The study aimed at assessing the relationship between dietary intake and blood pressure among urban adults in Umuahia North Local Government Area, Abia State. This cross-sectional study used simple random technique to select 439 adults comprising of 198 males and 241 females of Afara and Amuzukwu community in Umuahia North Local Government Area. A validated questionnaire was used to collect information on socio-demographic characteristics of the respondents, while the anthropometric measurement of the respondents were taken using standard equipment and procedures. Automatic blood pressure sphygmomanometer was used to determine the blood pressure of the respondents. Food frequency questionnaire (FFQ) and 24-hour dietary recall were used to assess food intake of the respondents which was used to calculate the nutrient intake. Statistical package for social sciences IBM (SPSS) software (version 23.0) was used to analyze the data. Data was analyzed using descriptive statistics, chi square and Pearson correlation. A P-value of less than 0.05 was accepted as statistically significant. Many (39.4%) of the respondents had normal blood pressure, (males = 37.4%; females = 41.1%). Furthermore, 32.2% of the males had stage I and stage 2 hypertension respectively, while very few (27.8%) of the females had stage 1 and 2 hypertension. Less than half (46.5%) of the respondents had a normal body mass index (BMI) (males were 56.1% and females were 38.6%). Some (27.0%) of the females were obese, using BMI classification whereas, majority (71.6%) of the males had high risk waist-hip ratio. The results indicated that the respondents had estimated intake above recommended nutrient intake (RNI) for energy (50.2%), carbohydrates (92.9%), protein (76.9%) and iron (93.1%). However the correlation result only showed a relationship between blood pressure and three nutrients which were protein (r = 0.102; P = 0.038), iron (r = 0.096; P = 0.048) and sodium (r = -0.117; P = 0.017). Nutrition remain a modifiable risk factor for reducing blood pressure of an individual. Therefore, efforts should be made to encourage the public on healthy and adequate nutrient intake as it has a bearing with blood pressure.
TABLE OF CONTENTS
COVER PAGE i
TITLE PAGE ii
LIST OF TABLES vi
1.0 Background of the study 1-4
1.1 Statement of problem 4-6
1.2 General objective: 6
1.3 Significance of study 7
2.1 Dietary intake 8
2.1.1 Evaluating dietary intakes 8-9
2.1.2 24hour dietary recall 9
2.1.3 Strength of 24 hour dietary recall 9-10
2.1.4 Weakness of 24 hour dietary recall 10
2.1.5 Food frequency questionnaire 10-11
2.1.6 Dietary history 11-12
2.1.7 Nutrient intake 13-14
2.1.8 Factors influencing dietary intake of adults 14-15
2.3 Blood pressure 16-17
2.4 Hypertension 17-18
2.4.1 Types of hypertension 18
2.4.2 Causes of hypertension 19
2.4.3 Complications of hypertension 19-20
126.96.36.199 Cardiovascular complications of hypertension 20
188.8.131.52 Cerebral complications of hypertension 20
184.108.40.206 Renal complications of hypertension 21
220.127.116.11 Retinal complications of hypertension 21
2.5 Pathophysiology of hypertension 21
2.5.1 Genetic factor 21-24
2.6 Preventive measures of hypertension 24
2.6.1 Non-pharmacological treatment 24-25
2.6.2 Dash diet 25
2.6.3 Pharmacological therapy 26
2.7 Anthropometric measurements 26-27
2.7.1 Body mass index (BMI) 27-28
MATERIALS AND METHODS
3.1 Study area 29
3.2 Study design 30
3.3 Study population 30
3.4 Sampling and sampling techniques 30
3.4.1 Sample size calculation 30-31
3.4.2 Sampling procedure 31
3.5 Preliminary activities 31
3.5.1 Preliminary visit 31
3.5.2 Informed consent 31-32
3.5.3 Ethical considerations 32
3.5.4 Training of research assistants 32
3.6 Data collection 32
3.6.1 Questionnaire administration 32
3.6.2 Socio-demographic data 33
3.6.3 Dietary habits 33
3.6.4 Lifestyle data 33
3.6.5 Dietary assessment 33-34
18.104.22.168 24 Hour dietary recall 34
22.214.171.124 Food frequency questionnaire 35
3.6.6 Anthropometric measurements 35-36
3.6.7 Blood pressure measurement 36
3.7 Data analysis 36
3.7.1 Body mass index 36-37
3.7.2 Waist circumference 37
3.7.3 Waist-hip ratio 38
3.7.4 Blood pressure classification 38
3.8 Statistical analysis 39
RESULTS AND DISCUSSION
4.1 Background information of the respondents 40-42
4.2 Blood pressure characteristics 43
4.2b Blood pressure of the respondents (x2) 44
4.3 Anthropometric characteristics of the respondents 44-45
4.4 Food frequency of the respondents 46-47
4.5 Nutrient intake of the respondents 47-48
4.6 Association between dietary intake and blood pressure of the respondents (P<0.05) 49-50
CONCLUSION AND RECOMMENDATION
5.1 Conclusion 51
5.2 Recommendation 51
Appendix 1 68-71
Appendix 2 72
Appendix 3 73
Appendix 4 74
Appendix 5 75-88
LIST OF TABLES
Table 2.1: Blood pressure classifications 15
Table 3.1: Recommended nutrients intake (RNI) 33
Table 3.2: Categorization on nutrient adequacy ratio of nutrients 33
Table 3.3: BMI Classification of Adults 36
Table 3.4: Waist circumference classification of Adults 36
Table 3.5: Waist-hip classification of Adults 37
Table 3.6: Blood pressure classification of Adults 37
Table 4.1a: Socio-demographic Characteristics of the respondents 40
Table 4.1a: Socio-demographic Characteristics of the respondents (continuation) 41
Table 4.2a: Blood pressure of the respondents 42
Table 4.2 Blood pressure of the respondents (X2) 43
Table 4.3: Anthropometric characteristics 44
Table 4.3b: Mean and anthropometric measurements of the respondents (T-test) 44
Table 4.4: Food frequency of the respondents 47
Table 4.5: Nutrients intake of the respondents 48
Table 4.6: Association between dietary intake and blood pressure of the respondents 50
1.0 BACKGROUND OF THE STUDY
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).
1.1 STATEMENT OF PROBLEM
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.
1.2 GENERAL OBJECTIVE:
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:
i. evaluate socio-economic characteristics of the adults
ii. assess the anthropometric status of the adults
iii. estimate blood pressure of the adults
iv. assess dietary intake of the adults
v. determine relationship between dietary intake and blood pressure of the adults
1.3 SIGNIFICANCE OF STUDY
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.
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