ABSTRACT
The aim of the study was to assess fruit and vegetable consumption pattern and the association with prevalence of selected NCDs among adults in Oyigbo LGA, Rivers State. This cross-sectional study was conducted among 379 randomly selected adults (18 -60 years). Food frequency questionnaire and 24 hour dietary recall were used to assess fruit and vegetable consumption. Average daily intake of 5 serving of fruits and vegetable was considered adequate intake. Anthropometric methods of height, weight, waist and hip circumference as well as blood pressure were measured following standard procedures. Body Mass Index (BMI) was calculated from height and weight measurements. Fasting blood glucose level was used to assess diabetes. Blood pressure measurement was done to assess hypertension. Physical activity levels were assessed using the Physical Activity Questionnaire for Adults (PAQ). Categorical variables were presented using frequency distribution, tables and graphs. Independent T-test was used to compare variables based on sex. The association of adequate fruits and vegetables with prevalence of NCDs was determined using Chi square and logistic regression. Result of the study showed that 57.5% of participants were civil servants, had attained tertiary education level (75.1%), and earned above ₦100,000 (34.1%). Slightly more than half (55.6%) of the participants had fair knowledge of the importance of FVs consumption. Availability (32%) and health reasons (20.9%) were the dominant reasons for choice of FVs consumed. Physical activity level of 66.7% participants did not meet WHO recommendation (> 600 MET-minutes/week) especially for adults older than 50 years. Men were significantly more physically active than women (p=0.028). Many of the adults did not smoke (87.8%) or consume alcohol (64.3%). The prevalence of overweight and obesity were 46% and 24.6%, respectively. Females had significantly higher WHR compared to men (p<0.05). The prevalence of hypertension and diabetes were 58.7% and 6.7%, respectively. The prevalence of adequate consumption of fruits and vegetables in this study was 21.2% and 16.7% respectively. Nutrient intake was generally below FAO/WHO/UNU recommendations. Mean Adequacy Ratio (MAR) was 58.52% and 56.72% for men and women, respectively. A significant association was found between BMI and adequate fruit and vegetable consumption. The study participants had low fruit and vegetable consumption, physical activity level, and diabetes. However, the prevalence of hypertension, obesity and overweight were high. Therefore, promotion of fruit and vegetable consumption and increased availability of FVs varieties by relevant sectors in Rivers State are recommended.
TABLE OF
CONTENTS
Title Page i
Declaration
ii
Dedication iii
Certification iv
Acknowledgment v
Table of content vi
List of Tables vii
List of Figures viii
Abstract ix
CHAPTER
1: INTRODUCTION
1.1 Background of the Study 1
1.2 Statement of Problems 6
1.3 Objectives of the Study 10
1.4 Significant of the Study 11
CHAPTER 2: LITERATURE REVIEW
2.1 Definition of Fruits and Vegetable
(FVs) 12
2.2 Global prevalence of Fruit and
Vegetable Intake 14
2.3 Health Benefits of Consumption of
Fruits and Vegetable 16
2.4
Factors Influencing FVs Consumption Among Adults 20
2.5 Dietary Intake Assessment 22
2.5.1 Dietary assessment 22
2.6 Measuring Fruit and Vegetable Intake 26
2.7 Definition of Non-communicable
Diseases 27
2.7.1
Populations of risk of NCDs 28
2.7.2 Socio-economic impacts of NCDs 29
2.8 Global Prevalence of NCDs 29
2.9 Reviews of the Relationship between
NCDs and FV Consumption 31
2.9.1 Relationship between cardiovascular
disease and FVs intake 32
2.9.2 Relationship between blood pressure and
FV intake 33
2.9.3 Relationship between cancer and FV
intake 33
2.9.4 Relationship between diabetes and FV
intake 35
2.9.5 Relationship between obesity and FV
intake 35
CHAPTER 3: MATERIALS AND METHODS
3.1 Study Design 36
3.2 Area of Study 36
3.3 Population 37
3.4 Sampling and Sampling
Techniques 37
3.4.1 Sample size
37
3.4.2 Sampling technique
38
3.5 Preliminary Activities
