Study of association of high fiber diet to blood Pressure & cardiac risk ratio A case control study

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1 Original articl Study of association of high fibr dit to blood Prssur & cardiac risk ratio A cas control study Dr. Manjiri S. Bhalkar 1, Dr. Pinaki Wani 2 1Dpartmnt of Biochmistry, 2 Dpartmnt of physiology K. J. Somaiya Mdical Collg, Hospital and Rsarch cntr, Sion, Mumbai Corrsponding author: Dr. Manjiri S. Bhalkar Abstract: Introduction Consumption of high fibr dit can b ffctiv in controlling hyprtnsion & rducing cardiovascular risk. Cardiac risk ratio (CRR) has a bttr prdictiv powr of cardiovascular disordrs. Hnc this study was dsignd to know th association of high fibr dit to blood prssur & CRR. Matrial and Mthodology 255 subjcts visiting K. J. Somaiya Hospital, wr intrviwd, out of which 150 subjcts wr slctd & dividd into four groups, namly high fibr consuming and low fibr consuming mn & womn. Th systolic & diastolic blood prssur was masurd. 12 hrs. fasting vnous blood sampls of th subjcts wr collctd & analyzd for total & HDL cholstrol. Th prcnt prvalnc of subjcts having hyprtnsion & CRR >5 was dtrmind in ach group. Th odds ratio was calculatd, to find th association of high fibr consumption to hyprtnsion and to CRR. Obsrvations & Rsults Amongst th 120 mn & 135 womn intrviwd, only 28.3 % mn & 28.8 % womn wr found to b rgularly consuming high fibr dit. Thr is a highr prvalnc of CRR > 5 in mn (14.71%) & womn (19.34%) amongst low fibr consuming compard to high fibr dit group. Also a highr prvalnc of hyprtnsion obsrvd in mals (5.89%) & fmal (21.92%), consuming low fibr than high fibr dit. Th odds ratio was significant, indicating an association btwn high fibr consumption & hyprtnsion in womn. Conclusion Consumption of high fibr dit rgularly is ffctiv in prvnting hyprtnsion & rducs cardiovascular risk. Kywords: Ditary fibr, Hyprtnsion, Cardiac risk ratio. Introduction: In th prsnt day changing lifstyl, it is ncssary to undrstand that a simpl, low cost habit of consumption of salad rgularly can b ffctiv in controlling hyprtnsion & rducing cardiac risk, as salads add high fibr contnt to th dit. Hyprtnsion or high blood prssur is dfind as systolic blood prssur of gratr than 140 mmhg or diastolic blood prssur gratr than 90 mmhg or both (1) Hyprtnsion is th third risk factor for dath from cardiovascular disas, togthr with LDLcholstrol and smoking, which is calld th silnt killr. Bsids, hyprtnsion is th major risk factor for strok and rnal dysfunction. (2) Epidmiological studis suggst that consumption of fruit, vgtabls may protct against high blood prssur. (3,4,5,6) Vgtabls, fruits may dcras blood prssur du to prsnc of phytochmicals. (7,8) Phytochmicals ar th functional nonnutrint food factors, found in vgtabls and fruits and ar ffctiv for halth promotion and disas prvntion. 621 (7,8,9) Phytochmicals lik anthocyanidins, rsratrol lutin, lycopn, β-carotn, isoflavons ar prsnt in brris, radish, spinach, lttuc, tomato, pumpkin,

