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Chapter 1

PROBLEM AND ITS SCOPE

INTRODUCTION

Rationale of the Study

In our world today, especially in the urban areas, people tend to adapt and

cope with the modern life. As we can observe, people who have a job or even the

jobless are experiencing a sedentary lifestyle.

In the fast pacing world, people tend to forget about their health just to

satisfy the demands of modernization. People will alter eating habits and food

choices just to catch up with the activities of daily life. Most people don’t have

any strict compliance on their health anymore. They would prefer eating fast

foods, they work overtime, and even the availability of the vices is getting more

convenient.

People who have a sedentary lifestyle are more prone to have diseases,

mainly disease affecting the heart. In our study we are focusing on the people

who are at risk of having coronary heart disease due to their diet and food

preferences. A diet that is high in saturated fats causes a rise in blood

cholesterol. In countries such as Japan where coronary heart disease is relatively

rare, lower fat intakes and lower blood cholesterol are found than is typical of

people in Philippines (American Heart Association).

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The amount of blood cholesterol is influenced mainly by the amount of

saturated fats in the diet rather than the amount of cholesterol. This increases the

deposition of cholesterol in the arteries leading to the formation of atheromatous

plaques which are the underlying cause of CHD.

CHD declined in developed countries from 1980 to 2000, the World Health

Organization predicts that CHD will become the major cause of death in almost

all countries by 2020, with over 10 million deaths per year predicted. Developing

countries are repeating the earlier lifestyle mistakes of developed countries,

ironically aided by aggressive promotion and export of cigarettes and unhealthy

fast foods. Economists predict that rising CHD costs will greatly sap these

countries' resources, delay economic growth, and cause unnecessary suffering.

Coronary heart disease is a long term degenerative disease and people

must be made aware of the complications of an unhealthy lifestyle early to try

and educate them towards a healthy lifestyle. It has long been considered that

Coronary heart disease is a self inflicted disease because the lifestyle led by

sufferers has influenced the onset of the disease. It is estimated that CVD kills

140,000 people a year under 75 years old, chronic heart disease causes

incapacitation, suffering and pain in many of its victims. Much heart disease is

also self-inflicted and therefore avoidable. Hence the research topic is to know

their common daily diet and what possible recommendation to minimize serum

cholesterol level and maintain it with the direction of their physicians.

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The researchers chose this topic because coronary heart disease is a

serious illness and the number of people diagnosed with CHD is growing.

Knowing their food intake would help us identify the cause and we could help

reduce the risk of the disease by giving them guidelines on what food contain

high serum cholesterol level so the patients can avoid them.

Theoretical Background

Ishizuka's theory is based on several simple concepts. First, he maintains

that human health and longevity are dependent on a proper balance in the body

between the salts of sodium and potassium. While western nutrition (then as

now) was emphasizing protein and carbohydrates, Ishizuka maintains that

MINERALS, especially sodium and potassium, are most crucial. The ratio

between them determines the body's ability to absorb and utilize the other

nutrients. The healthy functioning of the entire human organism depends on their

being in proper balance.

A second principle is that food is the most important factor in determining

this critical balance. Other factors, such as geography and climate and the

amount of physical activity play a role as well. Living by the sea or in the

mountains, in a dry or moist climate, being sedentary or hard working all have an

effect. But it is what a person ingests through the mouth that is the main

determinant of the Na/K ratio in the body.

Hence, thirdly, human health and sickness depend on diet above all. The

basis for physical well-being is daily food that provides a proper balance of
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minerals. Such a diet will give one a long life, free from disease On the other

hand, all sickness begins with an imbalance of Na/K caused by poor diet. Both

contagious and degenerative diseases, Ishizuka asserted, originate in food.

Bacteria and viruses afflict only those who are weak and susceptible because of

their Na/K imbalance. A truly healthy person, even coming into contact with such

pathogens, will not become sick. Thus allopathic medicine, seeking only to

destroy disease-causing micro-organisms, rather than strengthening the person

against them, is based on a total misconception."

The last few years have seen a growing appreciation of the fact that health

is determined by many factors among which medical care is only one. Indeed, it

has become increasingly accepted that medical care is not usually the major

determinant of health. Other determinants, such as food, heating, housing

conditions, and work environment, play equally if not, more important roles than

medical care. There has also been a growing realisation that very little is known

about the effectiveness of much of modern medicine. Such evidence that does

exist indicates that modern sophisticated techniques are often less effective than

the simpler techniques they replace. Some go further and argue that medical

care frequently impairs health rather than improves it.

Partly as a result of the growing realisation of the importance of non-

medical influences on health, there has been a noticeable shift of emphasis in

discussions concerning health policy away from strictly medical issues. One

issue currently receiving a good deal of attention is that of prevention. It is often

asserted that one of the most effective and, possibly, efficient ways to achieve
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further improvements in the quality and length of life in the developed world

would be to concentrate efforts on trying to encourage a switch from health-

endangering to health-enhancing consumption patterns.

In another theory, according to the Mayo Clinic and the Food and Drug

Administration, foods that cause a risk of heart disease include those high in fats

and sodium.

 Eggs

Eating eggs in moderation may not be harmful, according to the Mayo Clinic.

But if you eat too many eggs or products with egg yolks, your "bad" cholesterol

can increase, which can cause a risk of heart disease.

 Processed Foods

Eating foods that are heavily processed, such as potato chips, hot dogs or

cheese products may cause a risk of heart disease especially if you eat them in

large amounts.

 Salt

Salty foods include canned soups, pastas and vegetables as well as prepared

boxed meals and snacks; adding salt at the table to your food can also increase

your risk of heart disease.

 Saturated Fats
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Saturated fats are foods including red meats, whole milk dairy products and

coconut and palm oil, and cause a risk of heart disease by allowing your arteries

to harden and narrow.

