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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 16  |  Issue : 2  |  Page : 112-118

Role of Aharaja Nidana in etiopathogenesis of premature aging w. s. r. to skin health: A survey study


1 Department of Roga Nidan Evam Vikriti Vijnana, Government Ayurveda College, Rewa, Madhya Pradesh, India
2 Department of Roga and Vikriti Vijnana, NIA, Jaipur, Rajasthan, India

Date of Submission15-Oct-2020
Date of Decision07-Jun-2021
Date of Acceptance29-Jul-2021
Date of Web Publication4-Jul-2022

Correspondence Address:
Archana Singh
Department of Roga Evam Vikriti Vijnana, Government Ayurveda College, House No. 451, In Front of Krishna Raj Kapoor Auditorium, Narendra Nagar, Rewa - 486 001, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_235_20

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  Abstract 


Introduction: Modern gerontologist accepted aging as a natural phenomenon which cannot be avoided. In Ayurveda, it is mentioned as Jara and believed as Svabhavika Vyadhi. There are various factors mentioned in Ayurveda which accelerates the process of aging and results in Akalaja jara. The sign of aging reflects the first on the skin in the third decade of life. The present study was intended to identify the potential factors that may accelerate the process of aging in the context of food habits, with special reference to skin health. Methods: A Nidanatmaka study was conducted at NIA Jaipur in which 492 participants aging between 30 and 65 years, having signs of aging were included after informed consent, and the data were collected to measure the prevalence of the etiological factors of early aging by incorporating a well-designed questionnaire. Results: Majority of participants were of the age group 30–39 years (64.43%), belong to middle socioeconomic class (66.05%) and urban habitat (95.32%) and having graduate level (24.79%) of education. Majority of participants were female (61.78%), married (85.97%), and homemakers (40.44%). The majority of the participants reported excessive intake of Guru Ahara (46.13%), Snigdha Ahara (59.75%), and Ushṇa Ahara (56.30%) sometimes, while rare intake of Ati Shita Ahara (54.47%) was reported in majority of participants. Most of the participants reported Lavaṇa as dominant Rasa (49.59%) and practicing Viṣamasana (50.20%). Conclusion: These data advocate the fact that faulty food habits contribute toward accelerated intrinsic aging which reflects on skin health.

Keywords: Aging, Aharaja Nidana, dietary habits, skin health


How to cite this article:
Singh A, Godatwar P, Sharma R. Role of Aharaja Nidana in etiopathogenesis of premature aging w. s. r. to skin health: A survey study. J Ayurveda 2022;16:112-8

How to cite this URL:
Singh A, Godatwar P, Sharma R. Role of Aharaja Nidana in etiopathogenesis of premature aging w. s. r. to skin health: A survey study. J Ayurveda [serial online] 2022 [cited 2022 Aug 10];16:112-8. Available from: http://www.journayu.in/text.asp?2022/16/2/112/349764




  Introduction Top


Aging is a natural, continuous, and inevitable phenomenon, starts at the time of conception, runs throughout the life span and ultimately ends in death of an organism. Acharya Sushruta has described Jara as a natural phenomenon of the human body and divided in two types, i.e., Kalaja Jara (chronological aging) and Akalaja Jara (premature aging).[1]

In classical texts, it is clearly mentioned that the total span of life is 100 years and it is divided into three stages: Balya (childhood), Madhyama (elderly), and Vriddha (old). Balya is considered up to 16 years of age where all the Dhatu are present in Apakva Avastha. Madhyama is considered more than 16 years up to 70 years, again classified into four categories: Vriddhi up to 20 years, Yauvan up to 30 years, Sampurṇata up to 40, and after 40 Parihani will be occurred.[2] After the age of 70 years, Vriddhavastha begins. In this stage, different types of degenerative changes are found such as Balahani (loss of strength), Varnahani (loss of complexion), and Indriya Daurbalya (decreased strength of sense organs) which is mentioned in our compendium. All this process is considered as normal physiology of human being. If these degenerative physiological changes occur earlier, then it will be considered as pathological event mentioned in our classics as Akalaja Jara, i.e., premature aging.