2 carrot, xrt a positiv ffct on hart & blood vssl halth. (10) Cardiac risk ratio (CRR) mans Total Cholstrol : HDL Cholstrol ratio. CRR has a bttr prdictiv powr of cardiovascular disordrs than th individual paramtr. (11) Hnc this study was dsignd to know th association of high fibr dit to blood prssur & CRR. This pidmiological study can b usful to prvnt futur CAD by counsling patints about taking salads in thir dit for thraputic lifstyl changs. (12) Aims & Objctivs : To study th ffct of consumption of high fibr dit on blood prssur & cardiac risk ratio in mn & womn. Matrial and Mthods : Out of 255 subjcts intrviwd, 150 subjcts (75 mals & 75 fmals) visiting K. J. Somaiya Hospital, wr nrolld in this cross sctional study during August 2013 to Jun Th ag of th participants rangd btwn 25 yrs. to70 yrs. A convnint sampling mthod was usd. A protocol for study was approvd by th thics committ of K. J. Somaiya Mdical Collg & Hospital. A writtn consnt of th participants was obtaind bfor commncmnt of th study. Th patints having Diabts mllitus, hypo & hypr thyroidism, Nphritis, Livr disass, Pancratitis, Prgnancy and Malnutrition wr xcludd from th study. Thos, taking salad in thir dit occasionally & not rgularly wr also xcludd from th study.th information about ditary habits was collctd in a pr-validatd qustionnair. Th dmographic information of th participants was also gathrd in a pr-validatd format. Th participants wr dividd in to four groups, namly high fibr consuming mn & womn and low fibr consuming mn & womn. Thos who includ salad in thir vryday dit wr considrd as high fibr consuming. Thos who nvr consum salad in th dit wr considrd as low fibr consuming. A masurmnt of systolic blood prssur (SBP) & diastolic blood prssur (DBP) was carrid out using dlux sphygmomanomtr for ach subjct btwn 9 am to 11 am as pr th routin clinical procdur.th 12 hrs. fasting vnous blood sampls of th subjcts wr collctd in plain bulb. Th srum was sparatd within 2 hrs. of th collction & thn analyzd using a fully automatd Biochmistry analyzr Chmwll P2900 sris, manufacturd by Awarnss Tchnology, Florida, USA. Th srum total cholstrol concntration was dtrmind by nzymatic colorimtric assay using ragnts supplid by Simns. Th HDL cholstrol concntration was dtrmind by dirct nzymatic colorimtric mthod using Spinract ragnts. Th Cardiac Risk Ratio (CRR ) was calculatd for individual subjct. Statistical Analysis: Th prcnt prvalnc of subjcts having hyprtnsion & thos with CRR >5 was dtrmind in ach study group. Th odds ratio was calculatd & 95% confidnc intrval was dtrmind, to find th association of high fibr consumption to hyprtnsion and to CRR. Rsults: Tabl 1 : Charactristics of study population Charactristics High fibr dit Low fibr dit Mal, Ag in yars (man+sd) ± ± 17.7 Fmal, Ag in yars (man+sd) ± ± 10.1 Mal, (n) Fmal, (n)

3 Amongst th 120 mn & 135 womn intrviwd, only 34 (28.3 %) mn & 39 (28.8 %) womn wr found to b rgularly consuming high fibr dit.th cut-off risk lvl & targt lvl of CRR as primary targt in prvntion of cardiovascular risk is >5 & >4.5 rspctivly for mn which is >4.5 & >4 for womn. (11) Fig. 1: Prvalnc of CRR > 5 in mn & womn p r c n t a g Mal 50 Prvalnc of CRR > Fmal High fibr Low fibr In th Fig 1, thr is a highr prvalnc of cass with CRR > 5 in in mn ( 14.71%) & womn (19.34%) consuming low fibr compard to thir countrparts consuming high fibr. This is statistically insignificant. Fig. 2 : Prvalnc of Hyprtnsion in mn & womn p r c n t a g Prvalnc of Hyprtnsion Mal Fmal High fibr Low fibr In Fig. 2, th prvalnc of hyprtnsion is 5.89% highr in mal & 21.92% highr in fmal consuming low fibr in thir dit than thir countrparts consuming highr fibr. 623

4 Tabl 2: Odds ratio (OR) & 95% confidnc intrval (CI) for finding association of high fibr dit to th vnt. Evnt OR 95 % CI Lowr limit Uppr limit Hyprtnsion Mal Fmal CRR > 5 Mal Fmal Th odds ratio was found to b significant within 95 % confidnc intrval indicating an association btwn high fibr consumption & hyprtnsion in womn. Th sam is not statistically significant for mn. Th odds ratio was not found to b significant within 95 % confidnc intrval indicating that association is not stablishd btwn high fibr consumption and CRR in both th sxs. Discussion: Epidmiological studis suggst that consumption of a dit high in fruits and vgtabls is associatd with a rducd risk of chronic disas. (13) Th phytochmicals lik flavonoids, polyphnols, carotnoids prsnt in vgtabls & salads, rducs inflammation occurring in th artrial wall & prvnt blood clls from sticking togthr. (2) Flavonoids prsnt in salads ar scavngrs of fr radicals lik suproxid anions and lipid proxyl radicals and prvnt oxidation of LD-Cholstrol, which is athrognic. It dcrass th formation of athrosclrotic plaqus and rducs artrial stiffnss, laving artris mor rsponsiv to th ndognous stimuli of vasodilatation. (4,14) Polyphnols and carotnoids hav hypotnsiv ffct by virtu of inhibition of NADPH oxidas drivn gnration of ractiv oxygn spcis. This is du to supprssion of mrna xprssion. Polyphnols and carotnoids causs improvmnt in ndothliumdpndnt vasodilatation in th aorta Carotnoids also (7,15,16). nhanc nitric oxid (NO) gnration and rduc blood prssur in hyprtnsiv patints (17) Th rsults of this study clarly mphasiz mor bnficiary ffct of fibr consumption in fmals than mals. This could b du to synrgistic ffct of strogn. Th hormon strogn in fmals affcts th vascular systm by promoting a lowr vascular ton by rlasing of ndothlium - drivd Nitric Oxid. (18,19) Th study don in Japans population rvals that total, insolubl, and solubl ditary fibr intaks wr invrsly associatd with risk of mortality from CHD and total CVD for both mn and womn (20), which is in congrunc with th prsnt study. A systmatic rviw carrid out by Dian E Thraplton, Darrn C Grnwood, Charlott E L Evans, t al. rvals that gratr ditary fibr intak is associatd with a lowr risk of both cardiovascular disas and coronary hart disas. (21) Thir findings ar alignd with gnral rcommndations to incras fibr intak. Th prsnt study also concluds similarly that awarnss rgarding good ffcts of fibr consumption is lss & thr is a nd to rcommnd high fibr dit. According to a mta-analysis of randomizd placbo-controlld trials to stimat th ffct of fibr supplmntation on blood prssur ovrall and in population subgroups concludd that in wstrn populations, whr intak of fibr is far blow 624

