to the endpoint of the study, there was a significant increase in comprehensive HIV-related knowledge from 20% (10/49) to 60% (29/49), 22% (11/49) to 57% (28/49), and 49% (34/70) to 74% (52/70) among men who have sex with men (P=.004), transgender women (P<.001), and people who use drugs (P<.001), respectively. There was also a reduction in sexual activities without condom use from 22% (11/49) to 19% (9/49), 18% (9/49) to 12% (6/49), and 21% (15/70) to 10% (7/70) among men who have sex with men (P=.45), transgender women (P=.25), and people who use drugs (P<.001), respectively. There was an uptake of HIV testing by 31% (15/49) for men who have sex with men, 49% (24/49) for transgender women, and 26% (18/70) for people who use drugs after using the app. There was a reduction in injecting drugs with a used needle in drug users from 45/70 (78%) to 15/70 (26%). Measures of self-esteem increased among men who have sex with men (mean 26.4 vs mean 27.1), transgender women (mean 26.5 vs mean 27.8; P=.02), and people who use drugs (mean 24.0 vs mean 25.0). In addition, 27% (7/24) of men who have sex with men, 25% (4/15) of transgender women, and 11% (2/18) of drug users made an appointment for an HIV test through the app. The app was quite highly accepted by the key populations as nearly a quarter felt that they became more confident in discussing issues about sexuality, more than 80% found that the app provided sufficient knowledge about HIV, and more than half of the participants found the app to be user friendly. CONCLUSIONS: This one-of-a-kind mHealth intervention with an mHealth app as a self-learning tool is effective in increasing HIV-related knowledge and behavior, and access to services with strong acceptability by the community. There is a need to scale up such interventions for efficacy testing in a larger population to provide evidence for national-level mHealth programs addressing HIV.

Impaired Homocysteine Metabolism Associated with High Plasma Interleukin-17A Levels, a Pro-Atherogenic Marker, in an Endogamous Population of North India.

Background: Impaired homocysteine metabolism (IHM; hyperhomocysteinemia) has been linked with many complex disorders like cardiovascular diseases and immunological disturbances. However, studies understanding IHM in light of pro- and anti- atherogeneic markers like Interleukin-17A & -10 (IL-17A & IL-10) and Forkhead box p3 (Foxp3, a master transcription factor) are scarce. Aim: In our present study, we aimed to understand the relation of IHM with plasma IL-17A and IL-10 levels and Foxp3 mRNA expression in peripheral blood mononuclear cells (PBMCs) from an endogamous population (Jats of Haryana, North India) with high prevalence of IHM without the concurrence of significant adverse cardiovascular outcomes. Methods: Forty (40) clinically healthy individuals, unrelated up to first cousins, were recruited and were subjected to demographic, physiological and anthropometric profiling, followed by intravenous blood sample collection (fasting) and lipid profiling. Plasma homocysteine levels were estimated and individuals with homocysteine levels ≥ 15umol/L and <15umol/L were categorized as the impaired homocysteine metabolism group (IHM, n=30) and normal homocysteine metabolism group (NHM, n=10) respectively. Plasma folate and vitamin B12 and MTHFR C677T (methylenetetrahydrofolate reductase) polymorphism were detected. Relative mRNA expression of Foxp3 in PBMCs (normalized to 18S) was quantitated using SyBR green technology. Plasma IL-10 & 17 levels were estimated by ELISA assays. Results and Conclusions: None of the physiological, anthropometric and lipid variables were different between the two groups. Foxp3 mRNA expression levels were relatively lower, and plasma IL-10 levels were found to be comparable among IHM and NHM group. However, significantly higher IL-17A levels and relatively high LDL cholesterol levels were present in the IHM group as compared with NHM. Our findings suggest that the Jats of Haryana, North India, exhibiting high levels of homocysteine, might also carry the high IL-17A -pro-atherogenic marker, suggesting an increasing burden of pre-morbid condition. This apparently does not reach to significant mortality/morbidity attributed to the counter action or balancing act of IL-10 (an anti-atherogenic marker). This further suggests environment-influenced epigenetic control mechanisms of the targeted genes in the present population.

Metabolic distress in lipid & one carbon metabolic pathway through low vitamin B-12: a population based study from North India.

