Do dietary patterns explain high prevalence of cardiovascular risk factors among Pakistani urban adults? A cross-sectional study

Abstract

Background: The prevalence of cardiovascular disease (CVD) in South Asia is higher than in any other developing countries. The diversity of diets in populations among developing countries may be one explanation for the differences in CVD. This study was carried out to explore the association between dietary patterns and the presence of cardiovascular risk factors among Pakistani low income urban adults. Methods: Socio demographic, physical activity and dietary information was collected from 1546 Pakistani subjects aged ≥40 years from the Control of Hypertension and Risk Attenuation (COBRA) study. Anthropometric, clinical and biomarker measures were assessed. Cluster analysis was used to identify dietary patterns from a food frequency questionnaire (FFQ) and multinomial regression was employed to investigate the association between dietary clusters and cardiovascular risk factors, using one of the dietary clusters as a reference category. Results: The most prevalent CVD risk factors among participants were elevated low density lipoprotein-cholesterol (LDL-C) (69.8 %) and systolic blood pressure (SBP) (68.2 %), followed by central obesity (57.1 %), low levels of high density lipoprotein-Cholesterol (HDL-C) (56.3 %), overall obesity (46.0 %), high total cholesterol (32.3 %), and elevated fasting blood sugar (FBS) (34.9 %). The cluster analysis generated 3 non-overlapping diet patterns. Cluster 1(Traditional Pakistani Diet), was dominated by fruits, vegetables, milk products and chicken, included participants with high mean body mass index (BMI), waist circumference (WC), HDL-C and low mean SBP. Cluster 2 (Moderate Diet) reflected a moderate intake of most food items and included participants with significantly higher mean SBP. Cluster 3 (Fatty Diet) was characterized by high intake of beef, whole milk, paratha and lentils and those following this cluster had a low mean HDL-C and high SBP. In analyses controlling for age, gender, tobacco use and physical activity, participants in the Traditional diet cluster were more likely to be overweight (OR 1.39, 95 % CI 1.08 to 1.78) and high central adiposity (1.33, 95 % CI 1.04 to 1.71) than participants in the Moderate diet cluster, though less likely to have elevated SBP (OR 0.67, 95 % CI 0.51 to 0.86). LDL-C levels were higher in both the traditional Pakistani diet and Fatty diet cluster compared to the Moderate diet cluster. Low HDL-C was also more prevalent among the Traditional Pakistani diet cluster. Conclusion: Among Pakistani population discernable diet patterns can be derived using clusters analysis. CVD risk factors prevalence differed by cluster membership, though relations for specific CVD risk are not consistent across clusters.

Development of Nonlaboratory-Based Risk Prediction Models for Cardiovascular Diseases Using Conventional and Machine Learning Approaches

“…Further, the current study baseline RPM ranked dietary features after these classical features of CVDs and is supported by a recent study that reported that 60% of CVD-related deaths in Pakistan are associated with diet and its patterns [ 39 ]. The current study explored a significant positive role of high-salt foods and low vegetable consumption and found consistent with Pakistani literature [ 40 , 41 ]. Surprisingly, the PURE study found that usage of salty foods (≥1 time/day) and low vegetable consumption (<1 time/day) were insignificant features in the study, with logistic regression coefficients of −0.16 and −0.24, respectively.…”

Epidemiological trend and age-period-cohort effects on cardiovascular disease mortality and disability-adjusted life years attributable to dietary risks and high body mass index at the regional and country level across China and Pakistan

“…All these interrelated factors could explain a marked increase in CVD burden attributable to dietary risks. A previous study also reported that the Pakistani traditional diet was associated with high cardiovascular risk factors ( 29 ). The majority of Pakistani people eat deep-frying foods and foods high in saturated fats which ultimately increased the risk of CVD ( 30 ).…”

“…On the other hand, the Pakistani population showed a higher risk ratio of premature CVD mortality attributable to dietary risk. Several factors such as malnutrition ( 28 ) poverty and low diet quality ( 29 ) poor dietary habits ( 30 ) and a poor healthcare system ( 57 ) may contribute to the increased risk of diet-related premature CVD mortality in Pakistan.…”

An Exploratory Research to Assess Total Nutritional Knowledge of Students at the University of Lahore, Pakistan

“…They are mostly unable to make healthy food choices. Accordingly, they are more prone to develop different disorders, such as obesity and its related comorbidities (16) Therefore, unhealthy dietary habits are major risk factors for chronic diseases, particularly if adopted during the early years of adulthood (17). It is vital to explore how much the individuals have nutritional knowledge and follow the dietary guidelines.…”