1. PURE – India Overview Dubai – Jan 2006

2. PURE-India: Investigators and sites Bangalore Mario Vaz Anura V Kurpad Jaipur: Prof. Rajeev Gupta Chennai Prof V Mohan Trivandrum Prof. Soman Chandigarh Prof. Rajesh Kumar

3. TIME LINE OF PURE-India July 2000 Conceptualisation Jan 2001 Data starts-B’lore Dec 2001 ~ 2500 subjects PURE-India Mtg Identification of Other centres (3) Dec 2002 ~5000 Other centres start data Chandigarh As 5 th centre Dec2005 ~ 22,000

4. ALL CENTRES Chandig arh JaipurBangalo re ChennaiTrivan drum Households surveyed 25421158349881166831134069 Eligible households 2053014314462797227153950 Eligible individuals 40589282992471620550987210 Participants 2193421103801946530963462 Response Rate (%) 5474.641.158.460.748 Recruitment Status – PURE India Centers

5. UrbanRural Response rate (%)5256 Participants966512269 Completed measurements (%) 9391 Provided blood sample (%) 9083 PURE – INDIA Recruitment Status

6. The PURE-India Study is carried out in states with very diverse characteristics CENTREStatesBirth Rate /1000 Infant Mortality Rate / 1000 Life expectancy at birth Literacy rate (%) Population density / sq. km Bangalore Karnataka22.25863.361.1275 Andhra Pradesh 20.86662.467.0275 Chennai Tamil Nadu17.84964.168.6478 Trivandrum Kerala17.21173.390.9819 Jaipur Rajasthan31.0796061.0165 Chandigarh 16.124-81.27903 Haryana26.76564.173.5477 s N

7. Present analysis: numbers TotalUrbanRural Bangalore929033235967 Chennai287717731104 Trivandrum304813691679 Jaipur26891749940 Chandigarh587264223 All centres1849184789913

8. The PURE-India Study is carried out in states with very diverse characteristics CENTREStatesRelative Human Development Rank Bangalore Karnataka3 Andhra Pradesh4 Chennai Tamil Nadu2 Trivandrum Kerala1 Jaipur Rajasthan5 Chandigarh - Haryana-

9. Household income (Rs/month) by location ~ $ 235 ~ $ 45

10. Education level below high school (%): Urban-Rural - males

11. Education level below high school (%): Urban-Rural - females

12. TV ownership (%) by location

13. 2-wheeler ownership (%) by location

14. Kitchen mixer ownership (%) by location

15. Current tobacco use (%): Urban-Rural - males

16. Current tobacco use (%): Urban-Rural - females

17. Current alcohol use (%): Urban-Rural - males

18. % of males who are sedentary by location

19. % of females who are sedentary by location

20. Daily dietary intakes in urban and rural populations: Bangalore centre RuralUrban Energy (kcal)18432278 Carbohydrate intake (g) 362.4350.5 Fat intake (g)23.266 Sugar (g)5.228.5 Salt (g)2.48.1 Total vegetables (g)50158 Total fruits (g)49166

21. % of males who are overweight/obese (BMI ≥ 25) by location

22. % females who are overweight/obese (BMI ≥ 25) by location

23. Mean Waist-hip ratio: Males by location

24. Mean Waist-hip ratio: Females by location

25. Serum total cholesterol (mg/dl): Males - by location

26. Serum total cholesterol (mg/dl): Females - by location

27. Prevalence of hypertension (%): Males - by location

28. Prevalence of hypertension (%): Females - by location

29. Hypertension: known, treated and controlled(%): - by location

30. Prevalence of diabetes (%): Males - by location

31. Prevalence of diabetes (%): Females - by location

32. Prevalence of CHD (%): Males - by location

33. Prevalence of CHD (%): Females - by location

34. Daily dietary intakes in urban slums relative to other urban and rural populations RuralSlumsUrban Energy (kcal)184319712278 Carbohydrate intake (g) 362.4301.1350.5 Fat intake (g)23.255.466 Sugar (g)5.223.628.5 Salt (g)2.49.58.1 Vegetable intake (g)5099158 a Age and gender adjusted means,

35. Anthropometric profiles in urban and rural populations RuralSlumUrban Weight (kg) a 4954.765.4 BMI (kg/m 2 ) a 19.22325.2 % overweight (BMI ≥ 25<30 kg/m 2 ) Men4.912.439.3 Women5.924.341.1 % obese Men0.62.35 Women0.78.721.8 a Age and gender adjusted

36. Prevalence: diabetes and hypertension in urban slums relative to other urban and rural areas RuralSlumUrban Diabetes (Hx + FBS ≥ 126 mg/dl) Men4.28.220.5 Women211.015.4 Hypertension (Hx + BP ≥ 140/90 mmHg) Men14.934.533.3 Women12.037.029.7

37. Summary There is considerable heterogeneity in the variables that we have studied and in disease outcomes, across locations (urban-rural-urban slum), gender and region (centre) Urban-rural risk transitions generally follow patterns of development. In Kerala, there is evidence of a reversal of the transition with the rural population. Dietary data needs to analysed in most centres – this when available will help us understand some of the changes that we have observed across centres and locations Non responder data and issues of response bias are being analysed

39. CHALLENGES / ISSUES OF THE STUDY Subjects in rural areas / slums unwilling to participate due to loss of daily wages Responder burden due to the length of questionnaires Working men unavailable during the day / particular seasons. No perceived benefits in some groups slums / urban areas. Takes 45 mins to enter one subjects data in the data entry system.

40. % use of wood as cooking fuel by location

41. % use of LPG (gas) as cooking fuel by location

42. Mean Waist circ (cm) : Males by location

43. Mean Waist circ (cm) : Females by location