 Sugar

Although a sweet treat now and then may not be harmful, excessive amounts

of sugary foods can lead to diabetes, which is a risk factor for heart disease.

 Trans Fats

Trans fats are a type of fats that you may eat in prepared baked goods, fast

food that is fried, margarine, boxed snack crackers and snack cakes. These

should be limited to help avoid heart disease.

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THE PROBLEM

Statement of the Problem

This study aimed to determine the restricted food intake of Coronary Heart

Disease Patients in Baranggay Jaclupan Talisay City. This also aims to

determine the frequency and amount of dietary intake of these clients that might

predispose them to be diagnosed with heart disease.

Specifically, this study sought to answer the following inquiries:

1. What was the profile of the residents in Baranggay Jaclupan Talisay City

diagnosed with Coronary heart Disease in terms of:

1.1. Age;

1.2. Gender;

1.3. Employment; and

1.4. Body mass index?

2. What was the frequency of food intake of the respondents diagnosed with

Coronary Heart Disease?

3. What was the amount of food intake of the respondents diagnosed with

Coronary Heart Disease?

4. What recommendations can be suggested based on the findings to

promote a healthy lifestyle among patients with Coronary Heart Disease?

Significance of the study

The following entities would benefit from this study.

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To patients with coronary heart disease. Coronary heart disease can

be chronic, without a cure, and medical emphasis must necessarily be on

managing/avoiding possible long-term heart disease-related problems. There is

an exceptionally important role for patient education, dietetic support, sensible

exercise and monitoring of blood pressure this study shall then enrich client’s

education about the vitality of lifestyle modifications achievable by dietary

consciousness to reduce the risk of further serious complications.

To the significant others of Clients with heart diseases. Coronary

heart disease is so complex and so demanding that proper education becomes

an important and integral part of diabetes treatment that should as well include

the families of these clients. There should be a very significant collaboration

between the heart disease patients and their significant others in learning the

proper diet, correct exercise, continuous medications, proper care and correct

usage of the muscles, daily monitoring on blood pressure and record keeping.

Success is far guaranteed when there is cooperation and support in achieving

their common goals.

To the Student Nurses. As part of the Health Team, their role is in

becoming an educator and/or dietician. They will assess educational needs and

provide individual instruction and information necessary for appropriate self-

management skills for diabetic patients. The results of this study shall then

adjunct their knowledge regarding the importance of strict dietary intake

compliance.
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To the community. Coronary heart disease is a complex disease, which

can affect the entire body. Understanding heart diseases is important even if you

don’t have it. You most likely know someone who has a heart disease; either a

family member or a friend. This is because coronary heart disease has reached

epidemic proportions globally. Community awareness of the difference between

the types of heart disease is still surprisingly limited. As a community we need to

foster a culture of shared understanding of what heart diseases are and be part

pof the solution that turns the disease epidemic around.

To the future researchers. It is indeed a very significant study to the

researcher out of the prime motivation to yield a better understanding with the

nature of the disease especially with the importance of lifestyle modifications. A

lot of things have been said about lifestyle influence on the occurrence of this

particular disease. Different ways of living can have different impact, some

positive and some negative. The more we take up healthy ideas and apply them

to their daily living the healthier we shall be. Lifestyle modifications are usually

the first intervention that is sought in the treatment and prevention of the disease

unless there is an emergency or complication.

Scope and Limitations of the Study

Content Delimitation. The study presented the restricted dietary

intake of clients with Coronary Heart Disease which shall include the frequency

and amount of food intake per serving.

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Subject Delimitation. The study covers 30 respondents currently

residing in Baranggay Jaclupan Talisay City. There is no specification for age as

long as they were medically diagnosed with Coronary heart disease.

Time and Place Delimitation. The study was conducted at Baranggay

Jaclupan Talisay City. Due to time constraints, the study was conducted for two

days only from August 20-21, 2010 at around 8am to 3pm.

DEFINITION OF TERMS

To avoid vagueness of the study, the following terms were operationally

defined.
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Atherosclerosis. Also known as arteriosclerotic vascular disease or

ASVD), this term is a condition in which an artery wall thickens as the result of a

build-up of fatty materials such as cholesterol. It is a syndrome affecting arterial

blood vessels, a chronic inflammatory response in the walls of arteries, in large

part due to the accumulation of macrophage white blood cells and promoted by

low-density lipoproteins (plasma proteins that carry cholesterol and triglycerides)

without adequate removal of fats and cholesterol from the macrophages by

functional high density lipoproteins (HDL)

Body Mass Index (BMI). It refers to the statistical measurement which

compares a person’s weight and height. Though it does not actually measure the

percentage of body fat, it is a useful tool to estimate a healthy body weight based

on how tall a person is. Due to its ease of measurement and calculation, it is the

most widely used diagnostic tool to identify obesity problems within a population.

However it is not considered appropriate to use as a final indication for

sdiagnosing individuals.

Body Mass Index calculation formula

weig h t( kg)
BMI=
h eig ht 2 (m 2)

Body Mass Index Results

 Starvation – less than 14.9

 Underweight from 15 to 18.4

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 Normal from 18.5 to 22.9

 Overweight from 23 to 27.5

 Obese from 27.6 to 40

Chest pain (angina). Pressure or tightness in the chest is felt, as if

someone was standing on your chest. The pain, referred to as angina, is usually

triggered by physical or emotional stress. It typically goes away within minutes

after stopping the stressful activity. In some people, especially women, this pain

may be fleeting or sharp and noticed in the abdomen, back or arm.

Cholesterol. It is a waxy steroid metabolite found in the cell membranes

and transported in the blood plasma of all animals.[2] It is an essential structural

component of mammalian cell membranes, where it is required to establish

proper membrane permeability and fluidity. In addition, cholesterol is an

important component for the manufacture of bile acids, steroid hormones, and

fat-soluble vitamins including Vitamin A, Vitamin D, Vitamin E, and Vitamin K.

