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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 2  |  Page : 47-51

Effect of Fruit Rich Diet on Cardiopulmonary Efficiency in Short Term Smokers


1 Department of Physiology, PES Institute of Medical Sciences & Research, Kuppam, Chittoor District, Andhra Pradesh, India
2 Department of Physiology, Basaveshwara Medical College, Chitradurga, Karnataka, India
3 Department of Anesthesiology, Basaveshwara Medical College, Chitradurga, Karnataka, India

Date of Web Publication17-Jun-2014

Correspondence Address:
Amrith Pakkala
No. 40, SM Road 1st cross, T. Dasarahalli, Bangalore - 560 057
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-449x.134581

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  Abstract 

Background: Use of tobacco in cigarettes leads to an oxidant antioxidant imbalance. As a consequence of its addictive qualities, the consumption of cigarettes often becomes a lifelong habit with cumulative and deleterious effects on health. Previous reports have described long-term harmful effects of nicotine on various body parameters, including oxidative injury and a lack of antioxidants in the body. Fruits are known to be a rich source of dietary antioxidants. This study was conducted to know the effect of consumption of fruits in a group of short term smokers on cardio-pulmonary efficiency parameters. Materials and Methods: Treadmill exercise testing and pulmonary function tests were done before and after maximal exercise testing to assess cardiopulmonary efficiency in two groups' viz., healthy sedentary controls and healthy cigarette smokers on a fruit rich diet. Results: On studying the differences in cardiopulmonary efficiency in the two groups the resting heart rate (HR) was found to be statistically significantly higher in the study group and the delta HR (δHR) was found to be statistically significantly lower among cigarette smokers. There was no significant difference seen in parameters like maximal oxygen consumption max, maximum oxygen pulse, maximum voluntary ventilation, maximum minute ventilation as an acute effect of cigarette smoking. Conclusion: In this study, it appears that cigarette smokers are physically fit like controls, but after immediate smoking a lesser δHR suggests a higher risk for cardiovascular mortality. There seems to be no effect of including fruits in the diet of smokers. The predominant effect of smoking over dietary measures is obvious. Stopping smoking at this juncture can be helpful in reverting back the risk and parameters like resting HR, recovery HR and δHR can be used as prognostic assessment tools for any intervention therapy to stop cigarette smoking in asymptomatic individuals.

Keywords: Cardiopulmonary, cigarette smoking, delta heart rate, fruit consumption, maximal oxygen consumption max, maximum minute ventilation, maximum voluntary ventilation, oxidative stress, resting heart rate, tobacco


How to cite this article:
Pakkala A, Ganashree CP, Raghavendra T. Effect of Fruit Rich Diet on Cardiopulmonary Efficiency in Short Term Smokers. Heart India 2014;2:47-51

How to cite this URL:
Pakkala A, Ganashree CP, Raghavendra T. Effect of Fruit Rich Diet on Cardiopulmonary Efficiency in Short Term Smokers. Heart India [serial online] 2014 [cited 2019 Dec 7];2:47-51. Available from: http://www.heartindia.net/text.asp?2014/2/2/47/134581


  Introduction Top


Smoking cigarettes is the most common form of tobacco consumption known for about a 1000 years. Tobacco has been used orally alone or in combination with other ingredients. In India tobacco is taken in several other forms also, for example Pan (betel quid), dried leaves (Patti), paste (Kiwan, Zarda), tobacco with lime (Khaini/Mawa). [1] There has been a resurgence of tobacco use since 1970, [2] its use is common in various parts of the world, including India and central Asia. An increase in consumption of tobacco has been noticed among high school, college students and sportspersons. [3],[4],[5] Use of smokeless tobacco indeed represents a health concern of growing magnitude among these groups. As a consequence of its addictive qualities, the consumption of smokeless tobacco often becomes a lifelong habit with cumulative and deleterious effects on health. [6],[7] Despite the known health consequences of tobacco, "chewing" is not viewed by users as particularly dangerous and is considered less of a "social evil" than smoking by much of the public. [8],[9] Previous reports have described long-term harmful effects of nicotine on various body parameters, little is known about acute effect of tobacco smoking on cardiopulmonary parameters. [10] The effect of tobacco smoking on aerobic capacity and their predisposition to various unfavorable risk factors for disease is well studied on a long-term basis. Very few studies have been undertaken on the acute effect of use of cigarettes, a common form of tobacco consumption in India and all over the world on cardiopulmonary parameters of youngsters.


