ABSTRACT
Adequate nutritional status is an integral part of adults’ wellbeing and results from the balance between food intake and organic nutrition needs at each stage of life. This study assessed the correlates between perceived and actual nutritional status of adults (35 to 60 years) in Umuahia North and Umuahia South areas of Abia State. A total of 381adults were selected using simple random sampling technique. A well-structured validated questionnaire was used to determine their socio-economic characteristics, Anthropometric and blood pressure levels were obtained using standard procedures. Data gathered were analyzed using IBM SPSS version 22. Results revealed that 57.0% are female while 43.0% are male. About 45.1% of the participants were aged between 35-44 years, 32.8% were between 45-54 years and 22.9% were between 55-60 years. About 30.4% have 1-3 children, about 40.9% have 4-6 children while 4.2% have 7 and above. The result on the awareness and knowledge of anthropometric status of the adults revealed that majority (86.6%) believe they have a normal weight status, 6.8% believe they are overweight, 5.5% believe they are underweight and 1.0% believe they are obese while 63.5% believe they should maintain their current weight, 5.0% believe they should add a lot of weight, 20.7% believe they should add a little weight. The awareness of biochemical/clinical appraisal showed that Majority (90.3%) don't know what their blood pressure numbers should be, 36.5% don’t know what their blood pressure level should be, 2.6% thought their blood pressure is high while 57.7% thought their blood pressure was normal or okay at the time of the survey. The study showed that about 56.4% of the adults believed their diet was sometimes adequate, 43.0% believed their diet was always adequate while 0.5 believed their diet was never adequate. More than half (59.1%) always had a diverse variety of food, 40.4% sometimes had a diverse variety of food and 0.5% never had a diverse variety of food while a majority (64.3%) always had a healthy diet. The results on the anthropometric indices of the adults (35-60 years) showed that about 57.5% of the participants had a normal weight while less than a quarter of the participants (21.3%) were overweight. The result showed that there was a significant (>0.01) positive correlation between actual body mass index, perceived body mass index (r = 0.332, p = 0.000), and perceived waist circumference (r = 0.135, p =0.008) Therefore the study concludes that poor dietary assessment of the adults is characterized by sometimes adequate and fish and sea food diet as well as an oil and fats diet with high dietary diversity score were observed in this study. Also, the preponderance to underweight and excessive weight gain of some of the adults as well as the sedentary nature of their prevalent occupations (farming, trading and civil service) which meant engagement in physical activity will help maintain energy balance.
TABLE OF CONTENTS
Title
page
i
Certification
ii
Dedication iii
Acknowledgement
iv
Table
of Contents v
List
of Tables
viii
Abstract
ix
CHAPTER 1
INTRODUCTION
1.1 Background of
the Study 1
1.1 Statement of Problem 6
1.2 Objectives of the Study 8
1.3 Significance of the Study 9
CHAPTER 2
LITERATURE REVIEW
2.1 Adults 11
2.1.2 Adult development 13
2.1.2.1Contemporary
and classic theories 13
2.1.2.2
Normative physical changes in adulthood 17
2.1.2.3 Non-normative
cognitive changes in adulthood 18
2.2 Nutritional Assessment in Adults 19
2.2.1 Anthropometric Measurement 19
2.2.1.1 Weight 20
2.2.1.2 Height 21
2.2.1.3Body Mass
Index (BMI) 21
2.2.1.4 The
arm muscle diameter 22
2.2.1.5 Waist
Circumference 23
2.2.1.6 Hip
Circumference 23
2.2.1.7
Waist-Hip-Ratio 25
2.2.2 Biochemical Assessment
25
2.2.3 Clinical Assessment
25
2.2.4.