Coronary disease (or coronary heart disease). It refers to the failure of

coronary circulation to supply adequate circulation to cardiac muscle and

surrounding tissue.

High blood cholesterol levels. High levels of cholesterol in your blood

can increase the risk of formation of plaques and atherosclerosis. High

cholesterol can be caused by a high level of low-density lipoprotein (LDL), known

as "bad" cholesterol. A low level of high-density lipoprotein (HDL), known as

"good" cholesterol, also can promote atherosclerosis.

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Hypercholesterolemia (literally: high blood cholesterol). It is the presence

of high levels of cholesterol in the blood.[1] It is not a disease but a metabolic

derangement that can be secondary to many diseases and can contribute to

many forms of disease, most notably cardiovascular disease.

Hypertension (HTN) or high blood pressure. It is a chronic medical

condition in which the systemic arterial blood pressure is elevated.

Ischemia (from Greek ισχαιμία, ischaimía; isch- restriction, hema or

haema blood). It is a restriction in blood supply, generally due to factors in the

blood vessels, with resultant damage or dysfunction of tissue.

Low-density lipoprotein (LDL). It is one of the five major groups of

lipoproteins,

Medically, mathematically calculated estimates of cholesterol content carried by

the LDL particles are commonly used as part of blood tests to estimate how

much low density lipoproteins are driving progression of atherosclerosis.

Myocardial infarction (MI) or acute myocardial infarction (AMI),

commonly known as a heart attack. It is the interruption of blood supply to part

of the heart, causing heart cells to die. This is most commonly due to occlusion

(blockage) of a coronary artery following the rupture of a vulnerable

atherosclerotic plaque, which is an unstable collection of lipids (fatty acids) and

white blood cells (especially macrophages) in the wall of an artery.

Serving. A 3-ounce serving of meat is the serving size recommended for

a healthy diet.
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Chapter 2

Review of Related Literature and Studies

This section deals about reading matters related to the topic of the study.
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Related Literature

Coronary artery disease develops when the coronary arteries — the major

blood vessels that supply the heart with blood, oxygen and nutrients — become

damaged or diseased. Cholesterol-containing deposits (plaques) on the arteries

are usually to blame for coronary artery disease.

When plaques build up, they narrow the coronary arteries, causing the

heart to receive less blood. Eventually, diminished blood flow may cause chest

pain (angina), shortness of breath or other coronary artery disease symptoms. A

complete blockage can cause a heart attack.

Because coronary artery disease often develops over decades, it can go

virtually unnoticed until it produces a heart attack.

If the coronary arteries become narrowed, they can't supply enough

oxygenated blood to the heart — especially when it's beating hard, such as

during physical activity. At first, the restricted blood flow may not cause any

coronary artery disease symptoms.

Once the inner wall of an artery is damaged, fatty deposits (plaques)

made of cholesterol and other cellular waste products tend to accumulate at the

site of injury in a process called atherosclerosis. If the surface of these plaques

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breaks or ruptures, blood cells called platelets will clump at the site to try to repair

the artery. This clump can block the artery, leading to a heart attack.

Risk factors often occur in clusters and may build on one another, such as

obesity leading to high blood pressure. When grouped together, certain risk

factors put at an ever greater risk of coronary artery disease. For example,

metabolic syndrome — a cluster of conditions that includes elevated blood

pressure, high triglycerides, and excess body fat around the waist — increases

the risk of coronary artery disease.

Loss of excess weight and long-term maintenance of a healthy weight can

improve blood lipid levels and blood pressure and reduce risk for heart disease,

the most common form of diabetes, stroke, and certain cancers. In many

individuals with increased abdominal or visceral fat, even modest weight

reduction may result in improvement in many metabolic CHD risk factors,

particularly those associated with insulin resistance, including low HDL level,

elevated triglyceride level, and small dense LDL. Successful long-term

maintenance of a healthy body weight can be promoted by regular physical

activity in conjunction with a diet that is limited in calories, particularly those

derived from fat, and relatively rich in complex carbohydrates and fibres.

Diets with very low total fat intake have been tested with favourable results

in studies of persons at high risk, but such diets have not been demonstrated to

be of value for the general population and may have adverse consequences,

including potential nutrient deficiencies in certain subgroups such as children,

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pregnant women, and the elderly. For this reason, the AHA endorses the

recommendation of the World Health Organization for a lower limit of 15% of

calories as total fat. Moreover, the AHA recommends that for the general

population, the level of fat intake in the diet should be guided by emphasis on

adequate consumption of fruits, vegetables, and grains; a healthy weight goal;

and, as described below, dietary intake of saturated fatty acids and cholesterol

appropriate to individual risk for CHD.

The AHA emphasizes restriction of saturated fatty acid intake because this

is the strongest dietary determinant of plasma LDL cholesterol levels. Different

saturated fatty acids have varying abilities to raise blood cholesterol. Total

plasma and LDL cholesterol levels are mainly affected by lauric (12 carbon

atoms), myristic (14 carbon atoms), and palmitic (16 carbon atoms) acids.

Reduced intake of these cholesterol-raising saturated fatty acids has resulted in a

reduction in plasma LDL cholesterol levels in well-controlled dietary studies.

Short-chain (less than 10 carbon atoms) fatty acids and stearic acid (18 carbon

atoms) have little effect on cholesterol levels.

Currently the AHA recommendation for the general population is that less

than 10% of total calories come from saturated fatty acids. Equations developed

from carefully controlled clinical studies indicate that reducing saturated fat intake

from the current average intake of 12% to 14% of calories can lead to an average

reduction of 3% to 5% in CHD risk in the population as a whole. There is,

however, inter-individual variation in plasma LDL cholesterol response to reduced

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intake of saturated fatty acids, partially influenced by genetic factors. For this

reason and also because of varying CHD risk status, population-wide guidelines

do not address the specific needs of all individuals. In particular, persons with

elevated LDL cholesterol levels that are responsive to diet can benefit from even

greater limitation of dietary saturated fatty acids, such as 7% or less of total

calories. Specific dietary guidelines for persons at higher risk have been

developed by the AHA and the Expert Panel of the National Cholesterol

Education Program.

