Changes in population cholesterol concentrations and other cardiovascular risk factor levels after five years of the non-communicable disease intervention programme in Mauritius

BMJ 1995;311:1255-1259 (11 November)

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Changes in population cholesterol concentrations and other cardiovascular risk factor levels after five years of the non-communicable disease intervention programme in Mauritius

Gary K Dowse, senior epidemiologist,^a Hassam Gareeboo, project manager,^b K George M M Alberti, professor,^c Paul Zimmet, director,^a Jaakko Tuomilehto, professor,^d Anil Purran, chief medical officer,^b Djamil Fareed, WHO representative,^e Pierrot Chitson, operations manager,^b Veronica R Collins, epidemiologist,^a Farojdeo Hemraj, principal biochemist,^b for the Mauritius Non-communicable Disease Study Group

^a International Diabetes Institute, Melbourne, Australia, ^b Ministry of Health, Port Louis, Mauritius, ^c Human Diabetes and Metabolism Research Centre, University of Newcastle upon Tyne, Newcastle upon Tyne, ^d Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland, ^e World Health Organisation, Port Louis, Mauritius

Correspondence to: Dr G K Dowse, Geraldton Public Health Unit, PO Box 68, Geraldton WA 6530, Australia.

Abstract

Objective: To study changes in the prevalence of risk factorsfor cardiovascular disease after a five year population-wideintervention programme promoting a healthy lifestyle in a developingcountry.
Design: Cross sectional cluster surveys in 1987 and 1992. Methodologyincluded a two hour 75 g oral glucose tolerance test, measurementof body mass index, waist:hip ratio, basal lipid concentrations,and blood pressure; and a lifestyle questionnaire.
Setting: Mauritius, in the Indian Ocean.
Subjects: All adults aged 25-74 years residing in geographicallydefined clusters.
Main outcome measures: Age standardised prevalence of categoricaldisease and risk factor conditions and mean levels and frequencydistributions of continuous variables.
Results: Response rates were 86.2% (5080/5892) in 1987 and 89.5%(5162/5770) in 1992. Significant decreases were found in theprevalence of hypertension (15.0% to 12.1% in men and 12.4%to 10.9% in women); cigarette smoking (58.2% to 47.2% and 6.9%to 3.7% respectively); and heavy alcohol consumption (38.2%to 14.4% and 2.6% to 0.6% respectively). Moderate leisure physicalactivity increased from 16.9% to 22.1% in men and from 1.3%to 2.7% in women. Mean population serum total cholesterol concentrationfell appreciably from 5.5 mmol/l to 4.7 mmol/l (P<0.001).The prevalence of overweight or obesity increased, and the ratesof glucose intolerance changed little. The population frequencydistributions of blood pressure, serum lipid concentration,and a composite risk factor score shifted advantageously.
Conclusions: Lifestyle intervention projects can be implementedand have positive effects in developing countries. A pronouncedimprovement in the population lipid profile in Mauritius wasprobably related to a change in the saturated fat content ofa widely used cooking oil.

Key messages

Key messages
A national healthy lifestyle intervention programme in Mauritius included extensive use of the mass media, fiscal and legislative measures, and community health promotion activities
After five years there were reductions in population blood pressure and serum lipid concentrations, increased leisure exercise, and decreased smoking and alcohol consumption
A regulated change in the saturated fat content of a widely used cooking oil may have contributed importantly to the dramatic fall in serum cholesterol concentrations
Lifestyle intervention programmes can be implemented and have positive effects in developing countries

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