Objective: To estimate the prevalence and the socioeconomic and demographic correlates of tobacco consumption in India. Design: Cross sectional, nationally representative population based household survey. Subjects: 315 598 individuals 15 years or older from 91 196 households were sampled in National Family Health Survey-2 (1998–99). Data on tobacco consumption were elicited from household informants. Measures and methods: Prevalence of current smoking and current chewing of tobacco were used as outcome measures. Simple and two way cross tabulations and multivariate logistic regression analysis were the main analytical methods. Results: Thirty per cent of the population 15 years or older—47% men and 14% of women—either smoked or chewed tobacco, which translates to almost 195 million people—154 million men and 41million women in India. However, the prevalence may be underestimated by almost 11% and 1.5% for chewing tobacco among men and women, respectively, and by 5% and 0.5% for smoking among men and women, respectively, because of use of household informants. Tobacco consumption was significantly higher in poor, less educated, scheduled castes and scheduled tribe populations. The prevalence of tobacco consumption increased up to the age of 50 years and then levelled or declined. The prevalence of smoking and chewing also varied widely between different states and had a strong association with individual’s sociocultural characteristics. Conclusion: The findings of the study highlight that an agenda to improve health outcomes among the poor in India must include effective interventions to control tobacco use. Failure to do so would most likely result in doubling the burden of diseases—both communicable and non-communicable—among India’s teeming poor. There is a need for periodical surveys using more consistent definitions of tobacco use and eliciting information on different types of tobacco consumed. The study also suggests a need to adjust the prevalence estimates based on household informants

https://tobaccocontrol.bmj.com/content/tobaccocontrol/12/4/e4.full.pdf

Tobacco use in India: prevalence and predictors of smoking and chewing in a national cross sectional household survey

BACKGROUND AND AIMS: In this study, a prevalence survey of various atherosclerosis risk factors was carried out on hitherto poorly studied rural–urban migrants settled in urban slums in a large metropolitan city in northern India, with the aim of studying anthropometric and metabolic characteristics of this population in socio-economic transition. DESIGN: A cross-sectional epidemiological descriptive study. SUBJECTS: A total of 532 subjects (170 males and 362 females) were included in the study (response rate approximately 40%). METHODS AND RESULTS: In this study, diabetes mellitus was recorded in 11.2% (95% CI 6.8–16.9) of males and 9.9% (95% CI 7.0–13.5) of females, the overall prevalence being 10.3% (95% CI 7.8–13.2). Based on body mass index (BMI), obesity was more prevalent in females (15.6%; 95% CI 10.7–22.3) than in males (13.3%; 95% CI 8.5–19.5). On the other hand, classifying obesity based on percentage body fat (%BF), 10.6% (95% CI 6.4–16.2) of males and 40.2% (95% CI 34.9–45.3) of females were obese. High waist–hip ratio (WHR) was observed in 9.4% (95% CI 5.4–14.8) of males and 51.1% (95% CI 45.8–56.3) of the females. All individual skinfolds and sum of skinfolds were significantly higher in females (P 30%). Furthermore, total cholesterol and low-density lipoprotein cholesterol were high in both males and females. Stepwise multiple linear regression analysis showed that for both males and females BMI, WHR and %BF were positive predictors of biochemical parameters, except for HDL-c, for which these parameters were negatively associated. CONCLUSIONS: Appreciable prevalence of obesity, dyslipidaemia, diabetes mellitus, substantial increase in body fat, generalised and regional obesity in middle age, particularly in females, need immediate attention in terms of prevention and health education in such economically deprived populations.

High prevalence of diabetes, obesity and dyslipidaemia in urban slum population in northern India.

https://research-information.bris.ac.uk/ws/files/187397336/1_s2.0_S2214109X1730058X_main.pdf

Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review

OBJECTIVE: The primary objective of this review is to examine the demographic and nutrition transition in India in relation to its contribution to the emerging epidemic of chronic non-communicable diseases in this country. SETTING: India, the country as a whole and its different states with a population exceeding 1 billion in 2001. SUBJECTS: The review examines demographic changes in the population with consequent effects on the population pyramid, the rapidity and rates of urbanisation with striking variations in chronic disease patterns and the trends in obesity between rural and urban communities, attempting to relate their prevalence with the diet and lifestyle changes accompanying them. DESIGN: The review is based largely on representative large-scale surveys in the country and other reliable documented data on population characteristics. It also includes a review of the published literature. RESULTS: The results indicate that the demographic changes, rates of urbanisation and changes in dietary patterns are contributing to the changing trends in chronic disease in India. CONCLUSIONS: There is clear evidence of a demographic, epidemiological and nutrition transition in India that is fuelling the epidemic of chronic diseases and obesity, particularly in the urban areas.