Because foods contain fatty acids in varying types and amounts, it is not

practical to design an eating pattern that selectively eliminates or replaces one

fatty acid with another. For example, food labels list total fat by category. For the

purpose of designing an eating pattern, all saturated fatty acids are considered

equivalent.

Reduction in caloric intake resulting from limitation of total saturated fatty

acids may be beneficial for achieving and maintaining a healthy body weight.

When it is appropriate to reduce plasma lipid and lipoprotein levels while

maintaining caloric intake, saturated fatty acids in the diet can be replaced by

either polyunsaturated or monounsaturated fatty acids, carbohydrates, or protein,

all of which have differing effects on plasma serum lipids and lipoproteins. High

intakes of -6 polyunsaturated fatty acids, however, have been reported to

increase risk of formation of gallstones. In addition, results of animal studies

suggest that high intake of polyunsaturated fatty acids (more than 10% of
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calories) may promote cancer. The AHA currently recommends that intake of -6

fatty acids be no more than 10% of total calories. -3 polyunsaturated fatty acids,

derived primarily from fish, can also be substituted for dietary saturated fatty

acids and as discussed below may have beneficial effects beyond those

associated with lowering LDL cholesterol levels.

In recent years there has been an interest in monounsaturated fatty acids

as a suitable replacement for saturated fatty acids. Although their net effect on

serum lipids and lipoproteins is not much different from that of polyunsaturated

fatty acids, they may have some advantages. Unlike polyunsaturates,

monounsaturates are not as susceptible to oxidation, which may play a role in

atherogenesis. The AHA therefore recommends a monounsaturated fatty acid

intake in the range of 10% to 15% of total calories.

Another factor deserving attention is the use of trans fatty acids. Trans

fatty acids found primarily in hydrogenated vegetable oils tend to raise cholesterol

levels relative to their nonhydrogenated counterparts. This increase appears to

be less than occurs with similar amounts of saturated animal fat or highly

saturated vegetable oils, egg, coconut and palm kernel oils. Among the few data

available, analyses using plasma or tissue levels of trans fatty acids as a

measure of intake suggest that CHD risk is associated with trans fatty acids

derived from animal products but not with those from hydrogenation of oils. In

addition, there is no clear dose-response effect for trans fatty acid intake and

CHD risk. Based on this limited information, the AHA recommends limiting trans
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fatty acid intake, for example, by substituting soft margarine for hard. The AHA

also encourages the food industry to develop more products with reduced trans

fatty acid content.

Dietary cholesterol can increase plasma and LDL cholesterol levels and in

epidemiological studies has been shown to be related to CHD risk independent of

its effects on blood cholesterol levels. When compared with the effects of

saturated fatty acids, the effects of dietary cholesterol on LDL cholesterol levels

are weaker but can be substantial in some individuals. As with intake of saturated

fatty acids, there is considerable interindividual variation in response to dietary

cholesterol, which should be considered when making individual dietary

recommendations. Currently the AHA recommends that dietary cholesterol intake

be less than 300 mg/d. Diets high in unrefined

carbohydrates also tend to be high in both soluble and insoluble fiber. Foods rich

in soluble fiber, including oats, barley, beans, soy products, guar gum, and pectin

found in apples, cranberries, currants, and gooseberries can help maximize a

reduction in plasma total and LDL cholesterol levels as part of a fat-modified diet.

Total dietary fiber intake of 25 to 30 g/d from foods, not supplements, will help

ensure an eating pattern high in complex carbohydrates and low in fat.

Incidence of heart disease in those who consume moderate amounts of

alcohol (an average of 1 to 2 drinks per day for men and l drink per day for

women) is lower than that in nondrinkers. However, with increased consumption

of alcohol, there are increased public health dangers, such as alcoholism,

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hypertension, obesity, stroke, cardiomyopathy, a number of cancers, liver

disease, accidents, suicides, and fetal alcohol syndrome. In addition, some

persons with an inherited predisposition to a variety of metabolic conditions, such

as hypertriglyceridemia, pancreatitis, and porphyria should not consume alcohol

at all. For the person beginning to drink alcohol, alcohol addiction and alcoholism

is a real threat, heightened by a familial predisposition to alcoholism. In

consideration of these risks, the AHA concludes that it is not advisable to issue

guidelines to the general population that may lead some persons to increase their

intake of alcohol or start drinking if they do not already do so. The advisability of

consuming alcohol in moderation (no more than 2 drinks per day) is best

determined in consultation with the individual's primary care physician.

There is emerging evidence that interindividual variation of certain

responses to diet, such as reduction in LDL cholesterol with diets low in fat and

cholesterol or the effects of weight-loss diets, may be related in part to underlying

genetic influences. Differences in responses to diet in different populations may

also be important in designing specific guidelines in certain populations. As these

influences become more specifically and clearly defined by ongoing research and

as testing becomes available, individualized dietary and lifestyle

recommendations may provide more effective approaches to prevention of CHD.

Related Studies

A 2009 study of patients with acute coronary syndromes found an

association of hypercholesterolemia with better mortality outcomes. [41]. In the

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Framingham Heart Study, in subjects over 50 years of age they found an 11%

increase overall and 14% increase in CVD mortality per 1 mg/dL per year drop in

total cholesterol levels.

A 2007 study pooling data on almost 900,000 subjects in 61 cohorts

demonstrated that blood total cholesterol levels have an exponential effect on

cardiovascular and total mortality, with the association more pronounced in

younger subjects. Still, because cardiovascular disease is relatively rare in the

younger population, the impact of high cholesterol on health is still larger in older

people.