Premature aging is one of the most stressful conditions for every individual in the present era. Each and every person in the universe tries to delay the aging and keep themselves fit. Due to the environmental variations, changes in food pattern, various kinds of addictions, and this problem increases day by day.

In Ayurveda, it is clearly mentioned that different body tissues are affected with aging at different time period. Gradual declination of a particular faculty takes place in each decade of life, and by the end of decade, that particular faculty is lost. According to Acharya Sharangadhara; Balya (childhood), Vriddhi (growth), Chavi (well-structured and beauty), Medha (power of retention), Tvaka (skin health), Driṣṭi (vision), Shukra (sexual potency) Vikrama (working capacity), Buddhi (intelligence), and strength of Karmendriya (all motor activities) are decline or ends serially at the end of first to tenth decades of life.[3] It submits that the impression of aging first hamper skin health which is manifested as Chavi hani.

The process of skin aging is complex and multifactorial, as structural, functional, and esthetic changes happen at a variable rate. It is misleading to consider skin aging as a uniform biological event; several distinct biological processes may occur concurrently. It may be due to intrinsic factors such as diet and addiction or extrinsic factors such as sun exposure and environmental pollution. The manifestation of various features of aging depends upon different etiological factors, i.e., intrinsic or extrinsic.

Intrinsic aging

Intrinsic skin aging is a slow process with clinical features such as smooth, pale, dry, and less elastic skin having fine wrinkles that are not apparent until old age. Intrinsically aged skin shows epidermal and dermal atrophy, a reduced number of fibroblasts, less collagen and more matrix metalloproteinases. Its structurally altered dermal-epidermal junction may contribute to increased skin fragility and reduced nutrient transfer between the dermal and epidermal layers.[4]

Extrinsic aging

Extrinsic aging, due to chronic exposure to solar ultraviolet irradiation (photo-aging) and smoking, leads to deep and coarse wrinkles, mottled hyperpigmentation, and reduced skin elasticity. Facial skin bears the accumulation of life-long sun exposure, which is responsible for 80% of the effects of facial skin aging, i.e., premature skin aging and skin cancer. While photo-aged epidermis shows atrophy and abnormal keratinocyte maturation.[5]

Causative factors of premature aging according to Ayurveda

There is no direct reference of causative factors of aging in Vrihattrayi. Only Rasa Vagbhaṭa has quoted some factors as a causative of aging. Pantha (excessive walking or travelling), Shita (excessive cold food or spoiled food), Kadanna (food article devoid of nutritional properties), Vayovriddha Yoshita (aged women), and Manasa Pratikulata (unfavorable condition of mind) are the five reasons of premature aging described by Rasa Vagbhaṭa.[6]

Excessive cold food or spoiled food and food article devoid of nutritional properties are mentioned as the etiological factor of premature aging, Acharya Charaka also mentioned food-related etiological factors in the context of Rasayana.[7] As the factors related to faulty food habits first affects the Rasa Dhatu and after that affects Uttarottara Dhatu Pushti. Compromised Rasa Dhatu Poshana reflects on the skin.[8]

Aim

The aim of this study is to evaluate the potent Aharaja Nidana and their role in the pathogenesis of Akalaja Jara (Premature aging) w. s. r. to skin health.


  Materials and Methods Top


To analyze the relation between Aharaja Nidana Sevana and changes in skin health according to process of aging, a survey study was carried out in Jaipur during the session 2015–2016. Four hundred and ninety-two participants, of age group between 30 and 65 years having mild-to-moderate skin aging signs and willing to participate in the survey study were randomly selected irrespective of sex, religion, and socioeconomic status, from the general population reporting at outpatient department, inpatient department, Central Lab of the hospital, and other camp sites around Jaipur.

Ethical committee approval

The study protocol was approved by the Institutional Ethics Committee Approval number –(IEC/ACA/2015/70).

Before conducting the study, written informed consent was obtained from the study participants.

Study design

To interviewed the studied population, a well-structured questionnaire pro forma was prepared that can be divided into following sections.

Section 1-Questionnaire to assess the demographic and personal profile

The participants were provided the questionnaire in this section to collect the information about their age, sex, address, education, job profile, socioeconomic status, and marital status to draw the demographic picture. Questions about their diet, dietary habits, and addiction were also included.

