Introduction
While the impacts of globalization improve living standards for various global populations, it presents diverse threats to the healthy lifestyle that people previously led by promoting sedentary life behaviors such as smoking, unhealthy dietary habits, overindulgence in the use of technology, and lack of physical exercise. These unhealthy practices have given rise to a myriad of terminal and lifestyle diseases, such as cardiovascular diseases (CVDs).
Of 56 million deaths globally reported in 2012, about 17.5 million cases were directly linked to CVDs associated with a sedentary lifestyle and poor dietary habits (Mata, 2014). In the UAE, 30-70% of the population have CVDs or are at higher risk of developing CVD-related conditions, 32% are obese. Consequently30% of human mortality cases around the globe are associated with CVDs, representing 300 cases per 100,000 deaths (Zaman, 2017). These statistics indicate that an objective nutritional assessment method could help construct a healthy diet for CVDS prevention and reduce human mortality due to preventable lifestyle causes.
Statement of the Problem
In recent years, nutritional assessment has become one of the most common tools to measure CVD risks. A balanced diet and healthy nutritional habits boost the body’s immunity against diseases, minimizes the risk of cancer, coronary heart disease, and diabetes. Healthy nutrition also promotes the growth and development of infants, children, and adolescents, reducing morbidity and mortality among these population groups (Nieman, 2019).
Nutritional assessment refers to a comprehensive approach to diagnosing nutritional problems using a combination of medical, nutrition, and medication histories, physical examination, anthropometric measurement, and laboratory data (Nieman, 2019). Besides, the Academy of Nutrition and Dietetics also defines nutritional assessment as “a systematic method for obtaining, verifying, and interpreting data needed to identify nutrition-related problems, their causes, and their significance (Nieman, 2019, p. 3). Therefore malnutrition assessment would result in the lack of appropriate awareness about the relationship between nutritional status and the cardiovascular system.
Apart from unhealthy eating habits, CVDs also originate from several unhealthy practices in modern life, such as stress and anger, leading to hypertension (Zaman, 2017). Besides, most patients are unaware of the relationship between different developmental, psychological, physiological, social, and economic practices and CVDs. These practices heighten the risks of CVDs in daily life as they become a generally accepted social norm of modernization.
Due to globalization, societies across the globe have fallen victims to mass consumption of fast food, or a specific tradition that accompanies the development of a group of people, a community, or a country. Besides, cardiac patients require a special nutritional concern that ensures the best conditions for their cardiovascular systems. Raising awareness of optimal nutritional status, including malnutrition (undernutrition and overnutrition), can provide the requisite nutritional assessment to mitigate the incidence of CVDs.
Significance of the Study
Firstly, the study constructs healthy nutritional suggestions based on nutritional assessment methods, raising awareness of optimal nutritional status and malnutrition of cardiac patients. Secondly, the study identifies relevant CVDs risks of different groups of people, such as pregnant women, infants, children, aging adults, people with low incomes, and hospitalized people.
As the UAE government strives to reduce the mortality rates associated with CVDs from 300 per 100,000 of the population to 150 per 100,000 by 2021, the nutritional suggestions emphasize specific differences amongst groups of people, specifying how to increase the high-density lipoprotein (HDL) to over 40 milligrams per decilitre (Zaman, 2017). Thirdly, the nutritional assessment focuses on the balance between nutrient requirement and nutrient intake but also promotes a healthy lifestyle based on developmental, psychological, physiological, social, and economic practices.
Hypothesis
- Hypothesis 1: The HDL level of cardiac patients can be increased if they consume more fruits and vegetables per day or with the help of another source of fat such as fish, or olive oil.
- Hypothesis 2: Individuals with obesity, high C-reactive protein, and uncontrolled diabetes confront higher CVD risks.
Objectives
The formulation of clear objectives of the research contributes to the validation of the overall investigation process. The first objective aims to determine the overall nutritional status of the target population residing in the UAE (Gibson, 2005). The second objective of the study seeks the identification of the possible causes of malnutrition within the population (Gibson, 2005). The study will identify the optimal nutritional status and provide information on possible causes of malnutrition.
Methodology
Research Design
A cross-sectional research design will be conducted to test the first hypothesis. The second design aims at validating the second hypothesis and employs the nutrition surveillance approach. This method allows the researcher to identify the possible causes of malnutrition using the ABCD technique of nutritional assessment. The research design includes specific replicate observations, constituting the re-productivity of measurement to increase the validity and credibility of the result from the nutritional assessment. The choice of the given method can be justified by several factors.
