Assessment of nutrition knowledge and fat, fruit, grain, vegetables consumption in coronary heart disease patients in Yerevan

Abstract

Coronary Heart Disease (CHD) is the leading cause of deaths and disability in most industrialized countries, and its importance as a major public health problem is increasing in developing countries. CHD is the leading contributor to the mortality rates in Armenia as well. It has been increasing since 1994. It was estimated that in 1998 in Armenia among all cardiovascular diseases 40% morbidity was due to CHD. The role of diet as a risk factor for CHD was confirmed by epidemiological studies, clinical trials. Since the diet is a major modifiable risk factor for CHD, it plays an important role in CHD prevention. For that reason this study aimed at assessing the level of nutrition knowledge regarding low-fat diet, frequency of fat consumption, and cholesterol control in CHD patients in Yerevan. It was hospital-based case-control study . Cases defined as patients admitted to the hospital with acute or chronic CHD from August 8 to September 24 in 1999. Controls defined as patients admitted to the hospital with diagnosis other then CHD, who never experienced CHD before, aged > 30 from August 8 to September 24 in 1999.Exclusion and inclusion criteria were stated. Ascertainment of cases and controls were based on medical records, ECG and/or echocardiography. CHD diagnosis were made in accordance with WHO classification. One hundred eligible patients were enrolled in the study : 44 controls and 56 cases. Of these 56 cases 23 were incident and 33 were prevalent cases. Statistical analysis was done using STATA. Odds ratios and confidence intervals were calculated by unconditional logistic regression, statistical significance for differences between cases and controls was assessed by Chi- squared test. Knowledge scores reflected proportion of correct answers to the sixteen knowledge-related questions. The results had shown a low level of knowledge in both groups; proportion of patients identified as knowledgeable was dramatically small in both cases and controls : 33% and 15% respectively. Significant difference was found in the level of knowledge between cases and controls. Cases demonstrated relatively higher level of knowledge than controls, but the mean score in prevalent cases was higher than in incident ones. So, this difference could be accounted for relatively higher level of knowledge of prevalent cases. It was also found that frequency of fat consumption was positively associated with CHD: it increases the odds for CHD. Monthly income was a factor , which also associated with increased risk of CHD : the higher SES the higher odds for CHD. The study showed that 95% of the study population did not check cholesterol. The main mentioned reasons were : it was not important, it had never been advised by a health worker. Taking into consideration epidemiological findings of the study the following recommendations about preventive strategies can be suggested: elaborate education programs to increase awareness of population of the role of the diet in CHD prevention, importance of cholesterol control through the large variety of channels: TV, radio, other mass-distributed print media, and also to increase the role of health workers as a source of information.