Efficacy of CVD Risk Factor Modification in a Lower-Middle Class Community in Pakistan: The Metroville Health Study

Aziz, Kalim U.; Dennis, Barbara; Davis, C. E.; Sun, Kai; Burke, Gregory L.; Faruqui, Azhar; Chagani, Hasina; Ashraf, Tariq; Patel, Najma; Jafery, H.; Ghauri, Sophia Y; Faisal, Mohd Syazwan; Tareen, Asal Khan

doi:10.1177/101053950301500106

Cited by 11 publications

(9 citation statements)

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“…One study undertaken in an urban community in Pakistan evaluated the effects of a household-based intervention delivered by a social worker focussing on fat and salt in a lower-middle class community. After two years, there was a reported 48% lower fat intake and 41% lower salt intake in intervention households as compared to control households [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

The Association of Knowledge and Behaviours Related to Salt with 24-h Urinary Salt Excretion in a Population from North and South India

et al. 2017

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Consumer knowledge is understood to play a role in managing risk factors associated with cardiovascular disease and may be influenced by level of education. The association between population knowledge, behaviours and actual salt consumption was explored overall, and for more-educated compared to less-educated individuals. A cross-sectional survey was done in an age-and sex-stratified random sample of 1395 participants from urban and rural areas of North and South India. A single 24-h urine sample, participants’ physical measurements and questionnaire data were collected. The mean age of participants was 40 years, 47% were women and mean 24-h urinary salt excretion was 9.27 (8.87–9.69) g/day. Many participants reported favourable knowledge and behaviours to minimise risks related to salt. Several of these behaviours were associated with reduced salt intake—less use of salt while cooking, avoidance of snacks, namkeens, and avoidance of pickles (all p < 0.003). Mean salt intake was comparable in more-educated (9.21, 8.55–9.87 g/day) versus less-educated (9.34, 8.57–10.12 g/day) individuals (p = 0.82). There was no substantively different pattern of knowledge and behaviours between more-versus less-educated groups and no clear evidence that level of education influenced salt intake. Several consumer behaviours related to use of salt during food preparation and consumption of salty products were related to actual salt consumption and therefore appear to offer an opportunity for intervention. These would be a reasonable focus for a government-led education campaign targeting salt.

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Section: Discussionmentioning

confidence: 99%

The Association of Knowledge and Behaviours Related to Salt with 24-h Urinary Salt Excretion in a Population from North and South India

et al. 2017

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Section: Resultsmentioning

confidence: 99%

“…Of the 35 included studies (online supplemental table S1), 26 were parallel-arm RCTs,10 32 33 43–45 52–72 and 8 were cluster RCTs 30 34–40. Thirty-one studies were conducted in South Asian countries (20 in India, 5 in Pakistan, 3 in Nepal, 2 in Sri Lanka and 1 in Bangladesh)30 32–40 43–45 53–60 62–64 66–72 and 4 studies were conducted outside of Asia (1 in the USA and 3 in Canada) 10 32 52 61. Most participants in the studies had at least one major risk factor for CVD such as diabetes,33 54 60 63 67–69 71 dyslipidaemia,43 55 64 hypertension,35 40 44 45 65 66 70 72 obesity53 57 or metabolic syndrome 36 56.…”

Section: Resultsmentioning

confidence: 99%

“…Most participants in the studies had at least one major risk factor for CVD such as diabetes,33 54 60 63 67–69 71 dyslipidaemia,43 55 64 hypertension,35 40 44 45 65 66 70 72 obesity53 57 or metabolic syndrome 36 56. Eighteen studies assessed diet alone34 39 43–45 53–59 62 64 67–69 71; 5 studies assessed physical activity alone32 33 60 65 72; and 12 studies assessed a combination of diet and physical activity modifications 10 30 35–38 40 52 61 63 66 70. The comparator in all of the trials was usual lifestyle/dietary advice, with the exception of three trials in which the comparator was no intervention 37 58 71.…”

Section: Resultsmentioning

confidence: 99%

“…Cluster randomised trials were also assessed based on Cochrane guidelines 31. Most included cluster randomised trials reported individual participant data,30 34–39 adjusted for the clustering effect, which made it possible to use directly in the authors’ meta-analyses. Generic inverse variance meta-analysis was conducted for one of the cluster trials which reported effect estimates adjusted for clustering but not individual participant data 40.…”