Dietary Assessment
26
2.2.4.1 24 hours
recall
26
2.2.4.2 Food
Frequency Questionnaire
26
2.2.4.3 Food Group
Questionnaire
27
2.3 Challenges in Assessing Nutritional Status
Assessment 27
2.4 Nutritional
Requirements of Adults 26
2.4.1 Protein
Needs 26
2.4.2 Carbohydrate
Needs 27
2.4.3 Vitamins
and Minerals 27
2.5 Malnutrition
and Over-Nutrition in Adults 28
CHAPTER
3
MATERIALS
AND METHODS
3.1 Study
Design 31
3.2 Area of Study 31
3.3 Population
of the Study 34
3.4 Sampling
and Sampling Techniques 34
3.4.1 Sample
Size Determination 34
3.4.2 Sampling
Procedure 35
3.5 Preliminary
Activities 36
3.5.1 Preliminary
Visits 36
3.5.2 Training
of research assistants 36
3.5.3 Informed
consent/Ethical Approval 36
3.5.4 Validation of questionnaire 37
3.6 Data
Collection 37
3.6.1 Questionnaire
Administration 37
3.6.2 Interview 37
3.6.3 Anthropometric
measurement 38
3.6.4 Blood Pressure Assessment 39
3.6.4 Dietary
Assessment 39
3.7 Data
Analysis 39
3.8 Statistical
Analysis 41
CHAPTER 4
RESULTS AND DISCUSSION
4.1 Social
demographic characteristic of respondents 42
4.2 Social
economic characteristic of respondents 45
4.3 Perceive anthropometric status of respondents 49
4.4 perceived blood pressure of respondents 50
4.5 Perceived
dietary assessment 52
4.6 Actual
anthropometric status of respondents
53
4.7 Actual blood
pressure of respondents 54
4.8 Actual dietary
assessment of respondents 55
4.9 Relationship table between actual and perceived nutritional status of Respondents
CHAPTER
5
CONCLUSION
AND RECOMMENDATIONS
5.1 Conclusion 59
5.2 Recommendations 64
REFERENCES 65
LIST OF TABLES
Table 4.1 Social
demographic characteristic of respondents 44
Table 4.2 Social
economic characteristic of respondents 47
Table 4.3 Perceive anthropometric status of respondents 48
Table 4.4 perceived blood pressure of respondents 51
Table 4.5
Perceived dietary assessment 52
Table 4.6 Actual
anthropometric status of respondents 54
Table 4.7 Actual
blood pressure of respondents 56
Table 4.8.1 Food
groups consumed over time based on individual dietary diversity scores
58 Table 4.8.2 Dietary diversity score
58
Table 4.9 Relationship table between actual and perceived nutritional status of 61
Respondents
CHAPTER
1
INTRODUCTION
1.1 BACKGROUND OF
THE STUDY
An adult is a person that has
reached sexual maturity. The term adult has meaning associated
with social and legal concepts. An adult is a mature,
fully developed person. An adult is someone who is responsible for
his actions and for the consequences of his behaviours. Being an adult is
ideally being able to think and consider the effects that what you do has on
you and on the others (Lachman et al.,
2015). Adults are
characterized by maturity, self-confidence, autonomy, solid decision-making,
and are generally more practical, multi-tasking, purposeful, self-directed,
experienced, and less open-minded and receptive to change (Barbara,
2016).
According
to Tyrovolas
et al., (2011), adulthood (35 to 60years) is marked by
gradual physical, cognitive, and social changes in the individual as they age. Many people in their late thirties and in
their forties notice a decline in endurance, the onset of wear-and-tear
injuries (such as osteoarthritis), and changes in the digestive system. Wounds
and other injuries also take longer to heal. Body composition changes due to
fat deposits in the trunk. The body may slow down and become more sensitive to
diet, substance abuse, stress, and rest. Chronic health problems can become an
issue along with disability or disease. Adults from 35 to 60 years continue to
develop relationships and adapt to the changes in relationships. These changes
are highly evident in the maturing relationships between children and aging
parents (Gordon-Salant et al., 2010).
Adults (35 to 60
years) may begin to show visible signs of aging. This
process can be more rapid in women who have osteoporosis. Changes might occur
in the nervous system. The ability to perform complex tasks remains intact.
Women experience menopause in the years surrounding the age of 50,
which ends natural fertility. Changes can occur to skin and
other changes may include decline in physical
fitness, including a reduction in aerobic performance and a decrease in
maximal heart rate. Sensory sensitivity in middle-age adults has been shown to
be one of the lowest (Karim and Kather, 2003).
Adults (35 to 60
years) can be a time when a person re-examines their life by taking stock and
evaluating their accomplishments (Lachman et
al., 2015). It is well documented that middle age is the most productive
period of life in terms of work capacity but is also the time when unhealthy
eating habits and sedentary lifestyles may develop, resulting in malnutrition
and increased risk of chronic diseases. Intake of fat, animal products and
sugar is increasing while on the other hand, consumption of cereals, fruits and
vegetables is decreasing across developing countries (Tyrovolas and
Polychronopoulos, 2011).
Nutritional status has been reported to
deteriorate as people age, partly due to the loss of muscle mass and declined
food intake (German et al., 2008). The
nutritional status of adults aged 35 to 60 years impacts their health and
reasoning. Poor health and malnutrition impair both the growth and cognitive
development of adults (Srivastava et al.,
2012). Most diets taken by middle aged adults are of low quality, lack variety,
low energy and nutrient density, and multiple nutrient deficiencies are common
in this group as a result of much activities engaged in to make ends meet
(Ogbimi and Ogunba, 2011). Improving nutrient intake is important for health
and well-being of adults. Many adults are malnourished which prevents them from
reaching their optimum potential, because nutrition is a foundation on which
human progress in built (Veneman, 2011). Malnutrition is one of the devastating
problems, particularly for the poor and unprivileged across many states and
regions. Malnutrition makes us all more vulnerable to disease and premature
death. However, nutrition is a cornerstone that affects and defines the health
of all people, rich and poor, young and aged (Patel and Martin, 2008).
