DIETARY INTAKE AND BLOOD PRESSURE AMONG URBAN ADULTS IN UMUAHIA NORTH LOCAL GOVERNMENT AREA, ABIA STATE.

 

 

Nutrition as the science of food and its relationship to health has been recognized in recent years as the cornerstone of socioeconomic development (Parks, 2009). Adequate nutrition is important for a variety of reasons, including optimal cardiovascular function, muscle strength, respiratory ventilation, protection from infection, wound healing and psychological well-being (Martin, 2006).

Adequate nutrition entails a diet that contains the constituents (carbohydrate, fats, proteins, vitamins and minerals) that are required for body building, energy supply, body defense and regulatory functions in quantities commensurate with the body needs (Martin, 2006).

Malnutrition refers to either inadequate intake of nutrients due to lack of food, ignorance, socio-cultural factors, and diseases among other causes, resulting in underweight and other nutrient deficiency diseases; or intake of nutrients in excess of body requirements due to poor dietary habit (erroneously perceived as a sign of affluence), resulting in overweight and obesity (Morris, 2007).

Poor diet (high consumption of sugar, salt, saturated fat, etc.) and unhealthy lifestyle (smoking, alcohol consumption and physical inactivity) have been identified as major risk factors of cardiovascular disease and other non-communicable diseases (NCDs) (World Food Programme (WFP), 2015). Traditionally in Africa, communicable diseases and maternal, perinatal and nutritional causes of morbidity and mortality accounted for the greatest burden of morbidity and mortality (Lopez, 2006). This burden is fast shifting towards chronic non- communicable diseases, and by extension CVDs. This phenomenon is what is being termed as a "double burden of disease" (Bygbjerg, 2012). Whereas high blood pressure was almost non-existent in African societies in the first half of the twentieth century, estimates now show that in some settings in Africa more than 40 percent of adults have hypertension (Addo et al., 2007). The prevalence of hypertension has increased significantly over the past two to three decades (Opie and seedat, 2005). There were approximately 80 million adults with hypertension in sub-Saharan Africa in 2000 and projections based on current epidemiological data suggest that this figure will rise to 150 million by 2025 (Opie and seedat, 2005). Hypertension is a major risk factor for developing cardiovascular disease, stroke, and kidney disease (WHO, 2002). To reduce blood pressure (BP), several lifestyle changes are recommended such as weight loss, exercise, and following a healthy diet (WHO, 2002).

Hypertension which is a silent killer (asymptomatic) occurs when there is excessive pressure against the blood vessel walls (Verma and Solomon, 2009).  The heart has to work harder in order to pump the blood through the body when it is working against this elevated pressure, and this can eventually lead to an enlarged heart, kidney and heart damage (Wolf-Maier et al., 2003).

Several epidemiological stuies have reported that hypertension is common worldwide (Kunes et al., 2016), and is now regarded as a major public health problem in many countries (Kearney et al., 2005). Hypertension and its complications, including stroke, heart failure, and renal failure, have been reported in both developed and developing countries (Parks, 2009). Hypertension is a major public health problem due to its high prevalence all around the globe (Abebe et al., 2015). It is well-known that hypertension is a complex interaction of multiple genetic, environmental and behavior factors (Kunes et al., 2016). In adults, the interactions between genes and environmental factors could explain the pathogenesis of essential hypertension in different population. (Gupta et al., 2010), Age, gender, race, smoking, serum cholesterol, glucose intolerance, sedentary life style, dietary habits and obesity will contribute to the prognosis of the disease (Copertaro et al., 2009).

A highly saturated fat diet increases blood cholesterol concentration by 15 to 25% (Arthur and John, 2000). This results from increased fat deposition in the liver which then provides increased quantities of acetyl-CoA in the liver cells for production of cholesterol. It is therefore important to maintain a diet low in saturated fat as to maintain a diet low in cholesterol in order to decrease the blood cholesterol concentration (Arthur and John, 2000). 

Moreover, accumulating evidence suggested that unhealthy diet and lifestyle could play a significant role in the ongoing epidemics of obesity, hypertension and other symptoms of metabolic syndrome (Eaton, 2003). Dietary pattern consisting of a number of food items is widely used as an alternative method to reflect habitual exposure of foods and nutrients as a whole to assess diet and disease relations (Hu et al., 2004). Previous study suggests that the vegetarian dietary pattern which comprises of foods rich in vegetables, fruits, grains, poultry, legumes, nuts, vegetable oils, soya, and possibly dairy products and/or eggs has been associated with a lower risk for developing hypertension (Sabate et al., 2015). 

Blood pressure is the pressure of circulating blood on the walls of blood vessels. Most of this pressure is due to work done by the heart by pumping blood through the circulating system (Eaton, 2003).

