ABSTRACT
The study was aimed at assessing the relationship between obesity and blood pressure among adults in Umuahia North Local Government Area, Abia state. The study was a cross-sectional survey comprising of 439 randomly selected respondents. A total of 439 adults were selected from urban communities in Umuahia North LGA. A structured and validated questionnaire was used to collect information on socio-demographic characteristics. Anthropometric measurement (Height, Weight, Waist circumference and Hip circumference)was carried out in all standard procedure and blood pressure was measured using electronic sphygmomanometer. Data were analysed using descriptive statistics and Pearson correlation. A P value of less than 0.05 was accepted as statistics for significance. More than half of the participants (54.9% ) were females, while 45.1% were males. About 21.2% of the males had stage 1 hypertension, while,17.0% females had stage 1 hypertension. The prevalence of overweight was 29..4% of the sample population while obesity was 21.2% . There was a significant relationship between BMI and systolic pressure (r = 0.118; p = 0.014). The findings from this study show that hypertension increase with an increasing BMI. Educational programs on dangers of hypertension and obesity to health are recommended.
TABLE
OF CONTENTS
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TITLE
PAGE
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i.
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CERTIFICATION
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ii.
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DEDICATION
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iii.
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ACKNOWLEDGMENT
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iv.
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TABLE
OF CONTENT
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v.
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LIST
OF TABLES
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vi.
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LIST
OF FIGURES
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vii.
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ABSTRACT
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viii.
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CHAPTER
1
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INTRODUCTION
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1
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1.1
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Statement
of problem
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2
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1.2
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Objectives
of the study
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4
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1.2.1
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General
objectives of the study
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4
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1.2.2
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Specific
objectives of the study
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4
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1.3
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Significance
of the study
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4
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CHAPTER
2
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6
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LITERATURE
REVIEW
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6
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2.1
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Hypertension
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6
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2.2
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Definitions
of hypertension
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7
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2.3
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Obesity
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8
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2.4
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Predisposing
factors of overweight and obesity
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9
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2.4.1
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Diet
and calorie intake
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9
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2.4.2
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Genetics
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10
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2.4.3
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Hormones
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11
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2.4.4
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Individual
sedentary behaviour
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12
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2.4.5
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Sociodemographic
factors
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13
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2.5
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Association
between obesity and hypertension
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14
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2.6
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Prevalence
of obesity and hypertension amongst adults
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17
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CHAPTER
3
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19
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MATERIALS
AND METHODS
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19
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3.1
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Study
design
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19
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3.2
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Area
of study
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19
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3.3
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Population
of study
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19
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3.4
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Sampling
and sampling techniques
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20
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3.4.1
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Sample
size determination
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20
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3.4.2
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Sampling
procedure
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20
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3.5
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Preliminary
activities
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21
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3.5.1
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Preliminary
visits
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21
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3.5.2
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Training
of research assistants
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21
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3.5.3
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Ethical
approval
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21
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3.5.4
