Today, the burden of deaths and disability in developing countries caused by non-communicable diseases, particularly
cardiovascular,
overshadows that imposed by longstanding communicable diseases. Of an estimated 58 million deaths globally from all causes in 2005,
Cardiovascular disease (CVD) accounted for 30%. It is important to recognize that almost half of these deaths were of people who were in their most productive period of life1.
Cardiovascular diseases and other non-communicable diseases were considered as diseases of the industrialized countries – purported avant-garde society– brought about by erroneous lifestyle customs, but now it is emerging as one of the main causes of mortality and morbidity in the developing countries of Asia and Africa. Risk factors for the development of CVDs: · Smoking and Tobacco · Increased blood pressure · Increased blood
Cholesterol · Increased blood sugar · Overweight or increased BMI or increased Waist-to-hip ratio · Inappropriate diet · Sedentary habit or physical inactivity. The underlying pathology for development of
CVD is
atherosclerosis, which develops over many years and is usually advanced by the time symptoms appear, generally in middle age.
Cholesterol is the keystone for the development of
atherosclerotic lesions. WHO expert committee concluded that there is a well established triangular relationship between
habitual diet, blood cholesterol levels and Coronary Heart Disease(CHD)5.
Cholesterol happens to be in all foods of animal origin. It is worthy of note that only 25% of our body
cholesterol is obtained from food we eat, whereas rest of 75% is synthesized in liver itself, former is called as
‘exogenous source’ whereas latter is called as
‘endogenous source’.
Cholesterol is carried in plasma lipoproteins, in the form of
Very-low-density-lipoproteins (VLDLs),
Low-density-lipoproteins (LDLs), and
High-density-lipoproteins (HDLs).
LDL has been shown to function in the delivery of cholesterol to body cells, so excessive level of
LDL leads to the deposition of cholesterol in tissue cells particularly in the smooth muscle cells of the vascular system, thus involved in the atherosclerotic process. In contrast,
HDL functions in the removal of cholesterol from cells. This mechanism underlines its protective effect in
CHD.
Soluble fibers forms a gel in the stomach and checks the absorption of dietary
cholesterol14. Furthermore,
Soluble fibers undergo fermentation in the colon, with the help of
colonic bacteria, and are metabolized into gases and
Short chain fatty acids (SCFA). More over
SCFA, formed by the fermentation of
soluble fibers, enters into the portal system and acts upon the liver cells by inhibiting
HMG-CoA reductase, an enzyme involved in the production of
cholesterol by the liver. By lowering the activity of this enzyme, blood
cholesterol levels may be lowered. In this fashion
soluble fiber curbs the
exogenous sources as well as
endogenous sources of
cholesterol consequently very effective in lowering the blood
cholesterol level.
Psyllium seed husk18 (Isabghol ki bhosi),
Fengreek seed19 (Methi) and
Oat bran20 (Jowar ki bhosi) have been proven worldwide for being paramount source of
soluble fibers and having the aptitude to lower the blood
cholesterol level. Other high-quality sources of
soluble fibers are
legumes, peas, fruits like prunes, plums & berries, vegetables like broccoli, carrots etc. Several researches have been conducted worldwide which portrays that daily consumption of
fresh fruits and vegetables in adequate quantity may reduce the probability of several, so called,
lifestyle diseases like
CVDs, diabetes, obesity etc.
World health organization has recommended daily intake of no less than 400gm of fresh fruits and vegetables for prevention of these
lifestyle diseases. On the other hand
Poly unsaturated fatty acid (PUFA) and
Mono unsaturated fatty acid (MUFA) are non
atherogenic and preponderance of evidence indicates that dietary
MUFA &
PUFA have favourable effect on
CVD risk, by lowering
LDL cholesterol in blood
Trans fatty acids are geometrical isomers of unsaturated fatty acids that adapt a
SFA like configuration. They are naturally present in some animal and plant product, but in very low quantity. Obesity is a growing health problem in both developed and developing countries. Prospective or obesity and cardiovascular morbidity, CVD mortality and total mortality7. Obesity is strongly related to major cardiovascular risk factors, such as raised blood pressure, glucose intolerance, type 2 diabetes, and dyslipidaemia. Meta-analyses of RCTs have shown that a weight-reducing diet, combined with exercise, produces significant weight loss, reduces total cholesterol and LDL-cholesterol, increases HDL-cholesterol, and improves control of blood pressure and diabetes50. To be more precise body mass index (BMI) and waist-to-hip ratio (WHR) would be more important determinant for measurement of obesity. As there is increase in BMI and WHR, so there is more odds to develop CVD51. BMI < 25 kg/m2 and WHR ≤ 0.85 for females and WHR ≤ 1.0 for males is considered as high risk for CVD. Ideal BMI should be in between 18-25 kg/m2 whereas WHR should be ≥ 0.80 for females and ≥ 0.95 for males.