Section 2-Questionnaire about etiological factors

This section included questions regarding Nidana of Akalaja Jara, mentioned in Ayurveda and modern literatures with respective duration.

Section 3-Questionnaire about skin condition

In this section, a structured questionnaire was administered to each participant to assess problems/changes experienced by themselves, regarding skin age, dryness, change in thickness, elasticity, fine lines, loss of radiance, etc.

  • Sample size: 492 participants
  • Study location: Jaipur
  • Period of survey study: 1 year (session 2015-2016)
  • Statistical analysis: All values are presented as percentage prevalence in the studied population.


Assessment criteria

The studied population was assessed on the basis of various subjective parameters of skin aging such as skin is looking more aged than actual age of the participant, having any skin problem, Shushkata (Dryness), Snigdhata (Oiliness), Shosa (Change in thickness of skin), Shlatha mamsa (Change in elasticity), fine lines, Tvaka shaithilya (Loss of firmness), Vyang (Age spots), Vali (Wrinkles), Prabha hani (Loss of radiance), Varna hani (Dull Complexion), and Loss of volume.

Inclusion criteria

Participants of the age group between 25 and 65 years, of either sex, having mild to moderate skin aging signs, such as participants who felt that their skin is looking more aged than their actual age, having any age-related skin problem as described above in the assessment criteria, i.e., Shushkata (Dryness), Shosa (Change in thickness of the skin), Shlatha mamsa (Change in elasticity), fine lines, Tvaka shaithilya (Loss of firmness), Vyang (Age spots), Vali (Wrinkles), Prabha hani (Loss of radiance), etc., were included in the study.

Exclusion criteria

Participants not fulfilling the inclusion criteria, suffering from any systemic disease, or having any chronic medication were not included in the study.


  Observations and Results Top


The maximum subjects recorded were falling in the age group of 30–39 years (64.43%), followed by age group 40–49 years (25.20%) and 50–65 years (10.37%) [Table 1]. The maximum participants were females (61.78%) followed by males (38.21%). Maximum participants observed were Hindu (74.79%), whereas a substantial number was reported Islamic faith (21.74%) followed by other religion (3.45%). The majority in the present study sample were married (85.97%), whereas substantial number of participants (12.19%) was unmarried. Majority of married was again dominated by females.
Table 1: Percentage prevalence of age profile of study participants (n=492)

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The majority in the present study sample with changes in skin health belonged to middle socioeconomic class (66.05%), followed by lower class (24.18%) collectively make 90% of the population, while 9.75% population belongs to upper class.

Maximum participants belong to urban environment (95.32%). In the studied population, most of the participants belong to graduate level (24.79%) and higher secondary (24.79%) level. Postgraduate level (14.83%) nearly followed by illiterate (13.82%) and high school level (9.14%). Ph. D. level (5.28%) and primary and middle school level (2.43%) were also observed.

Majority of subjects were homemakers (40.44%), again showing female dominance in the sample, followed by government employees (21.74%), doctors (10.77%), and private employees (10.56%), labor (4.47%), student (3.86%), and others (6.30%).

In studied population, loss of radiance (97.36%), loss of volume (89.23%), fine lines (88.42%), and change in elasticity (82.12%) were the most evident signs of skin aging, whereas dryness (75.99%), age spots (75%), wrinkles (73.18%), loss of firmness (72.77%), and change in thickness of the skin (68.91%) were also observed in majority of participants [Table 2].
Table 2: Symptoms of aging: Participant assessment score (n=492)

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The prevalence of Aharaja Nidana (food related etiological factors) showed addiction of tea (44.10%) in majority of participants [Table 3]. Most of the participants were vegetarian (73.17%), used to Vishamasana (50.20%) and practicing meals two times/day (57.52%) [Table 4], [Table 5], [Table 6]. Lavana was reported as dominant rasa in maximum number of participants (49.59%), followed by Madhura rasa (41.26%) [Table 7]. Most of the participants responded intake of Guru Ahara sometime (46.13%), followed by often (28.25%) [Table 8]. Majority of participants reported rare intake of Shita Ahara (54.47%), followed by sometimes (25.40%) [Table 9]. Intake of Ati snigdha (oily) and Ati ushna (spicy) Ahara had been reported in substantial number of population (59.75% and 56.30%, respectively) [Table 10] and [Table 11]. Maximum number of participants had well balanced diet sometimes (35.16%), followed by rare (20.52%) [Table 12].
Table 3: Percentage prevalence of addiction profile of study participants