/pdf/nutrition-transition-in-india-12fm4bxv05.pdf

Nutrition transition in India

Multifactorial causation of obesity: implications for prevention.

A community-based epidemiological survey of coronary heart disease and its risk factors was carried out over the period 1984-87 on a random sample of adults aged 25-64 years: 13,723 adults living in Delhi and 3375 in adjoining rural areas. ECG examination and analysis of fasting blood samples for lipids were performed on subjects with the disease and asymptomatic adults free of clinical manifestations. The overall prevalence of coronary heart disease among adults based on clinical and ECG criteria was estimated at 96.7 per 1000 and 27.1 per 1000 in the urban and rural populations, respectively. Prevalences of a family history of coronary heart disease, hypertension, obesity and diabetes mellitus were significantly higher in the urban than in the rural population, and smoking was commoner among rural men and women. Mean levels of total serum cholesterol and low density lipoprotein cholesterol were higher among urban subjects; the mean level of triglycerides was higher in rural subjects. The proportions with total cholesterol levels > 190 mg/dl were 44.1% and 23.0% in urban and rural men, respectively, and 50.1% and 23.9% among urban and rural women, respectively. High density lipoprotein cholesterol levels < 35 mg/dl were found in 2.2% of urban men and 8.0% of rural men compared with 1.6% and 3.5% among urban and rural women, respectively. An abnormal ECG pattern (Q wave or ST-T changes) in asymptomatic individuals is also considered to be a risk factor for coronary heart disease. In asymptomatic adults, 1.7% of urban men and 1.2% of urban women showed abnormal Q waves compared with 0.3% of rural men and 0.4% of rural women. A higher proportion of asymptomatic women showed ST-T changes in both populations. Rural men and women had higher total calorie and saturated fat intakes than urban subjects. Differences in dietary cholesterol intake were marginal. Sodium intake was greater in urban adults. Average daily consumption of alcohol by urban men was 12.7 ml ethanol compared with 2.4 ml in rural men.

Urban-rural differences in the prevalence of coronary heart disease and its risk factors in Delhi

Objective: To determine the prevalence and predictors of smoking in urban India. Design: Cross sectional. Setting: Delhi, urban India, 1985-6. Subjects: Random sample of 13 558 men and women aged 25-64 years. Main outcome measure: Smoking prevalence; subjects who were currently smoking and who had smoked >/=100 cigarettes or beedis or chuttas in their lifetime were defined as smokers. Results: 45% (95% confidence interval 43.8 to 46.2) of men and 7% (6.4 to 7.6) of women were smokers. Education was the strongest predictor of smoking, and men with no education were 1.8 (1.5 to 2.0) times more likely to be smokers than those with college education, and women with no education were 3.7 (2.9 to 4.8) times more likely. Among smokers, 52.6% of men and 4.9% of women smoked only cigarettes while the others also smoked beedi or chutta. Compared with cigarette smokers, people smoking beedi or chutta were more likely to be older and married; have lower education, manual occupations, incomes, and body mass index; and not drink alcohol or take part in leisure exercise. Conclusion: There are two subpopulations of smokers in urban India, and the prevention strategy required for each may be different. The educated, white collar cigarette smoker in India might respond to measures that make non-smoking fashionable, while the less educated, low income people who smoke beedi or chutta may need strategies aimed at socioeconomic improvement. Key messages Lack of education was the strongest risk factor for smoking: men with no education were 1.8 times more likely to be smokers than those with college edu- cation, and women with no education were 3.7 times more likely There are two subpopulations of smokers in India: the affluent, white collar cigarette smoker and the less affluent labourer who smokes beedi or chutta Different preventive strategies may be required to target each of these two groups Prospective epidemiological studies of smoking in India will be of value

Prevalence and patterns of smoking in Delhi: cross sectional study.

