The Effect of Nutritional Education on Vitamin C and Dietary Fiber Intake among Patients with Rural Hypertension

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Public Health, School of Khalkhal Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran

2 Associate Professor, Food Security Researches Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Department of Surgery, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran

4 Professor, Department of Public Health, School of Health, Qom University of Medical Sciences, Qom, Iran

Abstract

Background: A healthy diet has beneficial effects on reducing risk factors for cardiovascular diseases. This study aimed to determine the effectiveness of theoretical educational intervention on blood pressure in patients with rural hypertension.Methods: In this quasi-experimental study, 138 patients with hypertension (68 in intervention and 70 in control group) were randomly selected from those referred to Ardabil rural health centers, Iran, during 2013. The intervention group received nutritional education based on the Dietary Approaches to Stop Hypertension (DASH) recommendations for 6 sessions. The pre- and post-test had an interval of 2 and 6 months. Pender’s Health Promotion Model was applied to extend the motivation of the behavior. Descriptive analysis, repeated measures analysis of variances, independent-t and paired-t tests were used to analyze the data.Findings: After intervention, vitamin C and dietary fiber intake increased significantly in the intervention group (P < 0.001); but these changes were not significant in the control group over the time.Conclusion: Educational intervention provided based on Pender’s health promotion model had a beneficial effect on vitamin C and dietary fiber intake.

