EFFECT OF DIET AND MODERATE EXERCISE ON CENTRAL OBESITY AND ASSOCIATED DISTURBANCES, MYOCARDIAL-INFARCTION AND MORTALITY IN PATIENTS WITH AND WITHOUT CORONARY-ARTERY DISEASE

Objective: To test whether a fat modified and fruit and vegetable enri ched diet in conjunction with moderate physical activity reduces the c ardiac event rate in patients with coronary artery disease (CAD) and i ts risk factors in an urban setting in India. Subjects and Methods: 48 0 patients either with CAD or with risk factors. Those with definite o r possible CAD including angina pectoris (n = 210) based on World Heal th Organization criteria and patients with risk factors were assigned to diet A (n = 231) or diet B (n = 232) for a period of 3 years. Both groups were advised to follow a fat modified diet. Group A was also ad vised to consume at least 400 g/day of fruits, vegetables and legumes according to World Health Organization advice and include moderate phy sical activity. Results: Waist-hip ratios, fasting and post-prandial b lood glucose, plasma insulin levels, blood pressure and weight fell si gnificantly in patients in group A compared with those in group B. Whi le triglycerides in group A showed a significant decrease, high densit y lipoprotein cholesterol showed a significant increase. Both groups s howed a significant reduction in total and low density lipoprotein cho lesterol, although the decrease was greater in group A than group B. C entral obesity decreased by 6.2% in group A vs. 1.2% in group B, 95% c onfidence interval of difference 2.3 to 7.8. The incidence of cardiac events was significantly lower in group A than group B (29 vs. 43 pati ents, p < 0.01). All-cause mortality also significantly declined in gr oup ii compared with group B (16 vs. 24 died, p < 0.05). The group A p atients with better adherence to exercise and diet showed greater redu ction in central obesity and greater decline in cardiac event rates an d total mortality compared to control group B. Conclusions: It is poss ible that moderate physical activity in conjunction with dietary chang es in patients with CAD may cause substantial reductions in central ob esity and associated disturbances corresponding to a significant decre ase in cardiac events and mortality during the follow-up of 3 years.