The 1987 report of National Cholesterol Education Program, Adult

Treatment Panels suggest the total blood cholesterol level should be: <

200 mg/dL normal blood cholesterol, 200–239 mg/dL borderline-high, >

240 mg/dL high cholesterol.

In another study, a small group of scientists, united in The International

Network of Cholesterol Skeptics, continues to question the link between

cholesterol and atherosclerosis. However, the vast majority of doctors and

medical scientists accept the link as fact.

It is recommended by the American Heart Association to test cholesterol

every 5 years for people aged 20 years or older.

A blood sample after 12-hour fasting is taken by a doctor or a home

cholesterol-monitoring device to determine a lipoprotein profile. This measures

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total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, and

triglycerides. It is recommended to have cholesterol tested more frequently than

5 years if a person has total cholesterol of 200 mg/dL or more, or if a man over

age 45 or a woman over age 50 has HDL (good) cholesterol less than 40 mg/dL,

or there exist other risk factors for heart disease and stroke.

In 1957 the American Heart Association proposed that modification of

dietary fat intake would reduce the incidence of coronary heart disease (CHD),

which had become the leading cause of disability and death in the United States

and other industrialized countries. Since then the AHA has issued seven policy

statements on diet and CHD as reliable new information has become available. In

each of these statements emphasis was placed on consumption of total fat,

saturated and certain unsaturated fatty acids, dietary cholesterol, and sodium

because of their significant contribution to risk of CHD. Later, excessive alcohol

intake was considered because of its association with hypertension, stroke, and

other diseases. Such knowledge has encouraged other health organizations and

the federal government to make similar recommendations.

In another study in London, measuring body mass index or waist size in

overweight people can accurately predict the risk of heart disease, Dutch

scientists said on Monday.

A large 10-year study found that half of all fatal heart disease cases and a

quarter of all non-fatal cases are linked to being overweight and having a high

body mass index (BMI) or large waist.

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Body mass index and waist circumference are well known risk factors for

cardiovascular diseases but the Dutch researchers said their work showed BMI

and waist size could actually help predict the risk of dying from or developing

heart disease.

"What this study shows is the substantial effect which (being) overweight

and obesity have on cardiovascular disease, whether fatal of non-fatal," said

Ineke van Dis from the Netherlands Heart Foundation, who led the study.

"In the near future the impact of obesity on the burden of heart disease will

be even greater."

Dis and colleagues at the monitoring project on risk factors for chronic

diseases at the Dutch National Institute for Public Health and the Environment

measured between both BMI and waist circumference in 20,500 men and women

1993 and 1997.

When age-adjusted BMI and waist sizes were correlated with hospital

records and cause-of-death data over 10 years, more than half (53 percent) of all

fatal heart disease cases and around a quarter (25-30 percent) of all non-fatal

cases were in people defined as overweight and obese.

Overweight people are defined as having a BMI of between 25 and 30 and

obese people of 30 or more, according to the World Health Organization (WHO).

BMI is calculated by dividing weight in kilograms by height in meters squared.

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Waist circumference measurements in men were defined as between 94

and 101.9 cm for overweight and more than 102 cm for obese. In women these

measurements were 80-87.9 cm for overweight and more than 88 cm for obese.

Obesity is increasing throughout the world and is now recognized as a

major global public health concern.

"These findings underline the need for policies and activities to prevent

overweight in the general population," Dis said in the study, which was published

in the European Journal of Cardiovascular Prevention and Rehabilitation.

       A study in Harvard School of Public Health revealed people who consume

the highest levels of trans fatty acids may have triple the risk of developing

coronary heart disease (CHD) than those consuming the lowest levels. Trans fats

are found primarily from fast foods, packaged foods, fried foods and bakery

goods. While earlier population studies showed a link between trans fats and

heart disease, this particular study is the first to show that people with highest

trans fats in their diet also had highest levels of trans fats in their red blood cells.

       It was also found that high trans fats level in the blood are associated with

increased levels of low density lipoproteins (aka bad cholesterol) and decreased

levels of high density lipoproteins (good cholesterol). These biomarker data

further reinforces evidence that high consumption of trans fats is a strong and

independent risk factor for CHD. The researchers thus recommend that, based
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on evidences gathered from the study, intake of trans fats should be kept as low

as possible.

       The study involved blood samples collected in 1989-90 from 30,000

participants of the Nurses? Health Study. During the six-year follow-up period,

167 nurses were diagnosed with heart disease. They were matched with 344

healthy nurses for age, smoking and diet. It was found that a person consuming

4 grams of trans fats in a daily diet that consisted of 2,000 calories of fat had

triple their risk of heart disease compared with a person consuming 2.6 grams of

trans fats in a 2,000-fat calorie diet.

A new study shows women who eat diets rich in unhealthy trans fats have

three times the risk of heart disease as those with the lowest intake. Dr. Frank

Hu, senior author of the study and an associate professor of nutrition and

epidemiology at the Harvard School of Public Health in Boston said the study just

reinforces the idea that trans fat is bad - worse than saturated fat - and thus

would need concerted effort to reduce trans fats on the part of individuals, food

manufacturers, as well as policy makers. The American Heart Association?s

journal, Circulation this April published the results of study.

       The Harvard team examined blood samples collected from almost 33,000

women participating in the ongoing Nurse?s Health Study. During the six-year

study period, 166 women developed heart disease. The researchers then pulled

information on 327 healthy women to serve as controls. The women were

grouped into four different quartiles based on the levels of trans fats in their
 27

blood. The researchers found that women in the fourth quartile, those with the

highest trans fats levels, had three times the risk of heart disease when

compared to women with the lowest levels, those in the lowest quartile. Women

in the second and third quartile had a 60 percent greater risk of heart disease.