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Informed
consent
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21
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3.6
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Data
collection
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22
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3.6.1
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Anthropometric
measurements
|
22
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3.6.1.1
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Weight
measurement
|
22
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3.6.1.2
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Height
measurement
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22
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3.6.1.3
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Waist
circumference
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22
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3.6.1.4
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Hip
circumference
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22
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3.6.1.5
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Systolic
blood pressure and diastolic blood pressure
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22
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3.7
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Data
analysis
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23
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3.7.1
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Body
Mass Index (BMI)
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23
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3.7.2
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Waist
Hip Ratio (WHR)
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23
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3.7.3
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Classification
of blood pressure
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24
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3.8
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Statistical
analysis
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25
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CHAPTER
4
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26
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RESULT
AND DISCUSSION
|
26
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4.1
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Socio-demographic
characteristics
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26
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4.2
|
Blood
pressure characteristics of the participants
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29
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4.3
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Anthropometric
characteristics of the participants
|
31
|
4.4
|
Relationship
between BMI and blood pressure
|
35
|
|
|
|
|
CHAPTER
5
|
36
|
|
CONCLUSION
AND RECOMMENDATION
|
36
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5.1
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Conclusion
|
36
|
5.2
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Recommendation
|
36
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| |
|
|
REFERENCES
|
37
|
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APPENDIX
I
|
43
|
LIST
OF TABLES
Table 3.1
|
International classification of BMI in adults
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23
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Table 3.2
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Waist Hip Ratio (WHR)
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24
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Table 3.3
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Blood pressure classification
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24
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Table 3.4
|
Waist circumference classification
|
25
|
Table 4.1a
|
Socio-demographic characteristics
|
27
|
Table 4.1b
|
Socio-demographic characteristics continued
|
28
|
Table 4.2
|
Blood pressure characteristics of the respondents
|
30
|
Table 4.3a
|
Anthropometric characteristics of adults
|
34
|
Table 4.3b
|
Mean anthropometric measurement of the respondents
|
34
|
Table 4.4
|
Relationship between BMI and blood pressure
|
35
|
CHAPTER 1
INTRODUCTION
Obesity is diagnosed by measuring the
weight in relation to the height of an individual (Shu-Zhong
et al., 2016). For adults, World Health Organization (WHO) defined
overweight as a BMI greater than or equal to 25kg/m2; while obesity
as a BMI greater than or equal to 30 kg/m2 (WHO, 2019). Accordingly,
the prevalence of obesity is on the increase in children and adults worldwide,
despite WHO warnings. Excessive weight gain remains among the most neglected
public health issues worldwide, while obesity is associated with increasing
risks of disability, illness and death (Shu-Zhong et al., 2016). Weight gain has been
associated with increases in arterial pressure, and it has been estimated that
60–70% of hypertension in adults is attributable to adiposity (Theodore, 2010). According to WHO, in 2005, approximately 1.6
billion adults over the age of 15 were overweight (Gill
et al., 2005). At least 400
million adults were considered obese and ≥20 million children under the age of
5 years were overweight (WHO, 2005). The estimation for 2015 was approximately
2.3 billion overweight adults and over 700 million obese ones (O'Connor, 2013).
In 2016, more than 1.9 billion adults, 18 years and older, were overweight and
from this population, over 650 million were obese (WHO, 2018).
Overweight and obesity lead to adverse metabolic effects on
blood pressure, cholesterol, triglycerides and insulin resistance (WHO, 2002).
Risks of coronary heart disease, ischemic stroke and type 2 diabetes mellitus
increase steadily with increasing body mass index (BMI), a measure of weight
relative to height. Raised body mass index also increases the risk of cancer of
the breast, colon, prostate, endometrium, kidney and gall bladder (WHO, 2002).
Mortality rates increase with increasing degrees of overweight, as measured by
body mass index (WHO, 2019).
Cardiovascular diseases are the leading cause of mortality
worldwide, particularly hypertension and diabetes, are the main illnesses
associated with obesity (Shu-Zhong et al., 2016). Hypertension (especially high blood pressure) is one of the
most common non-communicable diseases (NDCs) affecting adults all over the
world. It is now being widely reported in Africa and is the most common cause
of cardiovascular disease on the continent (Lukwiya, 2013). It is also a major
factor in the high mortality of adults in sub-Saharan Africa (WHO, 2003). This
situation may be high in Nigeria where ‘plumpness’ is regarded as a sign of
affluence. By itself, hypertension has no early recognizable symptoms and, as a
result, patients with hypertension often come to medical attention late when
they already have developed complications such as strokes, heart attacks, heart
failure and kidney failure, all of which are major causes of death in the adult
population (Osamor, 2011).
In this regard, the need for the study on the relationship between obesity and
blood pressure is therefore necessary in the regulation of blood pressure and
further prevention of cardiovascular diseases.
1.1 STATEMENT OF PROBLEM
The
prevalence of obesity is increasing in all age groups (Villareal et al., 2005). World Health Organisation report on Global Health Observatory (GHO) data
of mean body mass index (BMI) situation and trend, states that worldwide, at
least 2.8 million people die each year as a result of being overweight or
obese, and an estimated 35.8 million (2.3%) of global DALYs
(Disability-Adjusted Life Year) are caused by overweight or obesity (WHO, 2019).
