Academic journal article Bulletin of the World Health Organization

Do Lifestyle Interventions Work in Developing Countries? Findings from the Isfahan Healthy Heart Program in the Islamic Republic of Iran/Les Interventions Pour Modifier le Mode De Vie Fonctionnent-Elles Dans Les Pays En Developpement ? Resultats Du Programme Pour la Sante Cardiaque d'Isfahan En Republique Islamique d'Iran/?Son Eficaces En Los Paises En Desarrollo Las Intervenciones Sobre El Modo De Vida?

Academic journal article Bulletin of the World Health Organization

Do Lifestyle Interventions Work in Developing Countries? Findings from the Isfahan Healthy Heart Program in the Islamic Republic of Iran/Les Interventions Pour Modifier le Mode De Vie Fonctionnent-Elles Dans Les Pays En Developpement ? Resultats Du Programme Pour la Sante Cardiaque d'Isfahan En Republique Islamique d'Iran/?Son Eficaces En Los Paises En Desarrollo Las Intervenciones Sobre El Modo De Vida?

Article excerpt

Introduction

Non-communicable diseases currently represent 43% of the global burden of disease and are expected to account for 60% of the disease burden and 73% of all deaths in the world by 2020. (1) Most of this increase will reflect non-communicable disease epidemics in developing countries resulting from the epidemiological transition, recent changes in diet and social environment, and the adoption of lifestyles resembling those of developed societies. (2-4) In developing countries, lifestyle-related chronic diseases, particularly cardiovascular disease, heavily burden the health-care system. (5,6) It has been estimated that an unhealthy diet and physical inactivity alone accounted for approximately 20% of the deaths among adults in the United States of America in 2000, (7) and the figures could be even higher in developing countries. (4-6) Cross-sectional and prospective studies have shown that the prevalence and incidence of many chronic conditions, including obesity, atherosclerosis, coronary heart disease and certain cancers, are increased by unhealthy lifestyles, (8-12) particularly an unhealthy diet, physical inactivity, smoking and stress. Therefore, lifestyle modification, long considered the cornerstone of interventions, is extremely important in reducing the burden of chronic diseases.

Several intervention trials have reported the effects of lifestyle intervention programmes among high-risk populations. (13-18) Some have recently shown a 58% decrease in the incidence of diabetes in individuals with impaired glucose tolerance. (19,20) Others have reported the beneficial effects of lifestyle modification on blood pressure control. (21,22) Lifestyle interventions seem to be at least as effective as drugs. (23)

Despite the above, recent reviews have cast doubt on whether lifestyle interventions really help reduce multiple cardiac risk factors. (24) For developing countries the evidence is less clear, and intervention studies in such countries have been scarce. Moreover, most intervention studies in the developing world have targeted specific population groups, rather than the whole community. In the Islamic Republic of Iran the Isfahan Healthy Heart Program (IHHP), which relies on comprehensive community-based lifestyle interventions to improve diet, physical activity, smoking behaviour and stress management, (25) has provided an opportunity to assess whether such interventions really work in developing countries. The specific objective of this study is to evaluate the effects of this comprehensive, integrated community-based lifestyle intervention on diet, physical activity and smoking behaviours.

Methods

Population

The study design and rationale of the intervention methods employed in the IHHP have been described elsewhere. (26) In this study, which was initiated in the year 2000, two intervention counties (Isfahan and Najaf-Abad) and a control area (Arak), all located in central Islamic Republic of Iran, were studied. According to the 2000 national census, the population was 1 895 856 in Isfahan and 275 084 in Najaf-Abad, a neighbouring county. Arak, a county with a population of 668 531 located 375 km north-west of Isfahan, was selected as a control area because it resembled the intervention areas in its socioeconomic, demographic and health profile and offered good cooperation. (26) The intervention programme targeted the general population as well as specific groups in urban and rural areas within the intervention communities. Arak was monitored for evaluation purposes but did not receive any intervention. In each community, a random sample of adults was selected yearly by multi-stage cluster sampling. To achieve adequate sample size, those who declined to participate in the study were replaced by their neighbours. Assessments of dietary intake, physical activity and smoking behaviour were made at baseline and annually for up to 4 years in the intervention areas and up to 3 years in the control area. …

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