       Hu and colleagues also estimated the average daily trans fats intake from

the trans fats blood levels. Women in the lowest quartile were estimated to have

an average daily trans fats intake of 2.5 grams, while those in the highest quartile

were estimated to take in 3.6 grams per day trans fats intake. Hu stressed

though that these averages should be considered rough estimates. The U.S.

Food and Drug Administration (FDA) estimate that the average American diet

contains about 5.8 grams of trans fat daily. The American Heart Association

advises that trans fats should make up no more than one percent of daily caloric

intake.

Chapter 3

Research Methodology and Procedures

In this chapter, the researchers present the strategies and methods of the

study. It is specifically describes the research design, setting, respondents,

instrument, procedure, sampling and the statistical treatment used to deal with

the data.
 28

Research Method

The researcher used the descriptive research design. The information was

gathered using a self made questionnaire to determine the restricted dietary

intake of coronary heart disease patients. The study would determine the type of

food/diet the clients adapted to their lifestyle in response to their current health

condition.

Research Respondents

The researcher’s respondents consisted of 30 respondents in Baranggay

Jaclupan Talisay City. Within the area, there were approximately 100

households. There were no age limits. Any patients diagnosed with coronary

heart disease.

Research Instrument

The researcher’s instrument was a researcher-made questionnaire that

consisted of nine questions. The first five questions consist of the profile of the

respondent such as age, gender, employment, the height and weight. The sixth

question enumerates the common signs the respondent felt which prompted to

seek medical assistance.

Research Procedure
 29

The questionnaire was distributed to the respondents shown to have

coronary heart disease. Appearance was a contributory factor because it was

easy for the researchers to identify who had a heart disease based on the Body

Mass Index.

Results include the following:

 Starvation – less than 14.9

 Underweight from 15 to 18.4

 Normal from 18.5 to 22.9

 Overweight from 23 to 27.5

 Obese from 27.6 to 40

 Morbidly obese greater than 40

Statistical Treatment of the Data

In analyzing this study, the statistical treatment needed for the

interpretation of the data was the simple percentage. It was used in establishing

the profile of the research subjects such as the age, gender, employment, body

mass index and common food intake.

Formula:

f
P= x 100
N

Where:

P= percentage
 30

f= frequency

N= number of cases

To determine the body mass index of the respondents the following formula was

used:

Formula:

weig h t( kg)
BMI=
h eig ht 2 (m 2)

Chapter 4

Presentation, Analysis, and Interpretation of Data

This section cites the tabulation of the data collected from the researchers

made questionnaire. In order to quantify and facilitate the analysis and

interpretation of the data, simple percentage formula was used.

 31

PROFILE OF THE RESPONDENTS

This portion tallies the frequency distribution of the profile of the respondents

in terms of age, gender, civil status and Body Mass index.

Age

Table 1 reflects the profile of respondents with regards to age at Barangay

Jaclupan Talisay City.

Table 1

Profile of respondents with regards to age and gender.

n=30

Age Frequency Percentage

70-79 5 16.6%

60-69 6 20%

50-59 6 20%
 32

40-49 11 36.6%

30-39 2 6.6%

Total 30 100%

The table shows that the highest number or 11 out of 30 respondents

belonged to the 40-49 age group while 6 of the 30respondents were divided to

the 50-59 and 60-69 age group. The remaining 5 respondents belonged to 70-79

while 3 were among the 30-39 age group. This implies that Coronary Heart

Disease is usually evident among people aging 40 years old and above.

Gender

Table 2 reflects the profile of respondents with regards to age, gender and

civil status at Barangay Jaclupan Talisay City.

Table 2

Profile of Respondents with Regard to Gender

n=30

Gender Frequency Percentage

Female 20 66.6%

Male 10 33.3%

Total 30 100%
 33

Table 1.1 shows that the males were greatly outnumbered by the females

wherein there were 66.6% of them. This implies that there are more women who

have Coronary Heart Disease because of their lifestyle.

Employment

Table 3 reflects the profile of the respondents with regard to employment

at Baranggay Jaclupan Talisay City

Table 3

Profile of Respondents with Regard to Employment

n=30

Job Title Frequency Percentage

Call Center Agents 5 16.6%

Office Personnel 4 13.3%

Skilled Labor 8 26.6%

Retired/Unemployed 10 33.3%

Others 3 10%

Total 30 100%
 34

Table 3 shows that there are more retired or unemployed residents

diagnosed with CHD which comprise to 33.3% while 26.6% belongs to skilled

labors. Call center agents comprise to 16.6% while 13.3% were office personnel

and the remaining 3% are other job titles. This implies that inactivity can worsen

health condition especially those with Coronary Heart Disease.

Body Mass Index

Table 4 reflects the frequency distribution of the respondents in terms of

body mass index at Baranggay Jaclupan Talisay City.

Table 4

Frequency Distribution of the Respondents in terms of BMI

n=30

Body Mass index Frequency Percentage

Less than 14.9 5 16.6%

15-18.4 7 23.3%

18.5-22.9 8 26.6%

23 and above 10 33.3%

Total 30 100%

Table 4 shows that the highest percentage of respondents or 33.3% of them

have a Body Mass Index of 23 and above. Only 23.3% of them were not able to

maintain a healthy Body Mass Index which fell to the 18.5-22.9%. This implies
 35

that the respondents were either overweight or obese as indicated in their Body

Mass index.

CLASSIFICATION OF CORONARY HEART DISEASE PATIENTS

Classification

Table 5 reflects the number of patients diagnosed with Coronary Heart

Disease according to its classification.

Table 5

Frequency distribution on Coronary heart disease Classification

n=30

Classifications Frequency Percentage

M.I 5 16.6%

Angina 20 66.6%

Acute coronary syndrome 5 16.6%

Total 30 100%

The majority of the respondents are experiencing angina which accounted to

66.6% or 20 out of 30 respondents. 16.6% or 5 out of 30 respondents belong to

myocardial infarction or M.I. while the clients who comprised 16.6% of the entire

respondents or 5 out of 30 respondents belong to acute coronary syndrome. This

implies that majority of the respondents were having angina or chest pain.
 36

FOOD INTAKE OF RESPONDENTS

Frequency

The restricted food intake of the respondents includes the frequency of

food taken.

