Association of Smokeless Tobacco Use with Cardiovascular Disease Risk Factors in South Asian Population: Evidence from the South Asia Biobank

Main Applicant: Dr Wubin Xie
Principal Investigator: Prof John Chambers, School of Public Health, Imperial College London (UK)
Reference No. GHRU/2022/009
Approval Date: 19th September 2022

Lay Summary

Smokeless tobacco (ST) use is highly prevalent in South Asia. India alone is home to 66.6% of the world’s 356 million ST users. While cigarette smoking prevalence declined in recent years, smokeless tobacco use has increased in many South Asian countries. ST products in South Asia are often homemade or manufactured by small business, a virtually unregulated market.

ST products contain more than 30 harmful or potentially harmful constituents (HPHCs), many of which are cardiovascular toxicants. Many ST products found in South Asia contain higher levels of HPHCs compared with Swedish snus. While abundant evidence supports the association between cigarette smoking and cardiovascular disease, the cardiovascular effects of smokeless tobacco (ST) remain unclear. Existing epidemiological studies assessing ST use and cardiovascular diseases and risk factors (i.e., hypertension, dyslipidaemia, hyperglycaemia) reported inconsistent findings, with geographic variations indicating higher risks in Asia than in Sweden or in Europe.

Little data are available from South Asia. The existing SA studies were limited by small, local samples, with limited characterization by ST product type, user characteristics, and using patterns. The present study aims to address these gaps by assessing the association between ST use and CV risk factors in a well-characterized South Asian population.

To determine the prevalence and predictors of depression and anxiety among adults with NCDs in South Asia

Main Applicant: Dr. Swati Waghdhare Pandit
Principal Investigator: Dr Vinitaa Jha, Max Healthcare (India)
Reference No. GHRU/2022/008
Approval Date: 20th June 2022

Lay Summary

There is a steep rise in the Non-Communicable Disease (NCD) epidemic and mental health disorders. The co-occurrence of these health burdens in transitioning populations, particularly in low-income countries, makes it increasingly imperative to quantify the burden of comorbid NCDs and mental illness in order to be able to conceptualise frameworks to improve the understanding of risk factors and better design and implementation of holistic prevention and intervention programmes and address these comorbidities amongst patients. Therefore, this study must be conducted to determine the prevalence of depression and generalised anxiety disorder among a population with diabetes and/or cardiovascular disease and explore the associated risk factors.

Understanding the Prevalence and Risk Factors of Type 2 Diabetes Mellitus (T2DM) and Prediabetes among Bangladeshi Adults and Level of Care Available for T2DM Patients in Bangladesh: Epidemiological Analysis of a Nationally Representative Survey Data

Main Applicant: Dr. Ipsita Sutradhar
Principal Investigator: Dr Malay Mridha, BRAC James P Grant School of Public Health, BRAC University (Bangladesh)
Reference No. GHRU/2022/007
Approval Date: 20th June 2022

Lay Summary

Type 2 Diabetes Mellitus (T2DM) is one of the leading causes of death and disability across the globe. According to the World Health Organization, 451 million adults around the world lived with diabetes in 2019. Historically diabetes has been considered as the ‘disease of rich’ mostly affecting the developed nations. However, currently, the disease disproportionately affects the lower middle-income countries of Asia and Africa. Like other South Asian countries, Bangladesh is experiencing a high burden of T2DM. A recently published scoping review found that the prevalence of T2DM among Bangladeshi adults was 7.4%. Despite being greatly affected by the disease, a comprehensive investigation of T2DM hardly took place in Bangladesh. Additionally, the situation of diagnosis and management of T2DM has not been carefully investigated in Bangladesh yet. We, therefore, aim to conduct this study to identify the prevalence and determinants of T2DM and prediabetes among ≥18 years old Bangladeshi adults and to investigate the level of care available for Bangladeshi diabetic patients. The findings of this study will offer a strong insight to the pertinent stakeholders on the current situation of T2DM, which eventually will aid them in designing target specific interventions for prevention and control of T2DM.

Associations between the quantity and type of dietary carbohydrate consumption and cardiometabolic disease risk in South Asia

Main Applicant: Anwesha Lahiri
Principal Investigator: Prof Nita Gandhi Forouhi, MRC Epidemiology Unit, University of Cambridge (UK)
Approval Date: 18th April 2022
Reference No. GHRU/2022/006

Lay Summary

South Asians are known to have a much higher risk of developing serious medical conditions such as being twice as likely to suffer from heart diseases and three times more likely to have diabetes, compared to European people. Our diet and nutrition are important risk factors, and there has been a lot of research exploring dietary factors that can raise or reduce the risk of developing diabetes or heart disease in European populations. However, we have a limited understanding of whether these risk factors have the same effect in people from different ethnic and geographic or regional backgrounds. For example, on research based in western countries the existing dietary guidance advises to lower the consumption of saturated fat, but it is possible that carbohydrates may be more relevant than fat because of generally higher carbohydrate-rich foods in South Asians diets. The type of dietary carbohydrate consumed may also be relevant, such as starch, sugar or fibre. We will study the relevance of quantity and type of carbohydrates and their food sources with risk of developing diabetes and heart disease in South Asians.  