40
3.5.1 Preliminary visits
40
3.5.2 Inclusion/exclusion criteria 40
3.5.3 Training of research assistants 41
3.5.4 Pre-test of questionnaire 41
3.6 Data Collection Technique 41
3.6.1 Data collection 41
3.6.2 Anthropometric measurement 42
3.6.3 Dietary assessment
47
3.7 Lifestyle Factors Assessment
48
3.8 Data Analysis
50
3.9 Statistical Analysis
50
3.10 Ethical Approval
51
CHAPTER 4: RESULT
AND DISCUSSION
4.1a Socio-Demographic Characteristics of the
Participants
52
4.1b Socio- Economic characteristics of the
participants
54
4.2 Knowledge of Fruits and Vegetable Consumption 56
4. 3 Reason
for Choice of Fruits and Vegetable Consumed
61
4.4 Behaviour and Lifestyle Characteristics
of Participants 62
4.5 Nutrient Intake of Participants
66
4.6
Anthropometric Indices of the Participants 70
4.7
Blood Pressure Classification of the Participants 72
4.8 Mean, Anthropometric, Blood Pressure and Blood
Glucose
Classification According to Sex
74
4.9
Consumption Pattern of Fruits and Vegetables 75
4.10 Prevalence of Participants Meeting WHO
Recommended
Fruit and Vegetable 79
4.11 Relationship between Non communicable
Disease Risk
Factors and Adequate
Fruit and Vegetable Consumption 81
CHAPTER 5: CONCLUSION AND RECOMMENDATION
5.1 Conclusion
85
5.2 Recommendation 87
References
88
Appendices 106
LIST OF
TABLES
3.1 Selected
number of communities
39
3.2
Selected number of respondents from each communities 39
3.3 BMI
categories
43
3.4 Waist- Hip ratio categories
45
3.5 Blood
pressure categories
46
4.1a
Socio-demographic characteristics of the participants 53
4.1b
Socio-economic characteristics of the participants 55
4.2a Knowledge
of fruit and vegetable consumption 57
4.2b Knowledge
score of fruit and vegetable consumption 60
4.3 Reason for choice of fruits and vegetables
consumed 61
4.4a Behaviour
and lifestyle characteristics of
participants 62
4.4b Physical activity classification according to
sex and age of adults 66
4.5 a Nutrient Intake of participants
67
4.5b Nutrient adequacy ratio of participants
69
4.6 Anthropometric
indices of the participants
70
4.7a Blood
pressure indices of the participants 72
4.7b Blood glucose level of the participants 73
4.8 Mean anthropometric, blood and blood glucose
measurement 74
4.10 Prevalence of participant meeting recommended
fruit and vegetable
consumption per day 80
4.11 Relationship between NCD, risk Factors and
Adequate Fruit and
Vegetable Consumption
81
LIST OF
FIGURES
4.1 Frequency of fruits and vegetable
consumption of participants 77
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Dietary factors contribute to a
large percentage of the global burden of diseases. It was estimated that 10% of
all deaths (12.5 million) were attributable to dietary factors (Lim et al., 2010). Adequate consumption of
fruits and vegetables (FAVs) has protective benefits against the development of
NCDs (Kabwama et al., 2019). Fruits
and vegetables are important components of a healthy diet due to their low energy density,
micronutrients, fiber, and other functional properties (Lim et al., 2010). Reduced fruit and vegetable
consumption is linked to poor health and increased risk of non-communicable
diseases (NCDs) (Kabwama et al.,
2019).
Non-communicable
diseases (NCDs) are the leading cause of morbidity and mortality in developed
and developing countries. An FAO/WHO joint report showed low consumption of
fruits and vegetables to be associated with NCDs (Kabwama et al., 2019). An estimated 6.7 million deaths
worldwide were attributed to inadequate fruit and vegetable consumption in 2010
(Lim et al., 2010).
WHO
recommended a daily intake of ≥5 portions (400g) of fruits and vegetable, but
people generally have low intakes both in developing and developed countries
(WHO, 2005). World Health Organization (WHO) (2003) estimated that low intake
of fruits and vegetables caused about 19% gastro- intestinal cancers, about 31%
of ischemic heart disease and 11% of stroke. (WHO, 2003) of the global burden
attributable to low fruit and vegetable consumption, about 585% was from
Cardiovascular Diseases (CVD) and 15% from cancers.