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Table 4: Percentage prevalence of diet of study participants

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Table 5: Percentage prevalence of diet habits of study participants

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Table 6: Percentage prevalence of frequency of meals/day of study participants

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Table 7: Percentage prevalence of dominant rasa of study participants

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Table 8: Percentage prevalence of Guru Ahara Sevana of study participants

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Table 9: Percentage prevalence of Ati Shita Ahara Sevana of study subjects

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Table 10: Percentage prevalence of Ati Snigdha Ahara Sevana of study participants

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Table 11: Percentage prevalence of Ati Ushna Ahara Sevana of study participants

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Table 12: Percentage prevalence of intake of well-balanced diet of study participants

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  Discussion Top


The majority in the present study sample were of the age group of 30–39 years, followed by age group 40–49 years, suggest that changes in skin health begins in the third decade and become more prominent in the next decade.[9] Most of the skin specialist accepted that 29 is the age that marks the beginning of the aging process.[10] Females were the major part of studied population, suggest females are more vulnerable for the changes of aging and might be more sensitive about their appearance. It may be due to self-negligence, heavy work load in households, stress of family, etc. Estrogen levels strongly influence skin integrity in women as well; falling levels of estrogen in midlife produce premature aging as compared with similarly aged men.[11] As large number of population belongs to the age group of 30–39 years, most of the Indian population got married up to this age.

The majority in the present sample belonged to middle and lower class: Data also supported by the fact that the general trend of any cross section of an Indian society usually belongs to middle class population.[12] The data suggest that social burden; physical labor, compromised nutrition accelerates the process of aging that reflects on skin. Urban habitat has more exposer to environmental changes, pollution and unhealthy lifestyle, psychological stress causes early aging. Maximum population in this study reported urban habitat. Hence, it is clear that polluted environment, especially air pollution[13],[14] accelerates the process of aging and skin being exposed to pollution become more vulnerable for changes.

Education and occupation play a very important role among social factors that determine the rate of aging. In the present study, majority of the participants experienced age-related change in their skin belong to graduate level and secondary level. The data might be affected by the population studied in the college campus. After all, it suggests that the educated population was more conscious about skin health and appearance.

Majority of participants were homemakers, again showing female dominance in the sample, followed by government employees, doctors, private employees, and others. The data suggest compromised health care of females engaged in various households and family responsibilities, stressed lifestyle of government employees, busy schedule, and stressful mental status of doctors, private employees and students, physical extraneous works, and compromised nutrition in labors accelerates the process of aging.

The majority in the present study sample with changes in skin health were reported tea as habit cum addiction, followed by population reported no addiction. There are various studies reveals the anti-oxidant, anti-aging effect of green tea,[15],[16] but as per cost, it is not affordable for middle and lower class and the major population of the sample was of middle and lower socioeconomic status. On the other hand, more consumption of tea may cause various side effects such as loss of appetite, hinders absorption of iron may cause compromised nutrition and anemia, respectively.[17] As we already mentioned that deficient nutrition of Rasa and Rakta Dhatu adversely affects the skin, addiction of tea can be marked as a reason for skin changes.[18]

Incidences of smoking were also reported, followed by population reporting mixed addiction, whereas least population reported addiction of tobacco. The data again affected by female dominant sample population. Smoking and tobacco are considered as risk factors for aging.[19] In a study aims to determine the relationship between smoking and cutaneous aging it was found that larger the tobacco load, the larger was the amount of facial wrinkling.[20],[21] Tea, coffee, and cigarette are Kaṣhaya Rasa Pradhana causes Vata Vriddhi (vitiation of Vata) leading to age related changes in skin.

