Do lifestyle interventions work in developing countries? Findings from the Isfahan Healthy Heart Program in the Islamic Republic of Iran

Sarrafzadegan, Nizal; Kelishadi, Roya; Esmaillzadeh, Ahmad; Mohammadifard, Noushin; Rabiei, Katayoun; Roohafza, Hamidreza; Azadbakht, Leila; Bahonar, Ahmad; Sadri, Golnaz; Amani, Ahmad; Heidari, Saeid; Malekafzali, Hossein

doi:10.2471/blt.07.049841

Cited by 106 publications

(101 citation statements)

References 40 publications

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“…The study showed that GPs who received the education-based intervention attained improved clinical competence compared with the control group and achieved significantly better BP control and preservation of kidney function in their patients. Similar levels of benefit have been reported in studies that have assessed education-based hypertension management strategies in broader patient groups in developing countries (22,23), many of whom are at high risk of developing CKD. For example, in the COBRA Trial (19), the study from which the study by Jafar et al (16) derives its cohort, a reduction in BP of almost 11 mmHg at the end of the trial in the group that received the HHE and GP training intervention was reported.…”

supporting

confidence: 71%

Strategies for BP Control in Developing Countries and Effects on Kidney Function

Jun¹,

Hemmelgarn

2016

CJASN

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CKD is a major public health threat worldwide. The prevalence of CKD among adults has been estimated to be 10%-15% globally (1-3), with evidence showing a continually increasing trend made worse by the rising rates of diabetes and hypertension, the primary causes of CKD as well as the most commonly observed comorbid conditions in this high-risk group. This trend is particularly concerning in developing countries, where heightened resource constraints and underdeveloped health care infrastructure limit access to appropriate care. It is well established that management of patients with kidney disease, particularly those related to ESRD, is associated with enormous financial cost. For example, in the United States, approximately 26 million people suffer from CKD (4), with .660,000 people requiring some form of RRT (5), incurring a cost of $30.9 billion to Medicare in 2013 (6). The exorbitant costs associated with ESRD therapy make certain lifesaving treatments, such as dialysis, simply unaffordable in many developing countries, highlighting the particular importance of preventive measures in these settings.Of the strategies aimed at controlling established modifiable renal and cardiovascular risk factors among patients with CKD, control of BP has been considered the "single most effective intervention" (7). High BP is observed in the majority of patients with CKD, in whom a log-linear relationship (8,9) between elevated BP and an increased risk of ESRD has been reported. Accordingly, observational and trial data (10-14) have sufficiently established that reducing BP delays renal progression of CKD to ESRD. BP control is, thus, a cornerstone of management to both prevent the onset and delay the progression of CKD, and current clinical guidelines (15) widely advocate BP reduction strategies, including both pharmacologic and lifestyle interventions. Given the increasing prevalence of CKD in developing countries and the excessive costs associated with CKD management, there is a strong need for efficient, cost-effective prevention strategies aimed at adequate BP control to delay or prevent CKD progression in countries with developing health care systems.In this issue of the Clinical Journal of the American Society of Nephrology, Jafar et al. (16) assessed the effectiveness of interventions involving (1) a home-based communication strategy highlighting the importance of lifestyle changes and adherence to antihypertensive medication (referred to as home health education [HHE]) and/or (2) general practitioner (GP) education involving a single-day training session discussing standard BP management strategies on the basis of clinical guidelines (17,18) on kidney function and long-term renal and survival outcomes among patients with hypertension on the basis of an extended follow-up study of the previously completed Control of Blood Pressure and Risk Attenuation (COBRA) Trial. The COBRA Trial was a 232 cluster, randomized, controlled trial, which randomized 12 low-to middleincome communities in Karachi, Pakistan to HHE, GP tr...