Section: Methodsmentioning

confidence: 99%

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Effects of lifestyle interventions on cardiovascular risk factors in South Asians: a systematic review and meta-analysis

et al. 2022

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BackgroundThe cardiovascular disease (CVD) burden among South Asians is high. Lifestyle interventions have been effective in the primary prevention of CVD, but this has not been replicated, through a synthesis of randomised trials, in South Asians.MethodsFour electronic databases (MEDLINE, Embase, CENTRAL and CINAHL), two clinical trial registries and references of included articles were searched through June 2022 (featuring ≥90% South Asian participants). Random-effects pairwise meta-analyses were performed, and heterogeneity was quantified with the I2statistic. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to report on the quality of evidence (International Prospective Register of Systematic Reviews registration (PROSPERO).ResultsThirty-five studies were included. Twelve tested diet and physical activity interventions; 18 tested diet alone; and 5 tested physical activity alone. All reported effects of the intervention(s) on at least one established risk factor for CVD, including blood pressure (systolic blood pressure (SBP), diastolic blood pressure (DBP) and blood lipids (high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc) or triglycerides). No trials reported clinical CVD. There is moderate-quality evidence that diet and physical activity interventions improve SBP (mean difference (MD) −2.72 mm Hg, 95% CI −4.11 to –1.33) and DBP (MD −1.53 mm Hg, 95% CI −2.57 to –0.48); high-quality to moderate-quality evidence that diet-only interventions improve DBP (MD −2.05 mm Hg, 95% CI −2.93 to −1.16) and blood lipids (triglycerides (MD −0.10 mmol/L, 95% CI −0.14 to −0.06) and LDLc (MD −0.19 mmol/L, 95% CI −0.32 to −0.06)); and moderate-quality evidence that physical activity-only interventions improve SBP (MD −9.7 mm Hg, 95% CI −11.05 to −8.35), DBP (MD −7.29 mm Hg, 95% CI −8.42 to −6.16) and HDLc (MD 0.08 mmol/L, 95% CI 0.04 to 0.11) compared with usual care.ConclusionsLifestyle interventions improve blood pressure and blood lipid profiles in adult South Asians at risk of CVD. Tailored interventions should be used to modify cardiovascular risk factors in this at-risk group.PROSPERO registration numberCRD42018090419.

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Reduced or modified dietary fat for preventing cardiovascular disease

Hooper

Summerbell

Thompson

et al. 2011

Cochrane Database of Systematic Reviews

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Background Reduction and modification of dietary fats have differing effects on cardiovascular risk factors (such as serum cholesterol), but their effects on important health outcomes are less clear. Objectives To assess the effect of reduction and/or modification of dietary fats on mortality, cardiovascular mortality, cardiovascular morbidity and individual outcomes including myocardial infarction, stroke and cancer diagnoses in randomised clinical trials of at least 6 months duration. Search methods For this review update, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, were searched through to June 2010. References of Included studies and reviews were also checked. Selection criteria Trials fulfilled the following criteria: 1) randomised with appropriate control group, 2) intention to reduce or modify fat or cholesterol intake (excluding exclusively omega-3 fat interventions), 3) not multi factorial, 4) adult humans with or without cardiovascular disease, 5) intervention at least six months, 6) mortality or cardiovascular morbidity data available. Data collection and analysis Participant numbers experiencing health outcomes in each arm were extracted independently in duplicate and random effects meta-analyses, meta-regression, sub-grouping, sensitivity analyses and funnel plots were performed. Main results This updated review suggested that reducing saturated fat by reducing and/or modifying dietary fat reduced the risk of cardiovascular events by 14% (RR 0.86, 95% CI 0.77 to 0.96, 24 comparisons, 65,508 participants of whom 7% had a cardiovascular event, I2 50%). Subgrouping suggested that this reduction in cardiovascular events was seen in studies of fat modification (not reduction - which related directly to the degree of effect on serum total and LDL cholesterol and triglycerides), of at least two years duration and in studies of men (not of women). There were no clear effects of dietary fat changes on total mortality (RR 0.98, 95% CI 0.93 to 1.04, 71,790 participants) or cardiovascular mortality (RR 0.94, 95% CI 0.85 to 1.04, 65,978 participants). This did not alter with sub-grouping or sensitivity analysis. Few studies compared reduced with modified fat diets, so direct comparison was not possible. Authors’ conclusions The findings are suggestive of a small but potentially important reduction in cardiovascular risk on modification of dietary fat, but not reduction of total fat, in longer trials. Lifestyle advice to all those at risk of cardiovascular disease and to lower risk population groups, should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturates. The ideal type of unsaturated fat is unclear.

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Efficacy of CVD Risk Factor Modification in a Lower-Middle Class Community in Pakistan: The Metroville Health Study

Cited by 11 publications

References 20 publications

The Association of Knowledge and Behaviours Related to Salt with 24-h Urinary Salt Excretion in a Population from North and South India

The Association of Knowledge and Behaviours Related to Salt with 24-h Urinary Salt Excretion in a Population from North and South India

Effects of lifestyle interventions on cardiovascular risk factors in South Asians: a systematic review and meta-analysis

Reduced or modified dietary fat for preventing cardiovascular disease

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