Keywords


  1. Lee DS, Massaro JM, Wang TJ, Kannel WB, Benjamin EJ, Kenchaiah S, et al. Antecedent blood pressure, body mass index, and the risk of incident heart failure in later life. Hypertension 2007; 50(5): 869-76.
  2. Azadbakht L, Fard NR, Karimi M, Baghaei MH, Surkan PJ, Rahimi M, et al. Effects of the Dietary Approaches to Stop Hypertension (DASH) eating plan on cardiovascular risks among type 2 diabetic patients: a randomized crossover clinical trial. Diabetes Care 2011; 34(1): 55-7.
  3. Shirani F, Salehi-Abargouei A, Azadbakht L. Effects of Dietary Approaches to Stop Hypertension (DASH) diet on some risk for developing type 2 diabetes: a systematic review and meta-analysis on controlled clinical trials. Nutrition 2013; 29(7-8): 939-47.
  4. Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F. Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome. Diabetes Care 2005; 28(12): 2823-31.
  5. Bazzano LA, Green T, Harrison TN, Reynolds K. Dietary approaches to prevent hypertension. Curr Hypertens Rep 2013; 15(6): 694-702.
  6. Cook NR. Salt intake, blood pressure and clinical outcomes. Curr Opin Nephrol Hypertens 2008; 17(3): 310-4.
  7. Nowson CA, Worsley A, Margerison C, Jorna MK, Godfrey SJ, Booth A. Blood pressure change with weight loss is affected by diet type in men. Am J Clin Nutr 2005; 81(5): 983-9.
  8. Nowson CA, Wattanapenpaiboon N, Pachett A. Low-sodium Dietary Approaches to Stop Hypertension-type diet including lean red meat lowers blood pressure in postmenopausal women. Nutr Res 2009; 29(1): 8-18.
  9. Whitt-Glover MC, Hunter JC, Foy CG, Quandt SA, Vitolins MZ, Leng I, et al. Translating the Dietary Approaches to Stop Hypertension (DASH) diet for use in underresourced, urban African American communities, 2010. Prev Chronic Dis 2013; 10: 120088.
  10. Hermansen K. Diet, blood pressure and hypertension. Br J Nutr 2000; 83(Suppl 1): S113-S119.
  11. Desroches S, Lapointe A, Ratte S, Gravel K, Legare F, Thirsk J. Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults: a study protocol. BMC Public Health 2011; 11: 111.
  12. Epstein DE, Sherwood A, Smith PJ, Craighead L, Caccia C, Lin PH, et al. Determinants and consequences of adherence to the dietary approaches to stop hypertension diet in African-American and white adults with high blood pressure: results from the ENCORE trial. J Acad Nutr Diet 2012; 112(11): 1763-73.
  13. Obarzanek E, Vollmer WM, Lin PH, Cooper LS, Young DR, Ard JD, et al. Effects of individual components of multiple behavior changes: the PREMIER trial. Am J Health Behav 2007; 31(5): 545-60.
  14. Kwan MW, Wong MC, Wang HH, Liu KQ, Lee CL, Yan BP, et al. Compliance with the Dietary Approaches to Stop Hypertension (DASH) diet: a systematic review. PLoS One 2013; 8(10): e78412.
  15. Racine E, Troyer JL, Warren-Findlow J, McAuley WJ. The effect of medical nutrition therapy on changes in dietary knowledge and DASH diet adherence in older adults with cardiovascular disease. J Nutr Health Aging 2011; 15(10): 868-76.
  16. Troyer JL, Racine EF, Ngugi GW, McAuley WJ. The effect of home-delivered Dietary Approach to Stop Hypertension (DASH) meals on the diets of older adults with cardiovascular disease. Am J Clin Nutr 2010; 91(5): 1204-12.
  17. Couch SC, Saelens BE, Levin L, Dart K, Falciglia G, Daniels SR. The efficacy of a clinic-based behavioral nutrition intervention emphasizing a DASH-type diet for adolescents with elevated blood pressure. J Pediatr 2008; 152(4): 494-501.
  18. Tinker LF, Rosal MC, Young AF, Perri MG, Patterson RE, Van HL, et al. Predictors of dietary change and maintenance in the Women's Health Initiative Dietary Modification Trial. J Am Diet Assoc 2007; 107(7): 1155-66.
  19. Burke LE, Wang J, Sevick MA. Self-monitoring in weight loss: a systematic review of the literature. J Am Diet Assoc 2011; 111(1): 92-102.
  20. Airhihenbuwa CO, Kumanyika S, Agurs TD, Lowe A, Saunders D, Morssink CB. Cultural aspects of African American eating patterns. Ethn Health 1996; 1(3): 245-60.
  21. Williams JH, Auslander WF, de GM, Robinson AD, Houston C, Haire-Joshu D. Cultural relevancy of a diabetes prevention nutrition program for African American women. Health Promot Pract 2006; 7(1): 56-67.
  22. Hargreaves MK, Schlundt DG, Buchowski MS. Contextual factors influencing the eating behaviours of African American women: a focus group investigation. Ethn Health 2002; 7(3): 133-47.
  23. Boeckner LS, Pullen CH, Walker SN, Oberdorfer MK, Hageman PA. Eating behaviors and health history of rural midlife to older women in the midwestern United States. J Am Diet Assoc 2007; 107(2): 306-10.
  24. Levine AS, Kuskowski MA, Grace M, Billington CJ. Food deprivation-induced vs. drug-induced feeding: a behavioral evaluation. Am J Physiol 1991; 260(3 Pt 2): R546-R552.
  25. Azadbakht L, Mirmiran P, Saadati N, Azizi F. Assessment of diet quality in adults: Tehran lipid and glucose study. Payesh 2003; 2(3): 221. [In Persian].