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supporting

confidence: 71%

Strategies for BP Control in Developing Countries and Effects on Kidney Function

Jun¹,

Hemmelgarn

2016

CJASN

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“…The programme comprised 10 distinct projects, each targeted to different fields and groups, one of which was HFHC (7,8). In terms of healthier nutrition, main emphasis was put on activities toward changing the dietary environment of the population.…”

Section: Methodsmentioning

confidence: 99%

“…The IHHP objectives were described in details elsewhere. Healthy Food for Healthy Communities (HFHC) was a component of IHHP project, consisting of a wide variety of strategies, including initiatives regarding oil consumption and labelling as well as intake of healthy bread (7,8,9,10).…”

Section: Introductionmentioning

confidence: 99%

Healthy Bread Initiative: Methods, Findings, and Theories—Isfahan Healthy Heart Program

Talaei

Mohammadifard

Khaje

et al. 2013

J Health Popul Nutr

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The scientific evidences show that the content, baking methods, and types of bread can make health impacts. Bread, as a major part of Iranian diet, demonstrates a significant potential to be targeted as health promotion subject. Healthy Food for Healthy Communities (HFHC) was a project of Isfahan Healthy Heart Program (IHHP), consisting of a wide variety of strategies, like Healthy Bread (HB) Initiative. The HB Initiative was designed to improve the behaviour of both producers and consumers, mainly aiming at making high-fibre, low-salt bread, eliminating the use of baking soda, providing enough rest time for dough before baking (at least one hour), and enough baking time (at least one minute in oven). A workshop was held for volunteer bakers, and a baker-to-baker training protocol under direct supervision was designed for future volunteers. Cereal Organization was persuaded to provide less refined flour that contained more bran. Health messages in support of new breads were disseminated by media and at bakeries by health professionals. Evaluation of the HB Initiative was done using before-after assessments and population surveys. While HB was baked in 1 (0.01%) bakery at baseline, 402 (41%) bakeries in the intervention area joined the HB Initiative in 2009. Soda was completely eliminated and fibre significantly increased from 4±0.4 g% before study to 12±0.6 g% after the intervention (p<0.001). The preparation and baking times remarkably increased. Wastage of bread decreased from 13±1.8 g% to 2±0.5 g% and was expressed as the most important advantage of this initiative by consumers. People who lived in Isfahan city consumed whole bread 6 times more than those who lived in reference area Arak (p<0.001). The HB Initiative managed to add new breads as a healthy choice that were compatible with local dishes and made a model to solve the longstanding problems of bread. It used various health promotion approaches but was best consistent with Beattie's model.

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“…In the second stage, based on the results of surveys conducted in the first phase, the interventions including 10 projects (women, children, youth, individuals in worksite, health workers, non-governmental organizations and volunteers, high risk individuals, cardiovascular patients and nutrition and exercise project)was begun in1380 in the total population. These intervention projects are described in table1 [15]. Interventions were performed in three groups including health workers, the general public (children and adults) and high risk individuals.…”

Section: Healthy Lifestyle For Cardiovascular Patients Projectmentioning

confidence: 99%

Nutritional Interventions to Reduce Cardiovascular Risk Factors: An Iranian Perspective

Mirmiran¹,

Amirhamidi²,

Bahadoran³

et al. 2016

IJNFS

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Cardiovascular disease (CVD) is the most leading cause of morbidity and mortality worldwide. Despite efficacies of currently available clinical and pharmaceutical approaches for the control of CVD risk factors, it seems that designing and developing of population-based interventions reducing tobacco use, advocating of physical activity, reducing harmful alcohol use, and promoting healthy diet is a cost-effective, permanent way and could play a major role in reduction of the burden of CVD. In this study, we reviewed some population-wide interventional programs and some nutritional intervention studies designed to prevent cardiovascular disease among Iranian populations.

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Do lifestyle interventions work in developing countries? Findings from the Isfahan Healthy Heart Program in the Islamic Republic of Iran

Cited by 106 publications

References 40 publications

Strategies for BP Control in Developing Countries and Effects on Kidney Function

Strategies for BP Control in Developing Countries and Effects on Kidney Function

Healthy Bread Initiative: Methods, Findings, and Theories—Isfahan Healthy Heart Program

Nutritional Interventions to Reduce Cardiovascular Risk Factors: An Iranian Perspective

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