NCD are now seen to affect the poor of the
poorest countries in the world. The impact is greatest on the poor countries of
sub-Saharan Africa of which Nigeria occupy a significant position. This is
because they are often unable to access the education and services required to
prevent and treat NCDs. The little health resources remained focused on
reducing the already overwhelmed burden of communicable diseases and
preventable causes of infant and maternal mortality. Thus, it is not an
exaggeration to describe the situation in developing countries as an impending
disaster; a disaster for health, for society and most of all for national
economies.
The shift towards NCDs in developing countries dispelled the popular
myth that NCDs afflict mostly the affluence (high income) population. However,
the developed countries are equally sharing in the scourge, but while the
developing countries are facing a double burden, the developed and the high
income countries are experiencing a shift in the health trend from communicable
to non-communicable diseases.
Non-communicable diseases are the number one world’s killer, causing
60% of all deaths globally (Healthy Caribbean Coalition (HCC)
NCD Alliance, 2011) and a staggering 35 million people die every year
from these silence killers, of which 18 million are women. In 2008, this figure
rose to 36.1million (i.e. about 63% of global deaths), and nearly 80% of those
NCD deaths-equivalent of 29 million people occurred in low and middle income
countries with the projection of about 52 million deaths annually by 2030 (WHO,
2011). Globally, around 2.8% of deaths
are attributable to low fruit and vegetable (FAV) consumption, and these deaths
are 30mainly from these NCDs like gastrointestinal cancer, coronary heart
disease, and stroke (WHO, 2016). Low FAV consumption contributes to 1.8% of the
global burden of disease (Lock et al.,
2005). Regular, adequate consumption of FAVs has been reported to improve
survival (Nicklette et al., 2015) and
may confer protection against chronic diseases (Wu y et al., 2015). When consumed in adequate amounts on a regular
basis, FAVs can play an important role in management of weight, (Roll et al., 2004), lowering the risk of
obesity, and can ward off many oxidative stress related chronic diseases. One
report shows that higher FAV intake is associated with better overall
nutritional intake from other food sources as well (Bermejo et al., 2002). Also, NCDs will be
responsible for three times as many disability adjusted life years (WHO, 2004),
and nearly 5 times as many deaths as communicable diseases, maternal,
perinatal, and nutritional conditions combined (WHO, 2008). About one-fourth of
the global NCDs related deaths take place before the age of 60 years (WHO,
2010). These clusters of diseases represent the biggest threat to global health
care and economy, especially as it concerns women (HCC-NCD Alliance, 2011),
since prior studies have shown a higher prevalence of some of the predisposing
factors in women than men (Khuwaja et al.
2010).
In a study carried out in the south-south region in Nigeria to
determine the age and sex specific prevalence and associated risk factors for
non-communicable diseases in adult population, it was found that the overall
prevalence of NCDs is 32.8% (Ekpenyong et
al.,2012). In United States, 750 billion dollars is spent annually on
cardiovascular disease and diabetes mellitus (Venkat-Narayan et al. 2010) and about 87% of all deaths
in US are due to NCDs (WHO, 2011). Globally, cardiovascular disease account for
most death (about 17 million people annually) followed by cancer (7.6 million),
respiratory diseases (4.2 million) and diabetes (1.3 million) (WHO, 2016).
These cluster of diseases account for 80% of disease related deaths (Shukla,
2011). In Africa, most countries have not conducted risk factor surveys to
establish the national based line prevalence rates and accurately quantify the
magnitude of the problem (Mufunda et al.,2006)
In Nigeria, the impact of NCD is enormous and glaring. It was reported
that about 5 million Nigerians may die of NCDs by the year 2015, and diabetes
alone was projected to have caused about 52% of the mortality in 2015. Also,
the economic cost of NCDs in Nigeria in 2005 was about 400 million dollars from
premature death due to NCDs. By 2015, it was estimated to rise to about 8
billion dollars (Health Reform Foundation of Nigeria (HERFON), 2011). At
present, about 8 million Nigerians suffer from hypertension and
4 million has diabetes; 100, 000 new cases of cancers are diagnosed each year
in Nigeria (Baba et al., 2014). Researchers have empirically identified the
link between NCDs and globalization, urbanization, demographics, life style
transition, socio-cultural factors, poverty, poor maternal, fetal and infant
nutrition (Ekpenyong et al.,2014).
