Urban rural differences in diet, physical activity and obesity in India: are we witnessing the great Indian equalisation? Results from a cross-sectional STEPS survey

Abstract Background The rising morbidity and mortality due to non-communicable diseases can be partly attributed to the urbanized lifestyle leading to unhealthy dietary practices and increasing physical levels of inactivity. The demographic and nutrition transition in India has also contributed to the emerging epidemic of non-communicable diseases in this country. In this context, there is limited information in India on dietary patterns, levels of physical activity and obesity. The aim of the present study was thus to assess the urban rural differences in dietary habits, physical activity and obesity in India. Methods A household survey was done in the state of Punjab, India in a multistage stratified sample of 5127 individuals using the WHO STEPS questionnaire. Results No rural urban difference was found in dietary practices and prevalence of overweight and obesity except the fact that a significantly higher proportion of respondents belonging to rural area (15.6 %) always/often add salt before/when eating as compared to urban area (9.1 %). Overall 95.8 % (94.6–97.0) of participants took less than 5 servings of fruits and/or vegetables on average per day. No significant urban rural difference was noted in both sexes in all three domains of physical activity such as work, transport and recreation. However, rural females (19.1 %) were found to be engaged in vigorous activity more than the urban females (6.3 %). Males reported high levels of physical activity in both the settings. Absence of recreational activity was reported by more than 95 % of the subjects. Higher prevalence of obesity (asian cut offs used) was seen among urban females (34.3 %) as compared to their rural counterparts (23.2 %). Abdominal obesity was found to be significantly higher among females in both the settings compared to males (p < 0.001). Conclusions Poor dietary practices and physical inactivity seems to fuel the non-communicable disease epidemic in India. Non communicable disease control strategy need to address these issues with a gender equity lens. Rapid urbanization of rural India might be responsible for the absence of a significant urban rural difference

Prevalence of pre-hypertension and hypertension (self-reported and newly diagnosed) by place of residence, Punjab, India, 2014.

<p>Prevalence of pre-hypertension and hypertension (self-reported and newly diagnosed) by place of residence, Punjab, India, 2014.</p

Alarmingly high prevalence of hypertension and pre-hypertension in North India-results from a large cross-sectional STEPS survey

<div><p>Objectives</p><p>The study was primarily aimed at estimating the prevalence of hypertension and pre-hypertension and the risk factors of hypertension in the North Indian state of Punjab. It also aimed at assessing the magnitude of undiagnosed cases of hypertension in the community and ascertaining the blood pressure control status of those on treatment.</p><p>Methods</p><p>A non-communicable disease risk factor survey (based on WHO-STEPS approach) was done in the state of Punjab, India in a multistage stratified sample of 5127 individuals. The study subjects were administered the WHO STEPS-questionnaire and also underwent anthropometric and blood pressure measurements.</p><p>Results</p><p>Overall prevalence of HTN among the study participants was found out to be 40.1% (95% CI: 38.8–41.5%) whereas prevalence of pre-hypertension, isolated diastolic and isolated systolic hypertension were 40.8% (39.5–42.2%), 9.2% (8.4–10.0%) and 6.5% (5.9–7.2%) respectively. Age group (45–69 years), male gender, social group, marital status, alcohol use, obesity and salt intake (> = 5 gms/day) were the risk factors significantly associated with HTN. Among all persons with HTN, only 30.1% were known case of HTN or on treatment, among whom nearly 61% had controlled blood pressure. Patients with uncontrolled BP were more frequently male, obese patients, with sedentary lifestyle and patients with diabetes.</p><p>Conclusions</p><p>The study reported alarmingly high prevalence of hypertension, especially of undiagnosed or untreated cases amongst the adult population, a significant proportion of whom have uncontrolled blood pressure levels. This indicates the need for systematic screening and awareness program to identify the undiagnosed cases in the community and offer early treatment and regular follow up.</p></div

Prevalence of hypertension, isolated systolic hypertension and pre-hypertension among adults (> = 18 years) by age, sex and residence in Punjab, India, 2015.

<p>Prevalence of hypertension, isolated systolic hypertension and pre-hypertension among adults (> = 18 years) by age, sex and residence in Punjab, India, 2015.</p

Socio-economic, behavioural and clinical correlates of patients with hypertension^**, STEPS survey, Punjab, India, 2014–15.

<p>Socio-economic, behavioural and clinical correlates of patients with hypertension^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0188619#t005fn002" target="_blank">**</a>}, STEPS survey, Punjab, India, 2014–15.</p

Proportion of hypertensive patients on treatment and status of blood pressure control among those on treatment, STEPS survey, Punjab, 2014–15.

<p>Proportion of hypertensive patients on treatment and status of blood pressure control among those on treatment, STEPS survey, Punjab, 2014–15.</p

Mean blood pressure in different population groups in Punjab, India, 2015.

<p>Mean blood pressure in different population groups in Punjab, India, 2015.</p

Socio-demographic characteristic of the respondents, STEPS survey, Punjab, India, 2014–15.

<p>Socio-demographic characteristic of the respondents, STEPS survey, Punjab, India, 2014–15.</p