Abstract:

Hyperglycemia as a component of metabolic syndrome, appears to be an important risk marker of vascular disease in most developing countries which are under transition from poverty to affluence. Despite a moderate increase in fat intake and low rates of obesity, the risk of coronary artery disease (CAD) and diabetes is rapidly increasing in most of the developing economies. It is a paradox that in some of these countries the increased risk of people to diabetes and CAD, especially at a younger age, is difficult to explain by conventional risk factors. It is possible that the presence of new risk factors especially higher lipoprotein (a)(Lpa), hyperhomocysteinemia, insulin resistance, low high density lipoprotein cholesterol and poor nutrition during fetal life, infancy and childhood may explain at least in part, the cause of this paradox. The prevalence of obesity, central obesity, smoking, physical inactivity and stress are rapidly increasing in low and middle income populations, due to economic development. In high income populations, there is a decrease in tobacco consumption, increase in physical activity and dietary restrictions, due to learning of the message of prevention, resulting into reduction in coronary and sroke mortality. Hypertension, (5-10%) diabetes(3-5%) and CAD(3-4%) are very low in the adult, rural populations of India, China, and in the African sub-continent which has less economic development. However, in urban and immigrant populations of India and China, the prevalence of hypertension (>140/90, 25-30%), diabetes (6-18%) and CAD (7-14%) are significantly higher than they are in some of the high income populations. Mean serum cholesterol (180-200 mg/dl), obesity (5-8%) and dietary fat intake (25-30% en/day) are paradoxically not very high and do not explain the cause of increased susceptibility to CAD and diabetes in some South Asian countries. The force of lipid- related risk factors and refined starches and sugar appears to be greater in these populations due to the presence of the above factors and results into CVD and diabetes at a younger age in these countries. These findings may require modification of the existing American and European guidelines, proposed for prevention of CAD, in high income populations. Wild foods or designer foods (400-500g/day) substitution (www.columbus-concept.com) for proatherogenic foods; in conjunction with moderate physical activity and cessation of tobacco, may be protective against deaths and disability due to CVD and diabetes in most of these countries.