  

It is estimated that hypertension affects about 1 billion people all over the world and it is the main risk factor for many other cardiovascular disease (Adeloye et al., 2015). The prevalence of hypertension in Nigeria may form a substantial proportion of the total burden in Africa because of the large population of the country currently estimated to be over 170 million (World Bank Nigeria, 2013).  With and increasing adult population and changing lifestyle of Nigerians, the burden of hypertension may continue to increase as time folds (Kayima et al., 2013). In suggesting an evidence-based context for government and other health policy planners on strategies to reduce this burden in low-resource setting like Nigeria, it is important to have detailed up to date information on the prevalence of hypertension in order to match this with available resources (World Bank Nigeria, 2013). In Nigeria, the last two decades has been a rise in the number of prevalence studies concerning hypertension and other non-communicable disease (Ogah et al., 2012). Studies such as stroke, therapy for diabetic neuropathy, cardiovascular disease etc. also showed a reduction of 6 to 26 mmHg in systolic blood pressure and a reduction of 5 to 15 mmHg in diastolic blood pressure when stress-management techniques were used (Chobanian et al., 2003; Adler et al., 2000; Staessen et al., 2003; Lewington et al., 2002). Many people become hypertensive because of excessive alcohol intake (WHO, 2011). Besides, with a reduction of alcohol intake, 5 mmHg declines in systolic blood pressure and 3 mmHg declines in diastolic blood pressure have been reported (WHO, 2011). Therefore good knowledge and understanding of dietary choices and modification of lifestyle will create a positive impact in addressing high blood pressure and reduction of cholesterol in the blood (Stevens et al., 2001).

Globally, the burden of hypertension and other non-communicable disease (NCDs) is rapidly increasing, and African continents may be the most affected region in the world (WHO, 2013). In 2008, WHO estimated hypertension prevalence of 42.8% in Nigeria (WHO, 2011). This is believed to be due to an increasing adult population, rapid urbanization and uptake of western lifestyles, including high consumption of processed foods (with high salts and fats), tobacco and alcohol products (WHO, 2011).

Current evidence indicates that fruits and vegetables consumed as part of the daily diet can help reduce the risk of coronary heart disease and stroke (Hartley et al., 2013). The issue is also associated with the increased consumption of energy-dense nutrient-poor foods that are high in fats, sugar and salt as well as increasingly unhealthy diet of young adults and adolescents (Martin, 2006). A survey on non-communicable diseases in Nigeria reported the prevalence of hypertension in adult Nigerians to be at 10%– 12% in an urban community (Olawuji and Adeoye, 2018).

Researches and investigations have shown that over 26.4% of the world adult population had hypertension, and that by 2025 the global prevalence of hypertension would rise to 29.2% (Geriatar and Cardiol, 2005). It is now obvious that dietary pattern not only affect an individual wellbeing but also have implication on the society at large, so all individual should be aware (Okonkwo et al., 2001). The choice of which food to eat, where and when to eat are intensively personal and influenced by several factors which in turn influence an individual’s need (Okonkwo et al., 2001).

Hypertension has become a major contributor to the burden of cardiovascular related morbidity and mortality in the world (Gaziano et al., 2010, Kearny et al., 2005).

 

One major problem affecting the response to the burden of hypertension in Nigeria is that the knowledge, awareness, treatment and control of the problem is very poor (Wardlaw and Kessel, 2002). Consequently, many who live with high blood pressures end up in health facilities with cardiovascular complications, including heart failures, ischemic heart disease and strokes (Ogah et al., 2006). However, due to the informal nature of their settlement, cultural, social, and behavioral factors unique to them, little is known about the burden of these chronic but preventable disease in the communities surveyed (Ogah et al., 2006).  Proper nutrition is a very important factor in maintaining and promoting health and proved its role as a determining agent in chronic diseases (WHO, 2002). Over the past half-century, most countries, especially developing countries, have been in nutritional transition and have moved towards a pattern of food and physical activity associated with chronic non-communicable diseases (Bishwajit, 2015). For more comprehensive understanding between nutrition and diseases, it is better nutrition is considered a dietary pattern to take into account synergistic effects of foods and nutrients (Willett, 2013). In a recent study, the relationship between the dietary pattern of higher fish, eggs, milk, nuts, vegetables, and fruits, and lower salt intake with prevalence, and control of hypertension has evaluated and reported that the dietary pattern is inversely associated with the prevalence of hypertension (Huang et al., 2018). Excessive intake of saturated fatty acids and Trans fatty acids, along with higher consumption of salt and sugar, are risk factors for cardiovascular diseases including hypertension (Huang et al., 2018). Situation observed in the last 5-8 years such as incident of sudden death and sudden collapse among adults in most urban and rural part of Nigeria have been on the increase, poor access to hospital care, excessive intake of carbonated drinks, excessive intake of alcohol, excessive intake of processed foods, avoidance of natural foods, addition of salt during meals, negative attitude towards fruits and vegetables have modelled a lot of health challenges to individuals. Lack of proper knowledge in selection of foods from the various food groups and ignorant in blood pressure check-ups have also raised a lots of question about hypertension.

The general objective of the study is to determine the relationship between the dietary intake and blood pressure of urban adults in Umuahia North Local Government Area of Abia State.

The specific objectives are to:

This study is intended to be a primary source of information in Umuahia North Abia state, since the prevalence of hypertension is very much high in all part of the world. We deduce that this study shall be to address every form of ignorance behind the risk of hypertension. This study shall bring to the knowledge of the people how dietary intake, lifestyle and socio-economic status has an influence on the health of the people. Findings from this study will guide Government agencies in designing and implementing policies on the smoking and drinking attitudes of the people and the Nutrition education sectors shall engage in creating awareness on the dangers of some habitual deadly lifestyle and eating habits of the people if found necessary.

The importance and benefits of this study shall address the negligence found among adults who see exercise as only for the youths and also bring to their understanding the need for weight monitoring and regular blood pressure checkup.

This study is expected to improve people’s dietary intake and create awareness on the need for regular blood pressure checkup, adopt the habit of exercising and positive change of lifestyle to the adults in Umuahia.