ASSOCIATION OF DIETARY HABITS AND LIFE STYLE BEHAVIORS WITH CARDIOVASCULAR RISK FACTORS AMONG PATIENTS WITH CORONARY ARTERY DISEASES

Objectives: To determine the association of dietary habits and lifestyle behaviors with cardiovascular diseases risk factors. Methodology: It is a cross-sectional study of a total of 200 cardiovascular disease patients. Data related to age, gender, demographic characteristics, clinical history, dietary habits, lifestyle behaviors, smoking were collected with the help of a questionnaire. Anthropometric measurements like height, weight, BMI, waist circumference (WC) and biochemical parameters like fasting blood glucose, total cholesterol, triglycerides, HDL-C, and LDL-C were analyzed by standardized methods. Data were analyzed by means of SPSS software version 21. Results having p-value ≤ 0.05 were considered as statistically significant. Results: The mean age of the 200 participants was 59.5 ± 11.0 years. The commonly observed modifiable CVD risk factors were smoking (39.5%), abnormal WC (77%), abnormal systolic blood pressure (83.5%), abnormal fasting blood glucose (82%), abnormal cholesterol (51.5%), and abnormal triglycerides (84.5%). Frequency of weekly read meat consumption was 66%, similarly, vegetables and fruits, chicken, and fast food consumption was 64.5%, 52.5%, and 76.5% respectively. Nearly one third (31%) of the participants had sedentary lifestyle. The results of the study evaluated that bakery products found to be significantly associated with an increased WC with odds ratio (OR) of 2.18 [1.06 4.47]; p=0.034. Surprisingly, use of chicken was found to be lesser associated with SBP > 130 mmHg with OR of 0.19 [0.04 0.91]; p=0.037 and use of vegetables and fruits was found to be associated with inceased incidence of LDL > 100 mg/dl with OR of 2.34 [1.09 5.04]; p=0.029 respectively. Conclusion: Dietary habits are significantly associated with cardiovascular risk factors than lifestyle behaviors.


INTRODUCTION
Cardiovascular disease (CVD) is a challenging and common health issue that significantly increases the morbidity and mortality rate throughout the world. Unhealthy diet, physical inactivity or sedentary lifestyle, consumption of alcohol, smoking, obesity, hypertension, diabetes, and hyperlipidemia are the major modifiable cardio-metabolic risk factors that cause cardiovascular diseases. 1,2 Approximately 13 million deaths are accredited due to cardiovascular diseases and it is predicted that their associated mortality will rise up to 25 million next to the year 2030. 3 As per World Health Organization (WHO), per year 2 million deaths happen due to unhealthy dietary habits and altered lifestyle behaviors such as physical inactivity or sedentary lifestyle. Prevention of diet and lifestyle related to cardiovascular diseases have become a major health challenge worldwide. 4 Sarebanhassanabadi study results revealed Dietary behaviors are significantly linked with the cardiovascular risk factors, therefore modifications in lifestyle behavior, especially improving the dietary protocols are suggested. 5 In addition, Oguoma study found that increased consumption of alcohol in addition to intake of the unhealthy diet improved the prevalence of cardiovascular disease indications in Nigerian population. 6 The study of Afshin results showed that in 11 countries diet was the most predisposing risk factor for the mortality related to cardio-metabolic deases (CMD). Individual patterns of diet, limited intake of fruits and whole grains may cause cardio-metabolic deases (CMD) death. 7 The findings of the studies reported that cardiovascular diseases are significantly associated with physical inactivity, smoking, adverse effects of psychosocial factors and clustering of two or three lifestyle patterns. 8,9 The association of the lifestyle behavior and diet pattern with cardiovascular disease event is very important because both factors are responsible to enhance the risk of cardiovascular factors such as hypertension, low HDL, high TG, and central obesity. 