ABSTRACT
A cross-sectional survey was used to assess the dietary intake and blood pressure of 428rural adults in Ikwuano Local Government Area, Abia State. A structured and validated questionnaire was used to obtain information on sociodemographics, food frequency and 24-hour dietary recall. Anthropometric measurements (heights, waist and hip circumference, mid-upper arm circumference and weight) and blood pressure measurements were determined using standard procedures. Data were analysed using frequencies, percentages, means, standard deviation and correlation. Significance was accepted at p<0.05. Results showed that 52.9% of the subjects were males, while 47.1% were females. Most had normal blood pressure (47.8%), while 26.8% had hypertension (stage 1 and 2). Cereal and grain (41.3%), dairy products (48%), legumes (47.5%), fruits (43.8%) and vegetables (40.3%) were the main food groups consumed greater than three times weekly (>3 times). There was a significant negative correlation between systolic blood pressure and vitamin C (r = -0.139, p = 0.004) as well as diastolic blood pressure and vitamin C (r = -0.100, p = 0.038), while a significant positive correlation was observed between sodium and systolic blood pressure (r = 0.112, p =0.021). The study showed that nutrient intake (Sodium and vitamin C) were associated with blood pressure levels. Therefore, educational campaigns regarding dietary approaches to solving hypertension should be encouraged.
TABLE OF CONTENTS
TITLE PAGE I
CERTIFICATION Ii
DEDICATION Iii
ACKNOWLEDGMENT Iv
TABLE OF CONTENT V
LIST OF TABLES Viii
ABSTRACT Ix
CHAPTER 1
INTRODUCTION
1.1 Statement of problem 3
1.2 Objectives 5
1.3 Significance of study 5
CHAPTER 2
LITERATURE REVIEW
2.1 Adults 7
2.1.1Young adulthood (18-35 years) 7
2.1.2 Middle adulthood (35-55 years) 8
2.1.3 Late adulthood (> 56) 8
2.2 Blood pressure 8
2.3 Hypotension 9
2.3.1Signs and symptoms of hypotension 10
2.3.2 Causes of hypotension 10
2.3.4Management of hypotension 11
2.4 Hypertension 11
2.4.1 Types of hypertension 12
2.4.1.1 Primary hypertension 12
2.4.1.2 Secondary hypertension 12
2.4.1.3 Signs and symptoms of hypertension 13
2.4.3 Causes of hypertension 14
2.4.3.1 Primary hypertension 14
2.4.3.2 Secondary hypertension 16
2.4.2Diagnosis of hypertension 17
2.4.4.1 Measurement technique 17
2.4.4.2 Classification of hypertension in adults 19
2.4.5Prevalence of hypertension 20
2.4.6Prevention of hypertension 21
2.4 Management of hypertension 21
2.5 Dietary intake 23
2.5.1 Frequency of food consumption 24
2.5.1.1 Food frequency questionnaires 24
2.5.2 24-hour dietary recall 25
2.6 Factors that affect dietary intake of adults 26
2.6.1 Income 26
2.6.2Health 26
2.6.3 Socio-economics 27
2.6.4 Trade liberalization 27
2.6.5 Climate 28
2.7 Effect of dietary intake on blood pressure 28
CHAPTER 3
MATERIALS AND METHODS
3.1 Study design 32
3.2 Area of study 32
3.3Population of study 32
3.4Sampling and sampling techniques 33
3.4.1 Sampling size determination 33
3.4.2 Sampling procedure 34
3.5Preliminary activities 34
3.5.1 Preliminary visit 34
3.5.2 Training of research assistants 35
3.5.3 Ethical approval 35
3.6 Data collection 35
3.6.1 Questionnaire administration 35
3.6.2 Anthropometric measurements 35
3.6.2.1 Weight measurement 35
3.6.2.2 Height measurement 36
3.6.2.3 Hip circumference 36
3.6.2.4 Waist circumference 36
3.6.2.5 Mid-Upper Arm Circumference (MUAC) 37
3.6.2.6 Waist-Hip Ratio 37
3.6.2.7 Body Mass Index (BMI) 37
3.6.3 Blood Pressure Assessment 37
3.6.4 Dietary assessment 38
3.6.4.1 24-hour dietary recall 38
3.6.4.2 Food frequency questionnaires 38
3.7Data analysis 39
3.7 Statistical analysis 41
CHAPTER 4
RESULTS AND DISCUSSION
4.1 Sociodemographic characteristics 42
4.2 Blood pressure characteristics of the respondents 44
4.2.1 Anthropometric characteristics of the respondents 45
4.3 Dietary intake of participants 47
4.3.1 Food frequency consumption of participants 47
4.3.2 Nutrient intake of participants 49
4.4 Relationship between nutrient intake and blood pressure 51
CHAPTER 5
CONCLUSION
5.1 Conclusion 55
5.2 Recommendation 55
REFERENCES 56
APPENDIX I 72
APPENDIX II 82
APPENDIX III 83
APPENDIX IV 84
APPENDIX V 8
LIST OF TABLES
Table 2.1 Other investigations for diagnosis of secondary hypertension. 18
Table 2.2 Classification of hypertension in adults. 20
Table 3.1 Categories of Body Mass Index in Adults 39
Table 3.2 Classification of Waist to Hip Ratio 39
Table 3.3 Classification MUAC 40
Table 3.4 Blood pressure classification 40