Regional, demographic, and seasonal differences in fruit and vegetable consumption in South Asia

Main Applicant: Anwesha Lahiri
Principal Investigator: Prof Nita Gandhi Forouhi, MRC Epidemiology Unit, University of Cambridge (UK)
Reference No. GHRU/2022/005
Approval Date: 18th April 2022

Lay Summary

Most governments recommend that their populations should consume a diet that is high in fruit and vegetables for good health. In fact the World Health Organization advises that people should eat five or more servings per day of fruit and vegetables. However, this evidence is primarily based on decades of research in European populations, and a particular challenge is lack of understanding of the patterns of fruit and vegetable intake in other groups like South Asians, and how that would influence risk of medical problems. In South Asia Biobank, we will study how fruit and vegetable consumption can vary across different countries or regions in South Asia, and identify factors that contribute to such variation, including but not limited to income or education. This knowledge will aid in consideration of policies, programmes and actions that might be undertaken to improve the diet quality of South Asians and reduce the burden of chronic diseases like diabetes and heart diseases. 

Ultra-processed food consumption and cardio-metabolic health in adults living in South Asia

Main Applicant: Divya H Bhagtani
Principal Investigator: Prof Nita Gandhi Forouhi, MRC Epidemiology Unit, University of Cambridge (UK)
Reference No. GHRU/2022/004
Approval Date: 21st February 2022

Lay Summary

The sale of industrially manufactured or ultra-processed foods (UPFs) has been rapidly rising in South Asia where there has been a shift from traditional home-cooked meals to foods high in fat, sugar, salt, and low in fibre. UPFs include items such as crisps, candies, cake, fizzy drinks and others that are made in industries using food processing and additives to prolong food shelf-life. Research in other world regions suggests that higher consumption of UPFs is linked to greater risk of conditions such as obesity and diabetes, but this has hardly been studied in South Asia.
In our proposed research we will quantify UPF consumption, identify the characteristics of individuals with varying levels of UPF consumption and assess its associations with health status.

Findings from this research will enable understanding of the distribution, determinants and health impacts of UPF consumption in South Asia and will inform development of future interventions to reduce the burden of diseases.

Description of the development, evaluation and performance assessment of a digital technology based 24-hour dietary recall tool in Bangladesh, India, Pakistan and Sri Lanka: The South Asia Biobank

Main Applicant: Divya H Bhagtani
Principal Investigator: Prof Nita Gandhi Forouhi, MRC Epidemiology Unit, University of Cambridge (UK)
Reference No. GHRU/2022/003
Approval Date: 21st February 2022

Lay Summary

In South Asia there has been relatively little research into what makes-up a healthy or optimal diet for the prevention of chronic diseases such as diabetes or heart disease. Part of the reason for this is the lack of suitable methods and tools to measure the consumption of foods and overall diets specific to the local and regional types of eating.

Working together in close collaboration, the Cambridge Diet Assessment Team and colleagues in the regional teams of the Global Health Research Unit have adapted and implemented an instrument – ‘Intake24’ – for the collection of dietary information in South Asia. This comprehensive tool collects details from study participants on what foods and drinks they consumed in the previous 24 hours and in what quantities, aided by pictures to indicate the portion sizes consumed. Data collection by trained interviewers enables participation of people with varying literacy and digital accessibility.

Our proposed research will describe the tool and evaluate its’s performance. Our goal will be to make the tool available for researchers wishing to collect dietary data in South Asia.

Seasonal and regional differences in physical activity in South Asia

Main Applicant: Dr Tessa Strain
Principal Investigator: Dr Soren Brage, MRC Epidemiology Unit, University of Cambridge (UK)
Reference No. GHRU/2022/002
Approval Date: 16th May 2022

Lay Summary

This project will describe variation in physical activity between population subgroups and across time. Physical activity is measured by self-report in the full sample (n~100k) and by wrist accelerometry in a subsample (n~20k). Population subgroups will include age, sex and occupation and will be stratified by geographical setting. This project also serves to fully document the underlying methods for deriving physical activity estimates from wrist acceleration records, including calibration to local gravity and classification of wear and non-wear time.

Relationship between food and physical activity environments and diabesity in adults from Chennai, South India

Main Applicant: Aarthi Garudam Raveendiran
Principal Investigator: Dr R. M. Anjana & Dr R. Guha Pradeepa, Madras Diabetes Research Foundation (India)
Reference No. GHRU/2022/001
Approval Date: 21st February 2022

Lay Summary

The global prevalence of diabetes has reached epidemic proportions and is considered to be a major public health problem in India. Obesity is a major risk factor for diabetes and studies have shown a growing link between diabetes and obesity, termed as “Diabesity”. The term ‘diabesity’ expresses their close relationship, as both metabolic disorders are characterized by insulin action defects. Obesity and diabetes are linked by two path physiologic factors: insulin resistance and insulin deficiency. According to the World Health Organization, the plan, design and build of a city can have a great influence on public health, in particular, on diabetes and obesity. Recent studies have shown that development of diabetes and obesity is influenced by built environment, which refers to man-made surroundings that provide space for human activity. Many studies have revealed a gap in evaluating the importance of the food and physical activity environment on diabesity. The aim of the study is to understand the relationship between food and physical environments on diabesity among adults residing in Chennai. In this study it is planned to assess the prevalence of diabesity and also intends to assess the food and physical activity environments through audits and data collection using Geographical Information system for the first time in Chennai. This study integrates accelerometer data and GPS coordinates using Geographical Information system which will aid in understanding the relationship between behavioral patterns and the availability of physical activity environments.