Aharaja Nidana (dietary habits)

The majority in the present study sample were vegetarian, followed by a considerable number of subjects with mixed diet. The findings may be due to Hindu dominant population. The majority in the present study sample practicing Vishamasna (irregular food habits) followed by Samasana (taking wholesome and unwholesome food together). As majority of population belonged to urban habitat, had disturbed schedule that enforced people to compromise with their food and timing of meals. These unhealthy diet habits cause Vata Vriddhi (vitiates Vata) and Agni Vaishmya (vitiation of digestive fire) resulting in the production of ”Ama” (free radical) that results in early aging. Two time meal/day was practiced by majority of participants followed by three times/day. The data show that female population is affected as they skip their breakfast and are having meals two times in a day. Breakfast considered as the most important meal of the day, as overnight fasting triggered Jaṭharagni (digestive fire), demands a good protein diet, but if it is skipped results in various health consequences. As described in classics Agni first starts to digest Ahara (food material), after that Dhatu (body tissues). So being first in seven Dhatu (body tissue), diminution of Rasa Dhatu (nutritive fluid) begins first, causing accelerated visible changes in the skin.[22]

The majority in the present study sample with changes in skin health reported Lavaṇa (salt) as dominant Rasa (taste), followed by Madhura (sweet) Rasa. The data supports the role of Lavana (salt) rasa in accelerated process of aging. As described by Acharya Charaka, excessive use of salt vitiates Pitta Doṣha and compensates the consistency of muscles (Kushṇati Mamsani) results in formation of wrinkles,[23] it is also mentioned among the factors that vitiate the Rakta Dhatu (blood).[24] Madhura Rasa (sweet taste) is accepted as Satmya (wholesome), Dhatu Vardhaka (improves tissue mass), and Ayushya Rasa. It is mentioned as Rasa having Varnaya (complexion), and Tvachya (beneficial for skin) property.[25] In another reference, it was described that food having dominancy of Madhura (sweet) and Kaṭu Rasa and Abhisyandi Guna (quality which cause exudation in strotas/channels) are responsible for various skin diseases.

The majority in the present study sample reported intake of Guru Ahara (heavy food) Ati Snigdha Ahara (excessive oily food) Ati Ushṇa Ahara (excessive hot and spicy food) commonly, while majority of population reported rare intake of Ati Shita Ahara (excessive cold food).

All these factors are distinctively accepted as cause of Rasavaha-Raktavaha Strotoduṣṭi, resulted in Rasa-Rakta Dhatu Pradoṣaja Vikara which reflects on skin.[26],[27]

Intake of well-balanced diet reported very minimal in majority of subjects. As the socioeconomic distribution of sample population dominated by middle and lower class, there is a lack of proper nutritive supplements in daily foods. On the other hand, nutrition is compromised due to busy lifestyle of urban habitat. In Ayurveda, Kadanna is accepted as causative factor of premature aging. It lacks Jivaniya Guna (nutritional properties) causing nutritional deficiency leading to compromised nutrition of Rasa Dhatu resulting in Tvaka Hani (loss in skin health).


  Conclusion Top


Although aging is a natural and inevitable phenomenon, causative factors such as improper food habits, improper lifestyle, psychological stress, excessive sun exposure, environmental factors accelerate the process of aging intrinsically as well as extrinsically. In Ayurveda Ahara (food) is accepted as Tri-Upstambha (three sub-pillars of life) and any improper food and food habits can vitiate the Dosha (humors), causing various destructive changes. Guru (heavy food), Ati Ushna (excessive hot/spicy food), Ati Snigdha (excessive oil), Ati Sheeta (excessively cold) food items, intake of food having less or no nutritive value causes deficiency in nutrition hence diminution of proper formation of Rasa, Rakta, and Manasa Dhatu. Ultimately damaging of skin health and later on nutrition of other Dhatu will be compromised. Hence, it can be concluded that the objective to attain healthy aging with healthy skin could be achieved by practicing healthy dietary habits.

Strength of the study

Four hundred and ninety-two participant, of a wide range of age (between 30 and 65 years) having mild to moderate skin aging signs has been evaluated on the basis of various subjective parameters and studied for dietary habits as causative factors for premature skin aging. Frequencies of dietary causative factors were also assessed in the participants to evaluate the effect in prevalence of symptoms.

Limitations of the study

Standardized skin analysis instruments were not used for the assessment of the skin condition of the participants. The survey study was performed on a small population size and in limited places.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12]



 

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