For example, in 2012, NCD mortality rate for the African region alone was 28
million (Health Reform Foundation of Nigeria (HERFON, 2011). African countries
are undergoing an epidemiological transition indicating that sicknesses they
suffer are no longer infectious diseases but now chronic diseases or
non-communicable diseases (Anue et al.,
2017). This is as a result of urbanization, industrialization, increased life
expectancy and the adoption of western lifestyle characterized by reduced
physical activity and dietary changes from foods rich in fruits and vegetables
to refined, energy-dense and fatty foods (Anue et
al., 2017). Though previous studies have evaluated the
existence of factors that influence the consumption of fruits and vegetables.
Some of the factors are knowledge, beliefs, cost, convenience and the sensory
characteristics of vegetables (Anue et al., 2017).
Evidence shows that four major groups of diseases namely
cardiovascular diseases, cancers, respiratory diseases and diabetes mellitus
account for 82% of all NCD deaths (Lim et al.,
2010). These
diseases share four common behavioural risk factors (tobacco use, excess
alcohol consumption, unhealthy diet and physical inactivity) and four metabolic
risk factors (elevated blood pressure, overweight and obesity, hyperglycaemia
and hyperlipidaemia) (WHO, 2011).
According to the WHO/FAO (2003), the set population nutrient goals
and recommended intake was put at a minimum of 400g for fruits and vegetables
per day for the prevention and reduction of the risk of chronic heart diseases,
cancer, diabetes and obesity.
In a study conducted in the south-south part of Nigeria, including
Rivers-State. It was observed that fruits and vegetable consumption is a
commonly recommended element in a balanced and healthy eating pattern (Anune et
al., 2017). In
another study carried out to determine the heterogenous consumption patterns of
fruit and vegetables in Nigeria, it was found out that while fruit consumption
increased dramatically in both the North and the South over the past decade,
vegetable consumption declined in both regions, albeit marginally in the south,
yet fruit and vegetable combined consumption levels are well below the per
capita daily recommended level by WHO of 400grams across Nigeria and especially
lower in rural areas and among the poorest (Parkhi et al., 2023).
An adequate consumption of fruits and vegetables could lead to
significant improvements in public health, as it reduces the risk of the
development of chronic diseases (e.g., heart diseases, high blood pressure,
diabetes and obesity), several cancers and prevents or alleviates several
micronutrient deficiencies (Anune et al.,2017).
Despite all the recommendation, the consumption is still insufficient in
Nigeria as a whole (Chubike, 2013). A study
conducted in Oyigbo Rivers state, showed that the prevalence of hypertension,
obesity, and diabetics were linked with lifestyle factors
such as dietary, smoking, harmful use of alcohol, and even time factors as respondents barely have
time to go for check-ups in the hospitals. Similarly, the high occurrence of overweight in the same
study which itself could have led to high prevalence of hypertension may be due to life
style (poor diet and drinking alcohol), lack of proper dietary advice, diet consumption of high
calorie food and lack of knowledge about the possible etiology of essential hypertension and its
consequences to human health (Akinlua et
al, 2015).
The World Health Organization (WHO) has come up with the surveillance
of NCDs and their risk factors to facilitate the implementation of appropriate
public health strategies. This surveillance known as ‘WHO STEPWISE’ approach is
a standardized methodology for the surveillance of non-communicable diseases
(STEPS) (WHO, 2015) although; studies using this approach have just begun to
emerge (Choi et al., 2015).