5 rcommndd lvls, incras in th intak of fibr may contribut to th prvntion of hyprtnsion. (22) Th rsults of prsnt study show a similar infrnc that high fibr dit contribut to prvntion of hyprtnsion. Conclusion: Th high fibr dit has a significant association to blood prssur in womn. Rgular intak of high fibr dit dcrass CRR in mn & womn. It is ncssary to incras awarnss about bnfits of high fibr dit. Limitation Scop: Thr is a nd to study th mod of action of diffrnt typs of fibr componnts from diffrnt ditary sourcs Acknowldgmnts: W acknowldg th contributions from th Dpartmnts of Pathology, Physiology, and Biochmistry of th K. J. Somaiya Mdical Collg, Hospital & Rsarch Cntr. Mumbai. Rfrncs: 1. WHO. Classification of hyprtnsion. Rport of WHO Scintific Group, Tchnical Rport Sris 1978; 657: Akram Kooshki, BiBi Lila Hosini. Phytochmicals and Hyprtnsion. Shiraz E-Md J.Jan.2014; 15(1) : Liu S, Manson JE, L IM, Col SR, Hnnkns CH, Willtt WC, t al. Fruit and vgtabl intak and risk of cardiovascular disas: th Womn's Halth Study. Am J Clin Nutr. 2000;72(4): d Paula TP, Stmburgo T, d Almida JC, Dall'Alba V, Gross JL, d Azvdo MJ. Th rol of Ditary Approachs to Stop Hyprtnsion (DASH) dit food groups in blood prssur in typ 2 diabts. Br J Nutr. 2012;108(1): Alonso A, d la Funt C, Martin-Arnau AM, d Irala J, Martinz JA, Martinz-Gonzalz MA. Fruit and vgtabl consumption is invrsly associatd with blood prssur in a Mditrranan population with a high vgtabl-fat intak: th Sguiminto Univrsidad d Navarra (SUN) Study. Br J Nutr. 2004;92(2): Wang L, Manson JE, Gaziano JM, Buring JE, Ssso HD. Fruit and Vgtabl Intak and th Risk of Hyprtnsion in Middl- Agd and Oldr Womn. Amrican Journal of Hyprtnsion. 2012;25(2): Daucht L, Amouyl P, Hrcbrg S, Dallongvill J. Fruit and vgtabl consumption and risk of coronary hart disas: a mtaanalysis of cohort studis. J Nutr. 2006;136(10): Symour EM, Singr AA, Bnnink MR, Parikh RV, Kirakosyan A, Kaufman PB, t al. Chronic intak of a phytochmicalnrichd dit rducs cardiac fibrosis and diastolic dysfunction causd by prolongd salt-snsitiv hyprtnsion. J Grontol A Biol Sci Md Sci. 2008;63(10): Mlby MK, Murashima M, Watanab S. Phytochmical intak and rlationship to past halth history in Japans womn. Biofactors. 2004;22(1-4): ( march ) 11. Jsus Millan, Xavir Pinto, Anna Munoz t al. Lipoprotin ratios : `Physiological significanc and clinical usfulnss in cardiovascular prvntion. Dov Prss Journal: Vascular Halth and Risk Managmnt. 2009; 5: NCEP III. Excutiv summary of th third rport of th national cholstrol ducation program (NCEP) xprt panl on dtction, valuation, and tratmnt of high blood cholstrol in adults (Adult Tratmnt Panl III). JAMA. 2001;285: Hung, H.C., t al., Fruit and vgtabl intak and risk of major chronic disas. J Natl Cancr Inst, (21): p Molin J, Bukharovich IF, Wolff MS, Phillips R. Ditary flavonoids and hyprtnsion: is thr a link? Md Hypothss. 2000;55(4): Suzuki A, Fujii A, Yamamoto N, Yamamoto M, Ohminami H, Kamyama A, t al. Improvmnt of hyprtnsion and vascular dysfunction by hydroxyhydroquinon-fr coff in a gntic modl of hyprtnsion. FEBS Ltt. 2006;580(9):

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