Table 6

Frequency of Food Intake among Patients

With Coronary Heart Disease

n=30

Food Once a week 2x/week 3x/week More than

3x/week
1x/ 2x/ 3x/ 1x/ 2x/ 3x/ 1x/ 2x/ 3x/ 1x/ 2x/ 3x/

day Day Day Day Day Day Day Day Day Day Day Day
1. Pork 0 7 0 0 0 3 6 0 4 0 0 10

2. Beef 10 0 0 5 3 0 0 6 0 0 6 0

3. Poultry 0 0 4 0 6 0 0 10 0 5 0 5
4. Fast food 5 0 0 0 7 0 8 0 5 0 5 0

This table shows the persons diagnosed with coronary heart disease still

eats pork and poultry more than three times a week for three times a day which
 37

includes breakfast, lunch and supper. Others eat beef once a week for once a

day. Majority of the respondents eat fast foods three times a week, once a day.

This implies that even if patients diagnosed with Coronary Heart Disease were

restricted to often eat meat and fast foods in large amounts by the doctors, they

still include this food in their diet frequently.

Amount

The restricted food intake of the respondents includes the amount of food

taken.

Table 7

Amount of Food Intake of Patients with

Coronary Heart Disease.

n=30

Food 1 serving 2 servings More than 2

servings
1. Pork 20 7 3
2. Beef 17 3 10
3. Poultry 20 8 2
4. Fast foods 18 10 2

In table 7, it shows that majority of respondent eats pork for one serving.

17 out of 30 respondents eat beef for one serving, while another 20 respondents

eat poultry for one serving. 18 of the respondents eat fast foods also for one
 38

serving. This implies that there are still patients with Coronary Heart Disease who

cannot control their cravings for restricted food.

 39

Chapter 5

SUMMARY, FINDINGS, CONCLUSION AND RECOMMENDATIONS

This chapter summarizes the research study, shows the findings, conclusions

and their recommendations.

Summary

The objective of the study was to determine the restricted food intake of CHD

clients Baranggay Jaclupan Talisay City. The gathering of data was facilitated

with the use of researcher prepared questionnaires, replication of copies and the

distribution of it to every household within the area to clinically diagnosed CHD

clients. The method was non random purposive sampling as it was already

identified who are the CHD clients in the baranggay area.

In order to quantify the data gathered, a simple percentage formula was

employed especially the profile of respondents in terms of age, gender, Body

Mass Index and the frequency and amount of restricted food intake of the

predetermined clients with the use of the Body Mass Index formula based on the

height and the weight of the respondents.

Findings

Based on the tabulated results here with are the followings.

 40

1. The profile of the respondents as to age, gender, employment described

by the predominance includes the 40-49 age group, female gender, and

were retired/unemployed.

2. The profile of the Body Mass index shows that the most of the

respondents were overweight or obese due to the Body Mass index of

more than 23 and above.

3. Finding exhibits the positive signs manifested by the clients prior to

diagnosis of CHD which includes chest pain, fatigue, chest heaviness and

dyspnea.

4. Finding shows the frequency of restricted food intake among respondents

were three times a day within more than three times in a week.

5. The majority amount of restricted food intake of the patients diagnosed

with Coronary Heart Disease was one serving only per meal.

Conclusion

It is concluded that there is a restricted food intake among CHD clients in

Baranggay Jaclupan Talisay City which include high cholesterol in their diet. It

is concluded as well that these CHD clients had poor compliance to proper

dietary intake and thus poses a great health risk complications relate to CHD.

Recommendations

Therefore, the researcher recommended that in order to prevent further

complication of CHD due to poor compliance to proper dietary intake the

following suggestions are made by the researcher.

 41

1. The client together with the rest of the family members must be able to

understand fully the nature of the condition, its signs and symptoms,

possible complications and importantly the prevention. Awareness and

understanding of CHD is one way to encourage the patients to religiously

comply with the therapeutic regimen.

2. The family members should also assist the patient in creating a meal plan

could either on weekly or daily basis. Planning meal plans guarantee that

a well balanced diet is served to the patient. Apart from that, it is also best

that the family members or significant others may be able to encourage

the patient to follow the meal plan made.

3. Lifestyle modifications are key elements in CHD prevention. Obesity and a

sedentary lifestyle are the biggest risk factors a patient can control. Proper

diet and nutrition can help keep many other health conditions at bay,

including heart disease, high blood pressure and obesity. The use of a diet

low in serum and low density lipoprotein is an ideal strategy for preventing

CHD.

4. Along with exercise, this can indeed help manage blood pressure levels.

Exercise is vital to living a healthy lifestyle and managing CHD. Studies of

both men and women have shown that vigorous exercise, even if done

only once a week has a protective effect against CHD. Despite popular

belief, exercise doesn’t have to be difficult. A CHD patient can create a

practical exercise plan that fits into your daily life.