Therefore, it is crucial to pay close attention to NCDs among the working
population, different business men and women, farmers or adults as a whole
because these health challenges can perhaps lead to economic losses, household
poverty and reduction in productivity (Lock et
al., 2004). The World Health Organization (WHO) has also recommended FAV as
central to a healthy diet and has long advocated for increased consumption
through targeted campaigns. Despite the growing body of evidence and promotion
of consumption in guidelines and by other means, FAV intake is far less than
the recommended amount in many low and middle-income countries (LMICs). This study is therefore aimed at providing information
on fruits and vegetable consumption pattern and magnitude of NCDs risk factors
among adults in Oyigbo L.G.A to form the baseline for monitoring the trends,
guiding decision making, and implementing appropriate interventions.
1.2
STATEMENT OF PROBLEM
Non-communicable
diseases (NCD) have become a global health problem which threatens Sub-Sahara
Africa (SSA) including Nigeria. Adults which include business men and women,
civil servants, farmers etc are all affected in these conditions. This could be
as the result of stress encountered in the pursuit of money, lifestyle, dietary
pattern or sedentary nature of their occupation (Ekpenyong et al., 2014). It is also known that low consumption of plant-based
foods, including fruits and vegetables, is associated with an increased risk of
several chronic non-communicable diseases including hypertension,
cardiovascular disease (CVD), stroke, obesity, diabetes, osteoporosis and
certain cancers and with high all-cause mortality (Slavin et al., 2012). In 2009, it was estimated that excess of 2 million
deaths and 26 million disability-adjusted-life-years (DALYs; 1.8%) could be
attributable to suboptimal fruit and vegetable consumption worldwide (Hall et al., 2009). Data suggest that these
figures may be considerably higher, with nearly 8 million premature deaths
attributable to fruit and vegetable intake below 800 g per day (Aune et al.,2017). Modelling data also
suggest that 31% of ischemic heart disease, 19% stroke, 20% oesophageal cancer,
19% gastric cancer and 12% lung cancer cases globally could be avoided by
increasing the daily intake of fruits and vegetables to at least 400 g per
day (Lock et al., 2004), while 15 000
deaths each year could be avoided if similar dietary guidelines were followed
in the UK (Scarboroughh et al.,
2012). In the UK National Diet and Nutrition Survey (NDNS), 70% of all men and
women sampled reported eating less than the recommended minimum 5 daily
portions (400 g), with 62% of both sexes consuming fewer than 3 portions
of fruits and vegetables each day (Scarboroughh et al., 2012).
Low
fruit and vegetables consumption is not confined to high-income countries but
is prevalent across many nations. In a study, 77.6% of men and 78.4% of women
sampled from 52 low- and middle-income countries reported consuming less than
400 g of fruit and vegetables per day, the minimum recommended by the
World Health Organisation (WHO) Panel on Diet, Nutrition and Prevention of
Chronic Disease (Hall et al., 2009). The
consumption in Africa is lower than the recommended daily guidelines prescribed
by the World Health Organization (Hall et al., 2009). In sub-Saharan Africa,
estimates of fruit and vegetable consumption range from 70-312g per person per
day, which is far lower than the WHO recommendation of at least 400g per person
per day (Ruel and Minot, 2005). The steady rise in the burden of
non-communicable diseases (NCDs)in Sub-Saharan Africa over the past 20 years,
driven by an increase in risk factors such as unhealthy diets, (Bigna and
Noubiap, 2019) coupled with the concurrent challenges of infectious diseases,
makes it imperative to seek cost-effective interventions to address the low
consumption of FV in these settings.
There are a number of other
reasons why the intake of fruits and vegetables are low in developing country
of which Nigeria is one of. Some of these reasons are limited year-round availability,
affordability, need for convenience, food safety issues and the attraction to
modern or Western lifestyles which are reported as constraints for healthy food
choices by urban middle class consumers in Lagos (Hollinger et al., 2015). Cultural beliefs and
taboos, as well as religious beliefs are found to influence the food choices of
consumers (Ijewere et al., 2012). Religious environments serve
as potential avenues for health promotion and have become increasingly relevant
because of the existing social networks and support (Bigna and Noubiap, 2019). It
has been established that health programmes focusing on behaviours that can be
reinforced by social support are effective in religious settings.
