Abstract
BackgroundIndia's population exhibits diverse dietary habits and chronic disease patterns. Nutritional epidemiologic studies in India are primarily of cross-sectional or case-control design and subject to biases, including differential recall of past diet. The aim of this feasibility study was to evaluate whether a diet-focused cohort study of cancer could be established in India, providing insight into potentially unique diet and lifestyle exposures.MethodsField staff contacted 7,064 households within three regions of India (New Delhi, Mumbai, and Trivandrum) and found 4,671 eligible adults aged 35-69 years. Participants completed interviewer-administered questionnaires (demographic, diet history, physical activity, medical/reproductive history, tobacco/alcohol use, and occupational history), and staff collected biological samples (blood, urine, and toenail clippings), anthropometric measurements (weight, standing and sitting height; waist, hip, and thigh circumference; triceps, sub-scapula and supra-patella skin fold), and blood pressure measurements.ResultsEighty-eight percent of eligible subjects completed all questionnaires and 67% provided biological samples. Unique protein sources by region were fish in Trivandrum, dairy in New Delhi, and pulses (legumes) in Mumbai. Consumption of meat, alcohol, fast food, and soft drinks was scarce in all three regions. A large percentage of the participants were centrally obese and had elevated blood glucose levels. New Delhi participants were also the least physically active and had elevated lipids levels, suggesting a high prevalence of metabolic syndrome.ConclusionsA high percentage of participants complied with study procedures including biological sample collection. Epidemiologic expertise and sufficient infrastructure exists at these three sites in India to successfully carry out a modest sized population-based study; however, we identified some potential problems in conducting a cohort study, such as limited number of facilities to handle biological samples.
Highlights
India’s population exhibits diverse dietary habits and chronic disease patterns
Of the 4,177 individuals that agreed to participate in the study, 98% (4,099/ 4,177) provided all questionnaire information, 78% (3,272/4,177) provided anthropometric measurements, and 77% (2,586/3,373) provided all biological samples (New Delhi and Trivandrum only)
78% (739/942) in New Delhi and 76% (1,847/2,431) in Trivandrum, provided both blood and urine. Both types of biological samples were provided by a higher proportion of females (83%), as compared to males (71%) and adherence differed somewhat by religious group (71% of Christians; 81% of Hindus; and 76% of Muslims; data presented in text only)
Summary
Nutritional epidemiologic studies in India are primarily of cross-sectional or case-control design and subject to biases, including differential recall of past diet. The aim of this feasibility study was to evaluate whether a diet-focused cohort study of cancer could be established in India, providing insight into potentially unique diet and lifestyle exposures. Epidemiologic studies of diet and cancer in India are primarily of cross-sectional or case-control design and subject to biases, including differential recall of past diet [11,12,13,14,15,16,17]. Findings would be immediately useful to develop preventive strategies in the at-risk Asian-Indian (AI) and South-Asian populations living throughout the world, where diet and cancer incidence patterns remain unique [3,26,27,28,29,30,31,32]
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