 42

BIBLIOGRAPHY

Books

Dietary fat intake and risk of coronary heart disease: the Strong Heart Study From
the Center for American Indian Health Research, University of Oklahoma Health
Sciences Center, Oklahoma City, OK (JX and ETL); Medstar Research Institute,
Hyattsville, MD (SE-A, BVH, and CM); the National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (CL and RRF); the Indian Health Service,
Aberdeen Area Office, Aberdeen, South Dakota (EMZ); and the Department of
Epidemiology and Preventive Medicine, Sackler Medical Faculty, Tel Aviv University, Tel
Aviv, Israel

Internet Resources

www.yahoo.com

www.google.com

www.wikipedia.com

www.ahajournal.com

www.medline.com

www.wikianswers.com
 43

APPENDIX A

APPROVAL OF THE RESEARCH TITLE

August 5, 2010

Mrs. Sharon Rose P. Cabaluna

Instructor, Nursing Research
Larmen de Guia Memorial College
Mandaue City

Madame:

We would like to request for an approval of the title of our thesis as follow:

“Restricted Food Intake among Coronary Heart Disease Patients in Baranggay Jaclupan Talisay
City”

1. What was the profile of Coronary heart disease Patients in Baranggay Jaclupan Talisay City in
terms of:
1.1 Age;
1.2 Gender;
1.3 Employment; and
1.4 Body mass index?
2. What were the symptoms of their illness?
3. What was the frequency of restricted food intake of the respondents before diagnosed with
Coronary Heart Disease?
4. What was the amount of restricted food intake of the respondents before diagnosed with Coronary
Heart Disease?
5. What recommendations can be suggested to based on the findings to promote a healthy lifestyle
among patients with Coronary Heart Disease?

Thank you for the attention you have given to the above proposed thesis title and subproblems.

Very truly yours,

MARYJUNE LEA LABITAD

Nursing Research student

Approved by:

MRS. SHARON ROSE P. CABALUNA, R.N., R.M., MAN

Instructor, Nursing Research
 44

APPENDIX B

REQUEST APPROVAL OF THE ADVISER

Mrs. Sharon Rose P. Cabaluna, R.N., R.M., MAN

Instructor, Nursing Research
Larmen de Guia Memorial College
Mandaue City

Madame:

Good day!
I would like to request ____________ to be our adviser for our Nursing Research thesis.

I hope for your affirmative response to our request so that I could start our thesis the
soonest possible time through the guidance of a proficient adviser.

Thank you and God Bless!

Respectfully yours,
MARYJUNE LEA LABITAD
Researcher
 45

APPENDIX C

RESEARCH QUESTIONNAIRE

QUESTIONNAIRE

Dear Survey Respondent,

I am a fourth year student of Larmen de Guia Memorial College, conducting a study

entitled “Restricted Food Intake Among Coronary Heart Disease Patients in Baranggay Jaclupan
Talisay City”. In line with this, I have prepared the following instruments for the study.

This instrument is a self prepared questionnaire based on the restricted diet of coronary
heart disease patients. Rest assured that the data gathered will be dealt with utmost
confidentiality. Thank you for your kind cooperation.

Respectfully yours,

Maryjune Lea Labitad

Researcher

Please fill in or check the proper answers to the following questions:

1. Name:
2. Gender:
3. Employment:
4. Weight:
5. Height:
6. What did you feel before being diagnosed?
Chest heaviness
Dyspnea
Chest pain
Others please specify: _____________________
7. How frequent do you eat these foods?
a. Pork
Once a week:
1x/day
2x/day
3x/day
 46

Twice a week:
1x/day
2x/day
3x/day
Thrice a week:
1x/day
2x/day
3x/day
More than 3x/week:
1x/day
2x/day
3x/day

b. Beef
Once a week:
1x/day
2x/day
3x/day
Twice a week:
1x/day
2x/day
3x/day
Thrice a week:
1x/day
2x/day
3x/day
More than 3x/week:
1x/day
2x/day
3x/day

c. Poultry
Once a week:
1x/day
2x/day
3x/day
Twice a week:
1x/day
2x/day
3x/day
Thrice a week:
1x/day
2x/day
3x/day
 47

More than 3x/week:

1x/day
2x/day
3x/day

d. Fast food
Once a week:
1x/day
2x/day
3x/day
Twice a week:
1x/day
2x/day
3x/day
Thrice a week:
1x/day
2x/day
3x/day
More than 3x/week:
1x/day
2x/day
3x/day

8. What amount of food do you intake on every meal? Please check.

(3 ounce per serving)

Food 1 2 More than 2

serving servings servings
a. Pork
b. Beef
c. Poultry
d. Fast foods

9. What is/are the intervention/s adapted?

a. Exercise
b. Diet
Reduce
Same quantity
 48

APPENDIX D
LETTER OF PERMISSION

Joel Orbiso
Baranggay Capt., Brgy. Jaclupan
Talisay City

Dear Sir:

In view of the requirement for BSN degree, I, Maryjune Lea Labitad, a student of
Larmen de Guia Memorial College, School of Nursing, will conduct a research study entitled
“Restricted Food Intake Among Coronary Heart Disease Patient in Baranggay Jaclupan Talisay
City.”

For this purpose, I would like to ask you good office the permission to interview
the residence in your baranggay, as the respondents for my research. Rest assured that all
information gathered will be dealt with utmost confidentiality.

Very truly yours,

Maryjune Lea Labitad

Nursing Research Student

Noted by:

___________________
Research Adviser

Approved by:

Joel Orbiso
Brgy. Capt.,
Brgy. Jaclupan, Talisay City
 49

MARYJUNE LEA S. LABITAD

Jaclupan Talisay City Cebu
cell #0916-548-9934

PERSONAL DATA
Email Address: labitadmaryjunelea@yahoo.com
Date of Birth: June 26, 1984
Place of Birth: Lutopan Toledo City
Civil Status: Single
Nationality: Filipino
Sex:Female
Height:5''1
Weight: 100 lbs

EDUCATIONAL ATTAINMENT
College: University of the Visayas - Graduate as Midwifery
University of the Visayas
Colon St.,Cebu City
Year: 2002-2003
Bachelor of Science in Nursing (undergraduate)
Larmen De Guia College
U.N. Avenue Alang-alang, Mandaue City
Year: 2008-2009
Secondary: Jaclupan National High School
Jaclupan ,Talisay City, Cebu
Year: 2000-2001
Elementary: Jaclupan Elementary School
Jaclupan Talisay City, Cebu
Year: 1996-1997