  Aims and objectives Top


The present study has been undertaken to study the effect of fruits in diet of cigarette smokers on cardiopulmonary efficiency tests in young healthy smokers when compared to age and sex matched non-smoker healthy controls.


  Materials and methods Top


The present study was conducted in the Exercise Physiology lab of KIMS, Hubli. 30 apparently healthy sedentary male cigarette smokers of age group 18-30 years were taken as subjects and equal number of age and sex matched healthy non-smokers were taken as controls. Ethical clearance was obtained from institution ethical committee.

The subjects for this study were selected based on the following criteria:

Inclusion criteria

  1. Males between 18 and 30 years of age.
  2. Leading sedentary life.
  3. Cigarette smoking for 3-5 years duration of 1 or more packets per day.
  4. Daily consumption of 500 g of fresh fruits such as apples, oranges, grapes etc., for past 1 year.


Exclusion criteria

  1. Age more than 30 years.
  2. Leading physically active lifestyle.
  3. Suffering from cardiopulmonary or systemic illness like diabetes, hypertension.
  4. Involved in any sports or exercise regimen.
  5. Addicted (dependence) to any drugs.


The subjects for the control group were selected based on the following criteria:

Inclusion criteria

  1. Males between 18 and 30 years of age.
  2. Leading sedentary life.
  3. Not smoked even a single packet of cigarette up to the time of study.


Exclusion criteria

  1. Age more than 30 years.
  2. Leading physically active life-style.
  3. Suffering from cardiopulmonary or systemic illness like diabetes, hypertension.
  4. Involved in any sports or exercise regimen.
  5. Addicted (dependence) to any drugs.


Before starting the actual study subjects were briefed about the protocol and informed consent was obtained. Thorough history regarding the suitability as per the above inclusion and exclusion criteria was elicited. Basic clinical examination was carried out to rule out any cardiopulmonary or other illness. Subjects were instructed to come to the lab and smoke two cigarettes immediately before starting the recordings. Both controls and chewers were advised to refrain from consumption of coffee, tea and heavy meals at least 2 h prior to the recordings.

Resting heart rate (HR)

Resting HR was measured in both non-smoking and smoking group, with the help of Cardiart 108T-mk-VI; electrocardiogram (ECG) machine manufactured by BPL India Ltd., which is a single channel, 12 lead selection ECG, designed to record ECGs.

Measurement was carried out only after the subjects were thoroughly acquainted with working of the corresponding instrument and the prescribed maneuver.

Special instructions

  1. The subject was made to rest for 15 min after the attachment of leads.
  2. He was instructed to remain in sitting posture and completely relaxed.


The calibration (1 mv =10 mm deflection height) and paper speed (25 mm/s) were checked. Lead selection was switched to LEAD-II and ECG was taken. The resting HR was calculated and results were expressed as beats per minute.



Maximal voluntary ventilation (MVV)

MVV was measured in both the study and the control group with the help of computerized spirolyzer.

Spirolyser

In this study, the instrument used to measure respiratory parameters was spirolyzer model Spl -95 manufactured by FIM Company, which is an electronic spirometer.

The instrument has facility for calibration and gives reliable values of tests, which are displayed on the screen along with its graphical interpretation. The instrument is standardized. The instrument has an in-built printer, which prints on special thermal paper. The instrument has memory for 2-3 tests, hence best of the 3 tests can be chosen.

Recording of MVV

The sensor was placed on the stand and then MVV key was pressed. The subject was instructed to keep the disposable mouthpiece attached to pneumotachograph half way in the mouth above the tongue. The nose clip was applied and the start button was pressed. The subject was asked to breathe as deeply and as quickly as possible for 12 s, at the end of which the test terminates automatically. Now the sensor is replaced back on the stand. The screen displays the values of MVV along with its graph. This test has no memory. The print key was pressed to obtain a print.

Maximal oxygen consumption (VO 2 max)

VO 2 max was indirectly assessed by the astrand-astrand nomogram method from submaximal exercise data obtained while running on a treadmill.

In this study, the treadmill used was model GM1300 motorized treadmill manufactured by Afton Company, with assembling size: 146 (L) × 66 (W) × 143 (H) cm and running surface of 360 mm × 1150 mm. It is driven by a 1.25 H.P. DC motor capable of 4000 r.p.m. The treadmill has a speed range of 1-11 km/h with three levels of pre-set elevations which can be selected. The three possible elevations are 1° (1.75% grade), 3° (5.23% grade) and 7° (12.28% grade). This tread mill has a polyester-backed belt and waxed deck for silent operation and 8 elastomer cushions for a low impact running surface.

