Open Access Research article

Multi-center feasibility study evaluating recruitment, variability in risk factors and biomarkers for a diet and cancer cohort in India

Rashmi Sinha1*, Carrie R Daniel1, Niveditha Devasenapathy2, Hemali Shetty3, Susan Yurgalevitch4, Leah M Ferrucci1, Preethi S George5, Kerry Grace Morrissey4, Lakshmy Ramakrishnan6, Barry I Graubard1, Kavita Kapur7, K Srinath Reddy2, Mary J McAdams8, Tanuja Rastogi9, Nilanjan Chatterjee1, Prakash C Gupta3, Sholom Wacholder1, Dorairaj Prabhakaran2 and Aleyamma A Mathew5

Author Affiliations

1 National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA

2 Centre for Chronic Disease Control, New Delhi, India

3 Sekhsaria Institute for Public Health, Navi Mumbai, India

4 Westat, Rockville, MD, USA

5 Regional Cancer Center, Trivandrum, Kerala, India

6 All India Institute of Medical Sciences, New Delhi, India

7 Steno Diabetes Center, Gentofte, Denmark

8 Information Management Services, Silver Spring, MD, USA

9 United Nations World Food Program, Rome, Italy

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BMC Public Health 2011, 11:405  doi:10.1186/1471-2458-11-405

Published: 27 May 2011



India's population exhibits diverse dietary habits and chronic disease patterns. Nutritional epidemiologic studies in India are primarily of cross-sectional or case-control design and subject to biases, including differential recall of past diet. The aim of this feasibility study was to evaluate whether a diet-focused cohort study of cancer could be established in India, providing insight into potentially unique diet and lifestyle exposures.


Field staff contacted 7,064 households within three regions of India (New Delhi, Mumbai, and Trivandrum) and found 4,671 eligible adults aged 35-69 years. Participants completed interviewer-administered questionnaires (demographic, diet history, physical activity, medical/reproductive history, tobacco/alcohol use, and occupational history), and staff collected biological samples (blood, urine, and toenail clippings), anthropometric measurements (weight, standing and sitting height; waist, hip, and thigh circumference; triceps, sub-scapula and supra-patella skin fold), and blood pressure measurements.


Eighty-eight percent of eligible subjects completed all questionnaires and 67% provided biological samples. Unique protein sources by region were fish in Trivandrum, dairy in New Delhi, and pulses (legumes) in Mumbai. Consumption of meat, alcohol, fast food, and soft drinks was scarce in all three regions. A large percentage of the participants were centrally obese and had elevated blood glucose levels. New Delhi participants were also the least physically active and had elevated lipids levels, suggesting a high prevalence of metabolic syndrome.


A high percentage of participants complied with study procedures including biological sample collection. Epidemiologic expertise and sufficient infrastructure exists at these three sites in India to successfully carry out a modest sized population-based study; however, we identified some potential problems in conducting a cohort study, such as limited number of facilities to handle biological samples.