Table 3.5 Waist circumference classification 40
Table 3.6 Recommended nutrient intake 41
Table 4.1a Socio-demographic characteristics of the respondents 42
Table 4.1b Socio-demographic characteristics of the respondents 43
Table 4.2 Blood pressure characteristics of the respondents 44
Table 4.3 Anthropometric characteristics of the respondents 46
Table 4.4 Frequency of consumption from various food groups 48
Table 4.5 Nutrient intake of participants 50
Table 4.6 Relationship between nutrient intake and blood pressure 52
CHAPTER 1
INTRODUCTION
Blood pressure is the pressure that circulates blood on the walls of blood vessels (World Health Organization (WHO), 2006). Most of this pressure is due to work done by the heart by pumping blood through the circulatory system. Used without further specification, “blood pressure” usually refers to the pressure in the large arteries of the systemic circulation (Blood Pressure Association (BPA), 2008).
Blood pressure is usually expressed in terms of the systolic pressure (maximum during one heartbeat) over diastolic pressure (minimum in between two heartbeats) (BPA, 2008). Normal resting blood pressure in an adult is approximately 120 millimeters of mercury (16kPa) systolic, and 80 millimeters of mercury (11kPa) diastolic, abbreviated as “120/80mmHg”(Mbah et al., 2013). Globally, the average blood pressure, age standardized, has remained about the same since 1957 to the present, at approximately, 127/79mmHg in men and 122/77mmHg in women (Kannel, 1996).
A high fall in blood pressure is known as hypotension. It is a medical concern if it causes signs or symptoms such as dizziness, fainting, or in extreme cases, circulatory shock. It is characterized by a persistent systolic/diastolic blood pressure decrease of >20/10mmHg (Ogedegbe and Pickering, 2010).
On the contrary, hypertension occurs when there is excessive pressure against the blood vessel walls (Kannel, 1996). A certain amount of pressure is required to keep the blood flowing throughout the body (Ibekwe, 2015). However, if blood pressure is always high, then the lining of the blood vessels can be damaged (Mbah et al., 2013). Hypertension is a chronic disease which has been reported to be common mostly among elderly and young adults and it is an emerging health problem in semi-urban areas in Africa and Nigeria inclusive (Yameogo et al., 2012, Mbah et al., 2013, Adediran et al., 2013). It is the single most important cause of death worldwide and the second major cause of disability next to childhood malnutrition (Lopez et al., 2006). Consistent blood pressure readings of 140/90mmHg indicates the presence of high blood pressure (Kannel, 1996).
Dietary intake refers to the daily eating patterns of an individual, including specific foods and calories consumed and relative quantities (Piana, 2001). Dietary pattern of an individual reflects the type and amount of foods consumed together (Appel et al., 1997). It accounts for the cumulative effect of foods and nutrients (Appel et al., 1997). Inappropriate eating habits and frequency of the foods taken coupled with unhealthy lifestyles has predisposed many people to hypertension (Ibekwe, 2015).
Hajjar et al. (2001) suggested that changes in blood pressure can be modified by dietary intakes. Consistent with previous studies, blood pressure and dietary intake are associated less strongly than blood pressure and BMI (Ascherio et al., 1992; Kannel, 1996; Wassertheil-Smoller and Lamport, 1990). Appel et al. (1997) study showed that certain dietary intakes can favorably affect blood pressure in adults with average systolic blood pressures of less than 160mmHg and diastolic blood pressure of 80 to 95mmHg. Specifically, a diet rich in fruits, vegetables and low-fat dairy products and with reduced saturated and total fat lowered systolic blood pressure by 5.5mmHg and diastolic blood pressure by 3.0mmHg (Ascherio et al., 1992).
Furthermore, a reduction in high blood pressure due to dietary intakes was similar in magnitude to that observed in trials of drug monotherapy for mild hypertension (Svetkyet al., 1999b). Hence following a well-developed and modified dietary regimen might be an effective alternative to drug therapy in people with stage 1 hypertension (Appel et al., 1997). In this regard, it is therefore evident that non-pharmacologic approaches to decrease blood pressure at a population level are required to curb the predicted escalating increase in the rate of hypertension.