BACKGROUND: Dyslipidemia and hyper-homocysteinemia are the major independent risk factors of cardio vascular disease. Deficiency of folate and vitamin B-12 are associated with both hyper-homocysteinemia and dyslipidemia. The aim of the study is to evaluate the relationship of homocysteine and its associated dietary determinant levels (Folate and Vitamin B-12) with lipids and obesity parameters (WC, BMI, WHR) in North Indian population. METHODS: The participants were recruited under a major government funded project through household survey covering 15 villages of Haryana, India. Participants were both males and females, between age group 30-65 years, from a north Indian community. Initially 1634 individuals were recruited, of which 1374 were considered for analysis as they were not found to be on any kind of medication for high blood pressure, CAD, diabetes or any other disorder, and had no missing data. 5 mL of intravenous blood sample was collected after obtaining written informed consent from the participants. Homocysteine, folate and vitamin B12 levels were estimated through Immulite 1000 by chemi-luminescence technique. Triglyceride, total cholesterol and HDL-C were estimated by spectrophotometry technique using commercial kits. The values for LDL and VLDL were calculated using Friedwald's equation. Height, weight, waist circumference (WC), hip circumference (HC) was measured over light clothing. Statistical analysis for data was performed using SPSS 16.0 version. RESULTS: All the lipid indices, except HDL, showed a trend of negative correlation with homocysteine after controlling for confounders, though not significant. No association was found between obesity (WC, BMI, WHR) and homocysteine in the present study. Vitamin B-12 deficiency was significantly associated with both hyper-homocysteinemia and low HDL. Folate was found to have significantly reduced risk for high TC & LDL. CONCLUSIONS: The "hcy-lipid" hypothesis does not seem to be complementing in the present studied population. The population is vulnerable to severe under-nutrition due to the association of vitamin B-12 with HDL, leading to metabolic disturbance in both the pathways; lipid and one carbon metabolic pathway. Co-factors such as ethnicity, cultural practices, and lifestyle & dietary habits must be considered while making public health policies to control diseases.

Whole-of-society monitoring framework for sugar, salt, and fat consumption and noncommunicable diseases in India.

India has experienced a rising prevalence of cardiometabolic risk factors in the past 15 years: the prevalence of diabetes has increased from 5.9% to 9.1%, hypertension from 17.2% to 29.2%, and obesity from 4% to 15%. The increase is among all socioeconomic groups and in urban and rural populations, though the quantum of change varies. A concomitant increase in per capita consumption of sugar from 22 to 55.3 g/day and total fat from 21.2 to 54 g/day was observed, with significant differences between states of high and low human development index (HDI). Per capita consumption of sugar, salt, and fat is consistently and significantly associated with overweight and obesity but variably associated with the occurrence of hypertension and diabetes. Market research shows that approximately 50-60% of total salt, sugar, and fat in Indian markets is procured by bulk purchasers, generally for manufacturing processed food items. This sector of the Indian economy is among the fastest growing, with several policy incentives. It is not clear from most of the data sets whether available information on per capita sugar, salt, and fat consumption has considered the contribution of processed and ready-to-eat food items. The unprecedented changes of rapid urbanization, mechanization, and globalization demand close monitoring of social, developmental, and economic determinants. This paper provides pieces of evidence to justify a whole-of-society (WoS) framework for monitoring the inputs, processes, and behavioral components of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) in India.

PDE4D gene polymorphisms and coronary heart disease: a case-control study in a north Indian population.

BACKGROUND: The present study aims to assess the association of PDE4D gene polymorphisms (SNP83 and SNP87) with Coronary Heart Disease (CHD) in a single Mendelian population of Delhi. METHODS: A cross-sectional study was carried out wherein intravenous blood samples were collected from 100 cases and 100 age, sex and ethnicity matched controls along with their demographic, life style, and clinical profiles. RESULTS: Genotypic frequencies of PDE4D gene variants 83 and 87 did not differ significantly between cases and controls. Odds ratio revealed a 1.4-fold increased risk with PDE4D 83 C allele; though not significant. Both the SNPs showed significant association with serum triglyceride (TG) (P ≤ 0.05). A significant linkage disequilibrium was observed between the SNPs. The haplotype with mutant alleles of the two SNPs showed fivefold increased risk (though not significant) and that with normal allele of SNP 83 and mutant allele of SNP 87 (T-T) was found to be significantly associated with the disease in the present population. CONCLUSIONS: PDE4D gene variants 83 and 87 did not show any significant association with CHD. However, their interaction with TG and the haplotypic association found in the present population is indicative of the population-specific risk associated with CHD where majority of the individuals have high cholesterol and high Body Mass Index (BMI).

Pro-inflammatory cytokine gene polymorphisms and threat for coronary heart disease in a North Indian Agrawal population.