10 Presently the consumption of different dietary components has got attention because of their synergistic and inter related effects. Although, biomolecules of nutrients, single unit food and complex food groups are very useful to detect interrelation of diet and disease. 11 Single diet use is useful for helath but when used in combination it can be precursor to develop the non communicable diseases. 12 World wide diet uses pattern is different, some nations use single unit diets but most of the underdeveloped countries use complex unhealthy diet, in the results of CVD risk factors increased. 13 Due to diversity of the culture and dietary pattern, to assess adherence to dietary patterns is important to create independently dietary guidelines. 14 The USA developed their Healthy Eating Index (HEI) to promote healthy society and to prevent chronic disease. 15 Hence, in the developing country particularly in south asia there is not any specific HEI. 16 Along with diet the physical inactivity is also considerd and may be one of important modifiable risk factors for chronic diseases such as diabetes and CVD. It has been suggested that low physical activity is associated with increased risks of CVD and its related mortality. 17 Physically active indivisulas could reduce the risk of CVD through prevension of obesity, hypertension, dyslipidemia, and glycemic control. 18 The objective of this study is to evaluate the dietary pattern, lifestyle factors and their association with CVD risk factors among patients with coronary artery diseases. It will help to reduce the risk of cardiovascular disease in our population by modification of dietary and life style habits.

METHODOLOGY
This is a cross-sectional study, conducted during February, 2019 till May, 2019 at adult cardiology department of a tertiary care cardiac center. The data were collected from conveniently selected 100 male and female patients each. Adult patients diagnosed with coronary artery diseases, between 31 to 80 years of age were included from both inpatient and outpatient department. Whereas, subjects who do not have cardiovascular disease, pregnant and lactating women were excluded from study.
A questionnaire was designed to collect information from the patients regarding demographic status, personnel medical history, smoking, tobacco use, height (cm), weight (kg), dietary habits such as foods and beverages, red meat, processed meat poultry, fish, legumes, vegetables, fruits and physical activities includes moderate and vigorous etc. Anthropometric measurements include weight (kg), height (cm), body mass Index (BMI in kg/m 2 ), waist circumference (WC in cm), and systolic and diastolic blood pressure (mmHg) were measured.
Lifestyle of the patients was categorized as low physical activity, moderate physical activity, vigorous physical activity, and sedentary lifestyle using the yale physical activity survey (YPAS) method. 19 Whole blood sample of the patients was collected by using standard venipuncture technique, the 12 -14 hours fasting was recommended before collection of blood samples. After blood sample collection, the sample was transferred into distinct labeled collection tubes i.e. for glucose estimation 2ml in sodium fluoride potassium oxalate tube and 6 ml gel tube for the lipid profile . These samples of blood transported within 2-4 hours in the cold boxes filled with ice to the clinical laboratory. The sample collecting tubes were centrifuged for 15 minutes at a speed of 2500-3000 rpm and then separate plasma from sodium fluoride-potassium oxalate tube and serum from gel tube by transferring into separate aliquots. These aliquots were Pak Heart J 2020 Vol. 53 (02) 178 -187   Table 1.
The results of cardiometabolic risk factors presented that BMI (more than 30 Kg/m²), increased waist circumference (greater than 90 cm in male and greater than 80 cm in female), increased systolic blood pressure (more than 130 mmHg), high level of fasting blood glucose ( more than 100 mg/dl), raised level of triglyceride (greater than 150 mg/dl), and reduced HDL -cholesterol were equally prevalent in both male and feamel patients. Anthropometric measurements and biochemical characteristics of cardiovascular disease patients are presented in Table 2.