In Africa, the prevalence of obesity was as high as 63.8% and
21.3% respectively, for men and women in sub-Saharan Africa while in Nigeria,
the prevalence of obesity in adults ranged from 8.1% - 22.2%, although, this is
of epidemic proportions (Chukwuonye et al., 2013).
Globally an estimated 26% of the world’s population (972
million people) has hypertension and the prevalence is expected to increase by
2025 (WHO, 2008). The high prevalence of hypertension exacts a tremendous
publichealth burden (Kearney et al., 2005). As a primary contributor to
heart disease and stroke, the first and third leading cause of death worldwide,
respectively,hypertension was the top modifiable risk factor for disability
adjusted life-years lost worldwide in 2013(Forouzanfar et al., 2015).According
to the WHO, the prevalence of hypertension is highest in the African region
while the lowest was found in the American region (WHO, 2018).
Nigeria, the most populous African
country with a population of over 160 million on the other hand has a
prevalence of hypertension at 42.8% in 2008 and this contributes hugely to the
overall burden of Africa (WHO, 2008). This high-rise hypertension has been
shown to be due to lifestyle changes, many related to changing environmental
and social factors. Other factors included minimal physical activity and high
consumption of processed foods (WHO, 2019)
Obesity
and hypertension have become public health issues with rising prevalence
globally, associated with increased morbidity and mortality from cardiovascular
diseases as well as increased socio-economic costs (Narkiewicz, 2006). There is increased risk of co-morbidities for body
mass index 25.0 to 29.9kg/m2 (overweight), and moderate to severe
risk of co-morbidities for body mass index greater than 30kg/m2 (obesity)
(WHO, 2019).
Developing
countries are now witnessing an increase in overweight, obesity and
obesity-related morbidity (Pasquet et al.,
2003). These countries are currently undergoing
an epidemiological transition that has been previously observed in developed
countries (Abisola et al., 2014). As
a result of this, African populations now suffer under the dual burden of
infectious diseases and emerging chronic diseases (Njelekela et al., 2009).
According to WHO and World Economic Forum Report of a Joint
Event (2005), Nigeria was estimated to have lost 400 million United States
dollars in national income from premature deaths due to heart disease, stroke,
and diabetes and would have an estimated four-fold increase in income loss by
2015 (WHO, 2015). Nevertheless, it is difficult to determine the fraction of
hypertension that can be attributed to overweight and obesity (Appel, 2018). In
the present study, the relationship between obesity and hypertension would be
examined among adults in Umuahia North Local Government Area of Abia state.
1.2 OBJECTIVES OF THE
STUDY
1.2.1 General objective
of the study
The
general objective of this study is to assess the relationship between obesity
and blood pressureamong adults in Umuahia North Local Government Area of Abia
state.
1.2.2 Specific objectives
of the study:
The specific objectives are to:
i. determine the socio-demographic
characteristics of the adults.
ii. assess the prevalence of obesity among
the adult population in Umuahia North Local Government Area.
iii. evaluate blood pressure of the adults.
iv. establish the relationship between
obesity and hypertension.
1.3
SIGNIFICANCE OF THE STUDY
Obesity can be considered a
complex and chronic medical condition that requires deep understanding,
particularly for the mechanisms leading to hypertension to plan successful
preventive and treatment strategies as well as in nutrition and healthcare
policy-making. Also, studies on prevalence of obesity and raised blood pressure
(hypertension) among various groups in Nigeria are limited to few locations and
categories of people, resulting to inadequate data on prevalence of these
conditions in the country. The result of this study will provide information on
the prevalence of obesity and hypertension thereby contributing to the wealth
of knowledge on chronic diseases among Nigerians especially among adults and
help to make informed choices on intervention strategies as well as evaluate
any ongoing attempts to arrest these diseases.
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