It is important to assess the nutritional status of
adults because of its role in ensuring a better quality of life and its
association with functional ability (Galanos et al., 1994). Adequate nutritional status results from the
balance between food intake and organic nutrition needs at each stage of life.
Imbalances in this relationship are manifested as nutritional deficiencies
(when there are general or specific energy and nutrient deficiencies) or
nutritional disorders (caused by scarcity or excess of food leading to
malnutrition or obesity) (Duarte et al., 2016). According
to Norimah
and Leong, (2000),
the nutritional status of an individual is determined by a complex interaction
between internal/constitutional factors and external or environmental factors.
The internal or constitutional factors include age, gender, nutrition,
behavioural, physical activity and diseases while the external or environmental
factors are: food safety (security), cultural, social and economic
circumstances.
Nutritional assessment is the systematic process of
collecting and interpreting information in order to make decisions about the
nature and cause of nutrition related health issues that affect an individual (Anderson
et al., 2011). Nutrition assessment includes taking anthropometric
measurements and collecting information about a client’s medical history,
clinical and biochemical characteristics, dietary practices, current treatment,
and food security situation. Following a
structured assessment path enables health professionals to carry out a quality
nutritional assessment in order to identify those who need nutritional
intervention, and to improve clinical decision making using a person-centred
approach (Furman, 2006). Lifestyle changes related to unhealthy eating
habits, socio-economic pressure, smoking and decreased physical activity are
risk factors of chronic diseases (Norimah and Leong, 2000).
Anthropometric
measurements are the most basic methods of assessing body composition.
Anthropometric measurements describe body mass, size, shape, and level of
fatness (Gibson, 2005). Since the body size changes with weight gain,
anthropometry gives the researcher an adequate assessment of the overall
adiposity of an individual (Gibson, 2005). Nutritional status has been defined
as an individual's health condition as it is influenced by the intake and
utilization of nutrients. In theory, optimal nutritional status should be
attained by consuming sufficient, but not excessive, sources of energy,
essential nutrients, and other food components (such as dietary fibre) not
containing toxins or contaminants (Best
et al., 2010)
Traditionally, efforts to detect
poor nutritional status have centred on nutritional deficiencies in
populations, since defining or assessing optimal health is difficult.
Nutritional deficiency follows a pattern starting with low intake or
utilization of one or more nutrients, then progressing to biochemical
abnormalities, abnormal growth, abnormal body mass, and, eventually, to
full-blown deficiency. Poor nutritional status is not confined to
undernutrition. It may also result from excessive intake or inadequate
expenditure of food energy, or from excessive intakes of specific nutrients,
resulting in acute toxicity or chronic diseases.
Poor nutrition may increase the risk/susceptibility to
infection and chronic diseases. Under- nutrition may lead to increased risk of
infection and decreases in physical and mental development. Over nutrition may
lead to obesity (Smoliner et al., 2009).
Many genetic, physiological and behavioural factors play their role in the
ethnology of obesity, which has been associated with several medical disorders
such as hypertension, type 2 diabetes, hyper -cholesterolaemia and liver
diseases among others (Kaiser et al., 2010).
Actual
nutritional status of adults is the real, existing
in act or fact on the condition of the body as a result of the intake,
absorption and use of nutrition,
as well as the influence of disease-related factors. The perceived nutritional
status of adults deals with the observed or anticipated nutritional status of
the adult. It is the nutritional status observed by an individual about an
adult. Perceived
nutritional status includes several dimensions; the individuals’ internal and
external resources in combination with their perception of their physical and
psychological health. Perceived nutritional status is every individual’s own
perception of their health including important dimensions of life that are
meaningful to their health.
Individuals
perceive their health and nutritional status as good even if they have diseases
and symptoms of illness (Rosén and Haglund, 2005). The
perception of body-weight status plays a vital role in weight management, and
underestimation of body-weight can be a risk factor for obesity in some people
(Flynn et al.,
1998).
On the other hand, overestimation of the weight by underweight or normal weight
subjects can be a risk factor for unhealthy weight control practices (Park,
2011) and may cause eating disorders. Therefore, misperception of weight may
have adverse effects on nutritional behaviours. Understanding incorrect
perception of weight status is important for the prevention of depression,
social anxiety, and eating disorders.
1.1 STATEMENT OF PROBLEM
Adults contribute significant
percentage (42%) of the world population (United Nations, 2019). This
population is often threatened by malnutrition. Adults
(35-60 years) are the productive population of every country. They provide
assistance to family members and the development of the society.