Regarding the FV availability, this is region-
and season-dependent, and products are mostly eaten fresh, since storage
possibilities are few and substantial losses occur due to inadequate
preservation and transport. Also at the national level, the availability of
fruits and vegetables is insufficient to meet the recommended levels of intake
(FAO, 2017). For lower social economic classes (SEC), the affordability of
fruits and vegetables is problematic due to low purchasing power of households,
and necessities to prioritize energy-dense foods which are generally cheaper
(FAO, 2017). Across all urban consumers, including the lower SEC, constraints
in the time available for shopping and preparation of food appears to drive
consumers towards increased consumption outside the home (Hollinger et al., 2015). Convenience foods are
typically high in fat and carbohydrates, and low in vegetables and other
nutrient-dense foods. Those seeking to shift to healthier, but convenient
alternatives, such as fish, fresh fruits and vegetables are faced with the
increasingly expensive costs of nutritious foods relative to the fast-food
alternatives (Hollinger et al.,
2015).
Another
problem is that in developing countries, majority of the population are
involved in agriculture, yet availability and accessibility of FV is low
leading to low consumption. This is seen in a study carried out in Bangladeshi
where the majority of the populations are engaged in agriculture, which
confounds the availability and accessibility hypothesis of FAV consumption
(Brunt et al., 2012).
In a study
carried out by (Dauchet et al.,
2008), they investigated the correlation of low FAV consumption in different
populations and identified several socio-demographic, psychosocial, and
behavioral factors. They found associations of FAV consumption with place of
residence, socioeconomic status, educational attainment, occupational category,
household income, and television viewing along with non-modifiable factors such
as age, gender and ethnicity (Dauchet et
al., 2008).
Another
factor is that most studies on relationships between fruit and vegetable
consumption and NCDs were conducted in developed countries and so little is
known about the relationship in developing countries (Dauchet et al., 2008). For instance, studies
carried out in countries like Asia revealed that a higher intake of FAV is associated
with an improved NCD risk profiles such as a lowered systolic BP, waist
circumference and low- density lipoprotein cholesterol in southern India
(Radhika et al.,2008) and lower risk
of obesity in Iran (Radhika et al.,2008).
Based on the fact that some studies have shown that increasing FV could
potentially be a way to reduce the NCDs, it is then worthy to carry out a
research in this area, since more knowledge is needed in this area in Nigeria
and other developing countries. This study is therefore aimed at determining
fruit and vegetable consumption and relating it to selected NCDs among adults
in Rivers State
1.3
OBJECTIVES OF THE STUDY
The general objective of this study is to assess fruit and vegetable
consumption pattern and risk
factors of NCDs among adults (18-60 years) in Oyigbo L.G.A in Rivers-State.
The specific objectives are to:
1.
determine socio-demographic and socio-economic characteristics of the
adults
2.
determine the knowledge of fruits and vegetable consumption.
3.
assess the commonly consumed fruits and vegetables by these adults using
the food frequency questionnaire
4.
assess prevalence of fruit and
vegetable consumption (> 5 serving per day) among the adults daily
5.
assess the nutritional status of adults using anthropometric indices
6.
determine the behavioural and lifestyle habits of the adults
7.
to assess the prevalence of established selected risk factors for NCDs (obesity
and overweight, blood glucose and blood pressure)
8.
determine the relationship between, NCDs risk factors and adequate fruit
and vegetable consumption.
1.4 SIGNIFICANCE OF
THE STUDY
The findings of this study will:
·
help in developing effective policies, programmes, and
initiatives to promote adequate consumption of variety of both fruits and
vegetables in the population who are in urgent need, given the high attention
to population who consume less than the minimum recommended five daily
servings/400g of fruits and vegetables.
·
help health care professionals to disseminate
Information on health benefits of sufficient fruit and vegetable consumption.
·
Behavioral changes and dietary guideline programs will
help to promote fruit and vegetable consumption and it should be based on local
knowledge regarding the demographic, cultural, and psychosocial factors that
affect consumer choices. These should focus on translating accurate and useful
information to consumers about the health benefits of sufficient fruit and
vegetable consumption.
·
Government
policies are urgently required to support availability, affordability, and
accessibility of these fruits and vegetables.
·
The findings of this study will also provide insight
for nutrition/ health educators when developing family based interventions for
weight management.
Login To Comment