The association of IFN-γ (+874 A/T; rs2430561), TNF-α (-308 G/A; rs1800629) and TNF-ß (+252 A/G; rs909253) with Coronary Heart Disease (CHD) has not been rigorously tested in Indian population. In the present study we sought to examine the role of these cytokines in the causation of CHD and their association with conventional CHD risk factors. A total of 138 case and 187 unrelated healthy controls aged 35 to 80years, matched on ethnicity and geography were collected from North Indian Agrawal population. Single nucleotide polymorphisms at the promoter TNF-α -308 G/A and the intronic IFN-γ +874 A/T were analyzed by allele-specific PCR, and the intronic TNF-ß +252 A/G was analyzed by RFLP. Of the three selected polymorphisms, genotypic distribution of IFN-γ +874 A/T and TNF-ß +252 A/G polymorphisms was significantly different between patients and controls in the present study. OR revealed statistically significant risk for CHD with respect to IFN-γ +874 T allele, whereas OR for TNF-ß +252 A/G showed three fold risk in homozygous condition though not significant. No such trend could be observed for TNF-α -308 G/A polymorphism. Multivariate logistic regression after adjusting for all the confounders showed significant risk for CHD with the genotypes and genotypic combinations of all the three markers (albeit not significant with TNF-α). Increased risk for CHD was likely to be associated with interaction of IFN-γ with diastolic hypertension, TNF-α with diabetes and BMI, and TNF-ß with serum triglyceride and very low density lipoprotein (VLDL) levels. The results suggest that these selected cytokine polymorphisms could possibly serve as potential bio-markers for CHD in conjunction with specific conventional risk factors.

The association of non-HDL cholesterol with the presence of metabolic syndrome in North Indian subjects with and without CAD.

AIM: The present study aims to identify which lipid parameter is significantly associated with Coronary Artery Disease (CAD) and metabolic syndrome (MetS) and also to find out the association of non-HDL cholesterol (non-HDL-C) with the presence of MetS in North Indian subjects with and without CAD. SUBJECTS AND METHODS: One hundred and thirteen CAD and 140 non-CAD (controls) aged 35-75 years were recruited for the study, matched for ethnicity and geography after obtaining their written informed consent. The CAD patients were identified based on their medical diagnostic history. Height, weight, waist and hip circumferences, blood pressures (systolic and diastolic) and lipid profile were measured for all the subjects. RESULTS: Sixty-nine out of 113 (61.06%) of CAD and 52/140 (37.1%) of non-CAD had MetS. Age standardized prevalence of MetS was 23.2% and 16.1% in CAD and non-CAD individuals, respectively. Age standardized prevalence of metabolic abnormalities in the CAD group was in the order of abdominal obesity>non-HDL-C>systolic blood pressure (SBP) > triglyceride (TG) > total cholesterol (TC) > diastolic blood pressure (DBP) > Low Density Lipoprotein Cholesterol (LDL-C) > High Density Lipoprotein Cholesterol (HDL-C). Non-HDL-C, TG and HDL-C were found to be significantly associated with MetS. CONCLUSIONS: TG and HDL-C are established risk components included in the characterization of MetS; but significant association of non-HDL-C with MetS in the present study is a key finding. The study focuses on the use of non-HDL-C as a simple screening tool to identify individuals with clustering metabolic abnormalities which increase the propensity for CAD.

Differences in conventional cardiovascular risk factors in two ethnic groups in India.

BACKGROUND: Studies have been carried out at national and international levels to assess ethnic variations in the prevalence of cardiovascular diseases and their risk factors. However, ethnic variations in the contribution of various risk factors to complex diseases have been scarcely studied. OBJECTIVES: Our study examined such variations in two ethnic groups in India, namely, Meiteis of Manipur (northeast India) and Aggarwals of Delhi (north India). METHODS: Through random sampling, we selected 635 participants from the Meitei community and 181 Aggarwals from the Aggarwal Dharmarth Hospital, Delhi. Patients with coronary artery disease (CAD) and hypertension were identified based on their recent medical diagnostic history. Anthropometric parameters such as height, weight, waist and hip circumferences along with physiological parameters (blood pressures, both systolic and diastolic) and biochemical parameter (lipid profile) were measured for all study participants. Patient parameters were available from the medical reports recorded when patients were first diagnosed. RESULTS: Among CAD individuals, the Aggarwals showed higher mean values of weight, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TC), low density lipoprotein (LDL), and very low density lipoprotein (VLDL) but had lower high density lipoprotein (HDL) levels than the Meiteis. The same trend for weight, BMI and lipid parameters could be seen among hypertensive individuals. In step-wise regression analysis, SBP, LDL and TG were found to significantly contribute to the risk for CAD in the Aggarwals; whereas in the Meiteis, SBP, VLDL, HDL, TC and LDL were found to significantly contribute to the risk for CAD. In hypertensive Aggarwal participants, SBP, DBP and waist-to-hip ratio were significant contributors for hypertension; whereas SBP, DBP, and height contributed significantly to risk for hypertension among the Meiteis. CONCLUSION: We found marked differences in conventional risk factors between the two ethnic groups. In India, as found elsewhere, the presence of substructuring of groups and hence, genetic isolation is high. More research is needed within this context to unveil the conventional risk factors for complex diseases.