Poor nutritional status remains a
global problem affecting the adult as it leads to increased hospital admission,
morbidity and higher rate of mortality (Mullie et al., 2010). One in ten adults are obese (WHO, 2015), and this is
associated with myriad of disorder such as cardiovascular disease, diabetes,
hypertension, stroke, sleep apnea, osteoarthritis, depression, reduced quality
of life and several cancer (Carr, 2005 and Poirier, 2006). Studies on the
prevalence of obesity among adults have reported high rate of obesity among adults
in Akwa-Ibom state of Nigeria, 62.6% were obese whereas the combined prevalence
of overweight and obesity among middle aged adults (40 to 60 years) resident in
the same state was 34.8% according to the 2018 National Nutrition
and Health Survey (NNHS, 2018).
The dietary habits of middle-aged
adults may lead to poor and even dangerous lifestyle due to actively
involvement in wealth creation and little or no attention to their diet and
health. Some adults depend on street food for their daily foods due to their
strenuous workload, one may really wonder when these adults will have the time
to eat. The living condition of these adults are of paramount importance to
prevent the various nutrition deficiencies and disorders adults are prone to
(Akinloye, 2010).
Adults are vulnerable to poor
nutritional status for many reasons including physiological and functional
changes that occur with age, lack of proper relaxation, financial constraints
and inadequate access to food (Agarwalla et al., 2015). The nutrition and health of the adults is often
neglected. Most nutritional intervention programs are directed toward infants,
young children, adolescents, and pregnant and lactating mothers. However,
nutritional intervention programs could play a part in the prevention of
deteriorating conditions of the adults and an improvement of their quality of
life.Malnutrition and unintentional
weight loss adds to progressive decline in health, reduce physical and
cognitive functional status, increase utilization of health care services, lead
to premature institutionalization and increase mortality (Amarantos et al., 2001). The
nutritional status of middle aged adults is often times misperceived, leading
to cases of overestimation (where the perceived nutritional status of the adult
is higher than the actual nutritional status of the adult) and also
underestimation (where the perceived nutritional status of the adult is less
than the actual nutritional status of the adult) (Pedroso et al.,
2017).
Health
seeking behaviour is directly related to the availability and accessibility of
health facilities apart from motivations and ability of the individual to seek
medical treatment. About 94% middle aged adults believed that headache, common
cold, low grade fever, diarrhoea are mild illness and do not require any
medical treatment while about 96% perceived that hypertension, diabetes
mellitus, fits are serious illness and require medical treatment (Habibullah
and Afsar, 2013).
There is however, scarcity of
information on perceived and actual nutritional status of adults in Abia State.
Not
many studies have assessed the actual and perceived nutritional status of
adults (35-60 years), and most of them have demonstrated that there is a
tendency for the adults to underestimate their nutritional status, and not
recognizing their obese as such. This fact deserves much attention. Also, no research work has compared the actual
nutritional status of the middle aged adults to their perceived nutritional
status. Studies on nutritional status among middle aged adults have
concentrated on the nutritional status of older adults with few conducted in
Abia State.
It is therefore important to assess the
perceived and actual nutritional status of adults (35-60 years) in Umuahia
North and Umuahia South LGA, Abia State.
1.2 OBJECTIVES OF THE STUDY
The
general objective of this study is to assess the perceived and actual
nutritional status of adults in Umuahia North and Umuahia South LGAs in Abia
State.
Specific objectives
The
specific objectives are to:
i) Assess the social economic characteristics of the
respondents
ii) Determine the perceived nutritional status (body mass
index, waist/hip ratio, blood pressure level) using silhouettes classification
and recall techniques
iii) Assess their actual nutritional status using standard
procedures
iv) Evaluate the correlation between actual and perceived
nutritional status of adults (35–60years).
1.3 SIGNIFICANCE
OF THE STUDY
The findings from this study will
help highlight the perceived and actual nutritional status of adults (35 – 60 years)
in the study area and it will contribute to the already existing literature on
perceived and actual nutritional status of adults. It would help the society to
understand the nutritional status of adults, thereby improving
the health of adults.
It
will enable governmental and policy makers to formulate policies that will help
to promote appropriate nutritional status among adults in Nigeria. This study will help nongovernmental
organizations (NGOs),
nutritionist and nutrition workers to plan and carry out nutrition education
program that will help to improve nutritional status of adults.
This study will help It will help
agriculturist and others in the food value chain to improve on education and
administration relating to nutrition, food processing, marketing, distribution
of food and agricultural products.
It will provide researchers with
baseline data on how adults’ perceived knowledge of their nutritional status
comes close to reality (actual nutritional status).
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