  26. Saneei P, Hashemipour M, Kelishadi R, Rajaei S, Esmaillzadeh A. Effects of recommendations to follow the Dietary Approaches to Stop Hypertension (DASH) diet v. usual dietary advice on childhood metabolic syndrome: a randomised cross-over clinical trial. Br J Nutr 2013; 110(12): 2250-9.
  27. Lanza E, Schatzkin A, Daston C, Corle D, Freedman L, Ballard-Barbash R, et al. Implementation of a 4-y, high-fiber, high-fruit-and-vegetable, low-fat dietary intervention: results of dietary changes in the Polyp Prevention Trial. Am J Clin Nutr 2001; 74(3): 387-401.
  28. Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Young DR, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med 2006; 144(7): 485-95.
  29. Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 2006; 114(1): 82-96.
  30. Martinez-Gonzalez MA, Fuente-Arrillaga C, Lopez-Del-Burgo C, Vazquez-Ruiz Z, Benito S, Ruiz-Canela M. Low consumption of fruit and vegetables and risk of chronic disease: a review of the epidemiological evidence and temporal trends among Spanish graduates. Public Health Nutr 2011; 14(12A): 2309-15.
  31. Nemati A, Abbasgolizadeh N, Rahimi K. Nutritional knowledge and patterns of women in Ardabil province. J Health 2011; 2(3): 32-41. [In Persian].
  32. Myint PK, Luben RN, Wareham NJ, Khaw KT. Association between plasma vitamin C concentrations and blood pressure in the European prospective investigation into cancer-Norfolk population-based study. Hypertension 2011; 58(3): 372-9.
  33. Taylor EN, Fung TT, Curhan GC. DASH-style diet associates with reduced risk for kidney stones. J Am Soc Nephrol 2009; 20(10): 2253-9.
  34. Ledikwe JH, Rolls BJ, Smiciklas-Wright H, Mitchell DC, Ard JD, Champagne C, et al. Reductions in dietary energy density are associated with weight loss in overweight and obese participants in the PREMIER trial. Am J Clin Nutr 2007; 85(5): 1212-21.
  35. Locke E, Coronado GD, Thompson B, Kuniyuki A. Seasonal variation in fruit and vegetable consumption in a rural agricultural community. J Am Diet Assoc 2009; 109(1): 45-51.
  36. Pires CG, Mussi FC. Health beliefs regarding diet: a perspective of hypertensive black individuals. Rev Esc Enferm USP 2012; 46(3): 580-9. [In Portuguese].
  37. Pawlak R, Colby S. Benefits, barriers, self-efficacy and knowledge regarding healthy foods; perception of African Americans living in eastern North Carolina. Nutr Res Pract 2009; 3(1): 56-63.
  38. Henry H, Reimer K, Smith C, Reicks M. Associations of decisional balance, processes of change, and self-efficacy with stages of change for increased fruit and vegetable intake among low-income, African-American mothers. J Am Diet Assoc 2006; 106(6): 841-9.
  39. Mohebi S, Sharifirad G, Feizi A, Botlani S, Hozori M, Azadbakht L. Can health promotion model constructs predict nutritional behavior among diabetic patients? J Res Med Sci 2013; 18(4): 346-59.
  40. Kamran A, Azadbakht L, Sharifirad Gh, Abdoli R, Alizadeh A. Relationship between illness perceptions and nutritional knowledge with eating behaviors among Ardabil rural hypertensive patients. J Health Syst Res 2014; 10(2): 2905-305. [In Persian].
  41. Park S, Kwon JS, Kim C, Lee Y, Kim HK. Development of nutrition education program for hypertension based on health belief model, applying focus group interview. Korean J Community Nutr 2012; 17(5): 623-36.
  42. Shiplett BL. An examination of knowledge, health beliefs, and health-promoting behaviors related to heart disease among university women. Ann Arbor, MI: Pro Quest; 2007.
  43. Paryad E, Hosseinzade T, Kazemnejad E, Asiri Sh. A study of self-efficacy in patients with coronary artery disease and its predictors. Qom Univ Med Sci J 2013; 7(2): 41-8. [In Persian].
  44. Warren-Findlow J, Seymour RB, Brunner Huber LR. The association between self-efficacy and hypertension self-care activities among African American adults. J Community Health 2012; 37(1): 15-24.
  45. Bosworth HB, Oddone EZ. A model of psychosocial and cultural antecedents of blood pressure control. J Natl Med Assoc 2002; 94(4): 236-48.
  46. Edell BH, Edington S, Herd B, O'Brien RM, Witkin G. Self-efficacy and self-motivation as predictors of weight loss. Addict Behav 1987; 12(1): 63-6.
  47. Watters JL, Satia JA. Psychosocial correlates of dietary fat intake in African-American adults: a cross-sectional study. Nutr J 2009; 8: 15.
  48. Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willet WCt. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med 2000; 343: 16-22.
  49. Mularcik KA. Self-efficacy toward health behaviors to improve blood pressure in patients who receive care in a primary care network. [MSc Thesis]. Columbus, Ohio: Ohio State University; 2010.
  50. Strecher VJ, DeVellis BM, Becker MH, Rosenstock IM. The role of self-efficacy in achieving health behavior change. Health Educ Q 1986; 13(1): 73-92.