Indian Consensus for Prevention of Hypertension and Coronary Artery Disease: Indian Consensus Group: Report of a Consensus Development Workshop Conducted by the Indian Society of Hypertension and the International College of Nutrition, New Delhi, 1995

Abstract

There is evidence that rapid changes in diet and lifestyle combined with high levels of lipoprotein (a) are the main genetic causes of coronary artery disease (CAD) in Indians. Although CAD and hypertension have become a public health problem in India, there is no consensus on diet and lifestyle guidelines and desirable levels of risk factors for prevention. In the urban adult population between 25 and 64 years of age, the prevalence of CAD appears to be about 90/1000 and of hypertension about 160/1000. Both hypertension and CAD are three to four times less common in the rural population compared with urban subjects. In view of the lower fat intake in the low-risk rural population compared with those in urban areas (13.8% vs 25% kcal/day), the limit for total energy from fat intake should be < 21% kcal/day (7% each from saturated, polyunsaturated and monounsaturated fatty acids). The carbohydrate intake should be > 65% kcal/day, mainly from complex carbohydrates. A body mass index of 21 kg m⁻² should be considered safe for Indians, but the range may be 18.5–23kg m⁻² and > 23kg m⁻² should be considered as overweight. A waist-hip ratio of > 0.88 in males and > 0.85 in females should be considered as central obesity because the prevalence of risk factors and CAD beyond these limits is higher. Despite this there is a general international consensus that the desirable level of serum cholesterol should be < 170mg dl⁻¹ (5.20 mmol l⁻¹); in Indians the optimal limit should be < 170mg dl⁻¹ (4.42 mmol l⁻¹). The values between 170 and 200mg dl⁻¹ (4.42–5.20 mmol l⁻¹) should be considered as borderline. The critical values for low-density lipoprotein cholesterol may be <90mg dl⁻¹ (2.32 mmol l⁻¹), 90–110mg dl⁻¹ (2.32–2.84 mmol l⁻¹) and >110mg dl⁻¹ (2.84 mmol l⁻¹). Fasting serum triglycerides should be <150mg dl⁻¹ and high-density lipoprotein cholesterol > 35 mg dl⁻¹. Eating 400 g/day fruits, vegetables and legumes and mustard or soya bean oil (25 g/day) in place of hydrogenated fat, coconut oil or ghee, in conjunction with a low-salt diet (< 6 g/day), moderate physical activity (300 kcal/day) and cessation of tobacco consumption may protect against CAD in Indians. Tobacco consumption should be zero and alcohol intake should be reduced in South Indians (it is not yet common in other Indians).

Key Words:

• total fat
• saturated fat
• body mass index
• waist-hip ratio
• cholesterol triglycerides