The liquid-crystal display (LCD) monitor of the above treadmill has a five window display and displays time, distance travelled, speed, pulse rate and calories consumed. It also has an ear pulse sensor, magnetic safety key for emergency stop, ON/OFF and FAST/SLOW switches. In addition, there are switches for mode, set and reset.

Submaximal exercise testing

Subject preparation

  1. Subjects had to appear for the test only after 2-3 h have lapsed after the last meal.
  2. Contra-indications to testing are ruled out.
  3. A detailed explanation of the testing procedure was given outlining risks and possible complications. The subject was told how to perform the exercise test and the testing procedure was demonstrated.
  4. All safety measures for the exercise testing were undertaken. The treadmill was set to the elevation of 7°. The safety key wa s put in place and the mains switched ON. The sub j ect was made to stand on the belt and support his arms by side in the arm support provided. ECG limb leads were connected and the cables were securely tied to the legs. The ear pulse sensor was connected.


The "ON" Switch is pressed to start the motor. The "FAST" Switch is pressed to increase the speed gradually up to 5 km/h and the subject is instructed to run at this speed. The running is continued till a HR between 125 and 170 beats/min is obtained as shown on the LCD display. A steady HR for a given work load is indicated by a variation of not more than 5 beats/min. On attaining this HR, the speed is gradually brought down by pressing the slow switch and the machine is switched OFF.

Lead II is selected in the ECG machine and ECG is recorded for a few complexes and submaximal HR is calculated.

The distance travelled and time taken is noted down from the LCD display.

The power reached is calculated as follows:

X = sin α × B

Where, X = Vertical distance travelled

α = Elevation in degrees

B = Distance travelled on treadmill (in km)

Work done = Weight of subject × (X)

Power = Work done/time

The Astrand nomogram is used. The HR and the power reached are connected in the nomogram. VO 2 max (in l/min) is read from the VO 2 scale.

Corresponding values of VO 2 max in terms of body weight, height and surface area are calculated.

Since the subjects in this study did not exceed 25 years of age, age correction factor was not applied.

Maximal exercise testing

This is done after a rest period of 10 min. The LCD display of the treadmill is reset to zero values.

The spirolyzer is switched ON, subject's details entered and the VC key is pressed and kept ready. The ECG limb leads are connected and the cables secured as before. The subject was suitably instructed about the test maneuver. Elevation was continued at 7°. The subject was asked to run until exhaustion and to stop only when he felt that he could no longer run.

With the subject on the belt, the treadmill was switched ON and the FAST key pressed. The speed was gradually raised to 10 km/h. When the subject could no longer continue running, the speed was gradually brought down and the treadmill switched OFF.

Lead II is selected in the ECG machine and ECG is recorded for a few complexes and Maximal HR is calculated.

Maximal HR

Simultaneously, the nose clip is applied; the disposable mouth piece on the pneumotachograph of the ready spirolyzer is placed on the subject's mouth over the tongue. The start switch is pressed in the VC Mode to record the respiration at VO 2 max work load. After 50 s the test terminates automatically. The sensor is placed back in its place. A print is obtained.

Delta HR (δHR)

The δHR was the calculated difference between the maximal HR and the resting HR.

Minute volume at VO 2 max (V E max)

V E max is calculated from the respiratory rate and the tidal volume recorded.

Breathing reserve (BR) at VO 2 max

BR at VO 2 max is calculated using the formula:

BR at VO 2 max = MVV − V E max

Dyspneic index (DI) at VO 2 max

DI at VO 2 max is calculated using the formula:

DI at VO 2 max = BR at VO 2 max/MVV

Recovery HR (RHR)

This is recorded after a period of 1 min from the cessation of maximal exercise. Lead II is selected in the ECG machine and ECG is recorded for 15 s.

RHR is obtained by using the formula:

Recovery HR = 15 s HR × 4

Maximum oxygen pulse

This is calculated by using the formula:



All these set of recordings were done on both the study and control groups.

Statistical analysis was performed by using un-paired Student's test.