The prevalence of obesity and its associations were assessed during a community based epidemiological survey of coronary heart disease on a randomised sample of 13,414 adults in the age group 25-64 years living in urban Delhi. Body Mass Index (BMI) > 25 was considered to be the cut off point for defining obesity. By this criterion, the overall prevalence rate of obesity was 27.8%. Obesity was found to be more common in female subjects (Male--21.3%, Female--33.4%, p < 0.001). Obesity was more frequent in male subjects with lower physical activity compared to those doing heavier physical activity (29.3 vs 17.5%, p < 0.001). Physical activity did not influence the prevalence of obesity in females. Hypertension (24.8 vs 8.2%, p < 0.001) coronary heart disease (5.3 vs 2.4%, p < 0.001) and diabetes mellitus (3.2 vs 1.6%, p < 0.001) were more common in the obese than in the non-obese subjects. Hypercholesterolaemia (65.5 vs 53%, p < 0.001) and hypertriglyceridaemia (73.3 vs 61.1%, p < 0.001) were found to be associated with obesity.

An epidemiological study of obesity in adults in the urban population of Delhi.

Distribution patterns of blood pressure were studied in a randomised sample of 10,215 school children (5,709 boys 4,506 girls) in the age group 5-14 years in Delhi. The mean values of systolic and diastolic blood pressure (SBP and DBP) increased with age in both sexes. The cut-off points for high blood pressure were based on average SBP and/or DBP values of 95th percentile or greater for each age. The values for SBP ranged from 70 mm Hg to 140 mm Hg and for DBP from 36 mm Hg to 100 mm Hg for the age group 5-9 years. In the age group 10-14 years, the values for SBP and DBP ranged from 72 mm Hg to 160 mm Hg and from 46 mm Hg to 120 mm Hg, respectively. The prevalence of hypertension (systolic, diastolic or both) was 11.9 percent in boys and 11.4 percent in girls, an insignificant difference. Anthropometric variables like height, weight and body mass index showed positive correlation with systolic as well as diastolic blood pressure but the waist-hip ratio showed negative correlation coefficient with blood pressure. Family history of hypertension in one or both the parents was present in 20.4 percent children with high blood pressure compared to 6.8 percent in normotensives. Family history or diabetes was also significantly higher in hypertensive children (5.4%) than in normotensives (3.1%).

An epidemiological study of blood pressure in school children (5-14 years) in Delhi.

A community based dietary survey was carried out in 906 adults (25-64 yr) from 489 families in Delhi urban population and 275 adults from 196 families in rural population of Gurgaon district (Haryana state). A combination of 24 h recall and weightment method was used to assess the individual dietary intake. Daily average intake of various nutrients was calculated. A higher intake of cereals, milk and milk products and sugar and jaggery and a lower intake of pulses, vegetables, fruits, flesh foods and oils and fats were observed in the rural population. The average total calorie intake was 1,749 kcal in the urban and 1,910 in the rural population. The average intake of carbohydrates and proteins was 257.3 g (59.0 en %) and 54.7 g (12.5 en %) in the urban population compared to 295.6 g (61.9 en %) and 63.0 g (13.2 en %) respectively in the rural group. The fat intake was the lowest in the urban low socio-economic group (45.5 g). The contribution of total fat to energy intake ranged from 24.6 en to 31.2 en per cent in different population groups. The rural group showed higher intake of calcium and iron than the urban population. Intake of retinol was higher in the high socio-economic group (urban) than other population groups. Urban/rural differences were observed in intake of retinol, thiamine, niacin, vitamin C and vitamin E. Daily dietary cholesterol intake was the highest in the urban high socio-economic group (119 mg). The fibre intake was higher in the urban than the rural population (8.0 g vs 7.4 g).

N Gopinath

Papers

Urban-rural differences in the prevalence of coronary heart disease and its risk factors in Delhi

Prevalence and patterns of smoking in Delhi: cross sectional study.

An epidemiological study of obesity in adults in the urban population of Delhi.

An epidemiological study of blood pressure in school children (5-14 years) in Delhi.

Dietary profile of adults in an urban & a rural community.