1.1 STATEMENT OF PROBLEM
Hypertension is estimated to affect about one billion people worldwide and is a major risk factor for many cardiovascular diseases (WHO, 2013). Cardiovascular diseases are responsible for about 17 million deaths globally, with complications from high blood pressure resulting in about7.5 million deaths and 57 million disability-adjusted life years (DALYs) worldwide, both accounting for about 12.8 and 3.7% of global deaths and DALYs, respectively (WHO, 2013; Kaerney et al., 2005). Nigeria, currently with a population of over 160 million, is the most populous African country (World Bank, 2013), and the prevalence of hypertension in the country hugely contributes to the overall burden in Africa (WHO AFRO, 2005).
However, the prevalence reduced in 2014 with an estimated prevalence ofhypertension of 28.9% was reported for adults in Nigeria (Adeloye et al., 2014). 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 (Bello, 2013; Mezue, 2013). The 1997 Nigerian National NCDs survey committee reported a hypertension prevalence of 11.2% in both sexes, which was then about 4.33 million hypertension cases in people aged above 15 years (Akinkugbe, 1997). This survey could have underestimated the prevalence of hypertension in Nigeria, as the diagnosis was based on the old definition of hypertension (160/95mmHg) (Bello, 2013). From the 2003 national NCDs survey conducted mainly in the south-west region, which was based on SBP at least 140mmHg and/or DBP at least 90mmHg, the overall prevalence of hypertension was 28.9% (Adeloye et al., 2015). In addition, recent surveys in various parts of Nigeria based on at least 140/90mmHg have also shown a higher prevalence of hypertension, ranging from 25.0 to 36.6% (Mezue, 2013). Research has also indicated that blood vessels naturally harden with age, losing their elasticity. This may be one explanation for why older people/ adults are more at risk of developing high blood pressure (Xu et al., 2017).
One major problem affecting the response to this burden in Nigeria is that the awareness, treatment and control of hypertension have been low (Kayima et al., 2013). Consequently, many who live with high blood pressure end up in health facilities with cardiovascular complications, including heart failures, ischemic heart disease and strokes (Ogah et al., 2012) In fact, research findings show that high blood pressure is diagnosed in many people as an incidental finding when admitted for unrelated ailments (Perkovic et al., 2007). This obviously has resulted in high morbidities and mortalities from hypertension in Nigeria (DeGraft et al., 2010) and reports still show that there is yet to be a nationwide measure to facilitate regular screening and detection of high blood pressures (Bello, 2013). Additionally, there is also a high economic burden as a consequence of hypertension and associated cardiovascular complications in Nigeria (Abegunde et al., 2007). This is demonstrated by direct costs, for example: the cost of antihypertensive medications, administrative fees, laboratory fees and other out-of-pocket health expenditures, and indirect costs, such as: loss of savings from repeated healthcare expenses, hospital waiting times and work absenteeism (Ilesanmi et al., 2012). The burden of hypertension in Nigeria is high and still growing (Bello, 2013), and we still cannot say with certainty the exact burden. There is therefore a need for serious intervention strategies in order to control this silent killer disease.
The incidence and severity of hypertension are affected by nutritional status and dietary intake (Hajjar et al., 2001). Studies have also shown that excessive weight gain, salt intake, smoking of cigarettes, drinking of alcohol and physical inactivity are the major predisposing factors for hypertension (He, 2013; Law et al.,.1991; Ijarotimi and Keshinro, 2008; Olaitan et al., 2018). It is therefore evident that dietary intake, dietary pattern and lifestyle of an individual are important elements in preventing, managing and treating hypertension (Olaitan et al., 2018; Ijarotimi and Keshinro, 2008). Nevertheless, few studies are available yet regarding the relationship between dietary intake and blood pressure in Africa, especially in Nigeria, thus creating an insight in this area is of great importance.
1.2 OBJECTIVES OF STUDY
The general objective of this study is to evaluate the relationship between dietary intake and blood pressure of adults in Ikwuano LGA of Abia state.
The specific objectives include to:
i. assess socio-demographics of the adults.
ii. determine the dietary intakes of adults.
iii. assess the blood pressure of adults.
iv. evaluate the relationship between dietary intake and blood pressure of adults.
1.3 SIGNIFICANCE OF STUDY
Identifying the dietary intake and blood pressure of adults would help provide an insight to health care professionals, the government, the mass media and most importantly the masses on how nutrient intake can contribute negatively or positively to blood pressure. Results from this research would help them appreciate the importance of consuming adequate diets. If found necessary, it will serve as a source of reference to other researchers, nutritionists, dieticians, institutions and public health workers working to improve the health status of hypertensive patients as well as the general public and to advocate for resources for targeted interventions on improving domestic food production. It can be used by government ministries and other private sector organizations to evaluate local production and food distribution systems for increasing diversity of food supply. It can also be used by policy / programme decision makers to formulate national policies and evaluate fiscal and trade policies to enhance nutrition and well-being.
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