  Results Top


It is clear from [Table 1] that the study and control group were anthropometrically similar. From [Table 2] it is seen that the resting HR was significantly lower in the control group as compared to smokers. From [Table 3], [Table 4], [Table 5], it is seen that there was no significant difference in any of the other parameters studied.
Table 1: Anthropometric data of controls and smokers (mean ± SD)

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Table 2: Various heart rates of controls and smokers (mean ± SD)

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Table 3: Comparison of the differences between maximum MHR-RHR, MHR and resting heart rate (δHR) and maximum oxygen pulse of controls and smokers

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Table 4: Comparison of VO2 max of controls and smokers

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Table 5: Comparison of the differences between MVV, VE max and DI of controls and smokers

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  Discussion Top


The greatest concern for nicotine related effects is acceleration or aggravation of cardiovascular disease. [11] In a study of the cardiovascular effects of daily cigarette use, the prominent effects of nicotine use viz., HR acceleration and increased urinary catecholamine excretion were similar throughout the day in people smoking cigarettes and those using smokeless tobacco. [10]

In the present study, the resting HR was found to be statistically significantly higher in the study group. This is attributable to the lower vagal tone in cigarette smokers as a result of nicotine use even in the short term of 3-5 years, which becomes apparent as an acute effect. This finding is in agreement with other studies. [12]

The δHR was found to be statistically significantly lower among smokers. δHR is a long-term predictor of cardiovascular mortality independent of age, physical fitness and conventional coronary risk factors. [13] The lower δHR suggests that smokers are at a higher risk for cardiovascular mortality.

There was no significant difference seen in parameters such as VO 2 max, maximum oxygen pulse, MVV, VE max as an acute effect of cigarette smokers. Most of the workers had attributed decreased VO 2 max among smokers to the carbon monoxide saturation and less hemoglobin availability to carry oxygen.

In this study, it appears that smokers are physically fit like controls, but after immediate smoking a lesser δHR suggests a higher risk for cardiovascular mortality. There seems to be no significant effect of including fruits in the diet of smokers.

Respiratory parameters show marginal increase in values. This could be due to bronchodilatation due to the release of epinephrine or stimulation of sympathetic system or both.

Stopping smoking at this juncture can be helpful in reverting back the risk and parameters like resting HR, RHR and δHR more than any other measures.

 
  References Top

1.Council Report, Council on Scientific Affairs, American Medical Association, Chicago. Health effects of smokeless tobacco. JAMA 1986;255:1038-43.  Back to cited text no. 1
    
2.Gupta R, Gurm H, Bartholomew JR. Smokeless tobacco and cardiovascular risk. Arch Intern Med 2004;164:1845-9.  Back to cited text no. 2
    
3.Sankaranarayanan R, Duffy SW, Padmakumary G, Day NE, Padmanabhan TK. Tobacco chewing, alcohol and nasal snuff in cancer of the gingiva in Kerala, India. Br J Cancer 1989;60:638-43.  Back to cited text no. 3
    
4.Jones RB. Use of smokeless tobacco in the 1986 World Series. N Engl J Med 1987;316:952.  Back to cited text no. 4
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5.Hunter SM, Croft JB, Burke GL, Parker FC, Webber LS, Berenson GS. Longitudinal patterns of cigarette smoking and smokeless tobacco use in youth: The Bogalusa Heart Study. Am J Public Health 1986;76:193-5.  Back to cited text no. 5
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6.Schroeder KL, Chen MS Jr. Smokeless tobacco and blood pressure. N Engl J Med 1985;312:919.  Back to cited text no. 6
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7.Tomar SL, Giovino GA. Incidence and predictors of smokeless tobacco use among US youth. Am J Public Health 1998;88:20-6.  Back to cited text no. 7
    
8.Rothman KJ. Tobacco habits. Am J Public Health 1986;76:133.  Back to cited text no. 8
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9.Marty PJ, McDermott RJ, Williams T. Patterns of smokeless tobacco use in a population of high school students. Am J Public Health 1986;76:190-2.  Back to cited text no. 9
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10.Siegel D, Benowitz N, Ernster VL, Grady DG, Hauck WW. Smokeless tobacco, cardiovascular risk factors, and nicotine and cotinine levels in professional baseball players. Am J Public Health 1992;82:417-21.  Back to cited text no. 10
    
11.Benowitz NL. Systemic absorption and effects of nicotine from smokeless tobacco. Adv Dent Res 1997;11:336-41.  Back to cited text no. 11
[PUBMED]    
12.Bolinder GM, Ahlborg BO, Lindell JH. Use of smokeless tobacco: Blood pressure elevation and other health hazards found in a large-scale population survey. J Intern Med 1992;232:327-34.  Back to cited text no. 12
    
13.Sandvik L, Erikssen J, Ellestad M, Erikssen G, Thaulow E, Mundal R, et al. Heart rate increase and maximal heart rate during exercise as predictors of cardiovascular mortality: A 16-year follow-up study of 1960 healthy men. Coron Artery Dis 1995;6:667-79.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Abstract
Introduction
Aims and objectives
Materials and me...
Results
Discussion
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