Distribuitn of dietary habits and life style behaviors of cardiovascular disease patients are presented in    The results of the dietary habits stated that the intake of fast food and red meat per week is significantly associated (p < 0.05) in cardiovascular disease patients, including males and females. Drinking of sweet beverages, dairy products, nuts and legumes, and fishes are mostly ingested per week, but they have no significance difference (p >0.05). Sun et al results revealed four models of dietary pattern developed named as "traditional food pattern," containing of vegetables, fruits, rices, porksmeat, and fishes; a "fast and processed food pattern" comprising of fast food or a processed cane food products, artificial sugar, and sweet; a "soybean, grain, and flour food pattern"; or "dairy, animal liver, and other animal food pattern." The results revealed that, intake of dietary patterns especially ingestion of "traditional Chinese food" is significantly associated with decreased blood pressure and cholesterol level and dietary habit of sayabean and grain decrese the risk of cardiovascular diseases by lowering triglycerides, fasting blood glucose (mg/dl), waist circumference (cm), and increased intake of dairy and any type of animal meat intake, it is siginifactly associated with high level of BMI. 29 The results of the study noted that sedentary lifestyle has the highest frequency followed by low physical activity, moderate physical activity, and vigorous physical activity, males are more common to spent sedentary lifestyle and perform low physical activity than females, whereas moderate and vigorous physical activities are frequently seen in females than males. Brugnara et al suggested that prevalence of sedentary lifestyle was in 32.3% males and 39% females (p < 0.0001). Low physical activity was significantly seen in individuals that were known to have diabetes, prediabetes and normal glucose regulation (p = 0.0014), The result of the study stated that the overall prevalence of cardiovascular risk factors is significant (p= <0.05) in 61 -70 years of age group. 30 The results of cardiometabolic risk factors showed that BMI (more than 30 Kg/m²), increased waist circumference (greater than 90 cm in men and greater than 80 in women), increased systolic blood pressure (more than 130 mmHg), high level of fasting blood glucose (greater than 100 mg/dl), raised level of triglyceride (mcholesterlore than 150 mg/dl), and reduced igh density lipoprotein cholesterol (HDL -C) are significant (p < 0.05) with both male and female in cardiovascular disease patients While, age (years), diastolic blood pressure (mmHg), Fasting cholesterol mg/dl), and low density lipoprotein low density lipoprotein cholesterol, low density lipoprotein -cholesterol (LDL-C) has no significant difference (p > 0.05) in both men and women. Comparatively, the results of a Malaysia studydescribed the CVD risk factors are more common in 48 -50 years of age group. The results of BMI have high significance. The cardiometabolic risk factor in males were increased due to high frequency of smoking, increased systolic blood pressure, reduced level of HDL-C, and greater frequency of diabetics among than females. 31 Similarly, Khetan et al (stated that people live in West Bengal (India) may suffered from the major cardiovascular risk factors that include 18.3% hypertensive patients (n=650), 9.0% diabetics (n=317) and 14.1% smokers (n=500). 32 The multivariate binary logistic regression analysis showed that the use of bakery products found to be significantly associated with an increased WC, in Eastern India, Verma et al reported that junk foods and sweat dishes increases CVD risk. 33 Surprisingly, use of chicken was found to be lesser associated with SBP > 130 mmHg with and use of vegetables and fruits was found to be associated with inceased incidence of LDL > 100 mg/dl respectively. The vegitables reduced the risk of CVD events due to its micrfonutrients valus but in our study the association with LDL is infact due to deep cooking with the help of saturated faty oils.It is proved that chicken have some benefit compounds to reduced the hypertension. 34 Sedentary lifestyle behaviors such as sedentary lifestyle has no significant difference with any risk factor of cardiovascular diseases. Similar results are observed by Htun et al in Japanese adults. They evaluated the association between food intake and CVD rish factors, Intake of meat and fat was connected with incresed WC, body mass index, blood pressure and lipid profile levels in both males and females. 35

CONCLUSION
The outcomes of this study indicated that dietry habbits are potencially associated with the CVD risk factors such as high coloric diet, bakery items, and surprisingly fruits and vegitables. Use of chicken was noted to be very weak associated with hypertension, along with the sedentary lifestyle which have not shown any strong association with