Firstly, the use of the ABCD technique can help to conduct a comprehensive and in-depth investigation of the state of a patient, including the vital showings indicating their current state. Secondly, the approach remains a potent data collection tool that can be used in various situations and for broad populations to gather the information that will be later used for the assessment and description of outcomes of particular interventions. Finally, the ABCD paradigm remains a recognized intervention that is utilized in multiple research projects and proves its effectiveness by providing accurate, relevant, and credible knowledge. For this reason, the choice of the model to conduct the study is justified by the factors mentioned above.
As for the second hypothesis, the analysis of CVD risks will also be performed during the application of the ABDC technique to collect information about their states and conclude about the correlation between outlined risks and such diseases as diabetes and obesity. That is why the selected methodology can be considered a capable paradigm to conduct the study.
Sampling Method
The study employs the stratified random sampling method of the probability sampling protocol to minimize the bias in results (Gibson, 2005). In this way, the sampling of the cross-sectional nutrition survey focuses on national cardiac patients in the UAE. The sampling of the nutrition surveillance approach is divided into a target population with six categories, namely pregnant women, infants, children, aging adults, people with low incomes, and hospitalized people.
Sample Size
The sample size is often constrained by cost and logistical considerations (Gibson, 2005). Therefore, the study will use a random sample size of 1,000 cardiac patients from 10 hospitals and medical institutions in the UAE before proceeding to the cross-sectional nutrition survey. The second sampling size is 600 participants who will proceed to the nutrition surveillance approach in 30 days. Such numbers will be time- and cost-effective and will be sufficient for obtaining valid study results.
Description of Population
The target population will be comprised of permanent residents in the UAE, with ages ranging from 18 to 60 years. Since the study will employ the stratified random sampling method, 1,000 cardiac patients from selected hospitals will have different types of CVDs, such as coronary heart disease, cardiomegaly, heart attack, atrial fibrillation, and cardiomyopathy among others. Regarding the 600 participants of the nutrition surveillance, the hospitalized people may be current patients or individuals who are not current patients but have been previously hospitalized with CVDs related problems. The category of hospitalized people does not require the participants to be patients of CVDs.
Tools and Technique
The choice of tools and techniques of the study is predetermined by the particularities of the designated research problem and the target population. Numerous risk factors are leading to the development of CVDs. Some of the highlighted factors include obesity, diet, physical inactivity, cholesterol, sex, age, smoking, and blood pressure (Sánchez-GarcÃa et al., 2007). Hence, ABCD will be the most appropriate technique for nutritional assessment among the patients since it covers a wide range of factors.
Description of Technique
The A in tool stands for anthropometric, B for biochemical or laboratory, C for clinical, and D for dietary types of assessment. Although the anthropometric method has six parameters, the study will require only the parameters that address the risk factors for CVDs. For the anthropometric method, the weight and height of the patients will be obtained to determine the BMI (Nieman, 2019). The weight will be obtained using a portable scale with a maximum capacity of 125 kg. On the other hand, subjects will stand with their scapula, heels, and buttocks resting against the wall and the neck in the natural position to obtain the height in meters. The BMI will be obtained by dividing the weight by height squared.
Respondents with a BMI of less than 18.5 will be considered malnutrition while those between 18.5 to 24.9 will be considered normal, and those above 25 will be considered overweight and hence have high chances of getting CVDs (Nieman, 2019). Also, the waist circumference of the respondents will be obtained by taking measurements at the plane between the umbilical scar and the inferior rib border. This measurement aims to help identify individuals with possible health risks based on the values of more than 89 cm for women and above 103 cm for men. A physically inactive individual is likely to have a huge waist circumference indicating high chances of CVDs.
The biochemical (B) method measures the nutrient or its metabolites, such as serum lipid and lipoprotein levels in blood, feces, or urine (Nieman, 2019). In this regard, a blood test will be conducted to determine the level of High-density lipoprotein (HDL) cholesterol in the plasma. In this regard, the low-level concentration of HDL-cholesterol (35mg/dL) will be associated with an increased risk of CVDs (Center for Disease Prevention and Control, 2004). Measurement of cholesterol level will also be significant in determining the chances of high blood pressure, which is also a predisposing factor for CVDs. The normal cholesterol level for an adult is below 200mg/dL, and for children is below 170mg/dL. An expert can be used to test the cholesterol level of the participants in the study.
In the clinical assessment method, numerous factors can be assessed, ranging from physical assessment to family history. In this regard, only the factors predisposing the participants to CVDs will be considered. For instance, visual signs of nutritional deficiencies will be checked. Also, the signs of wasting will be assessed, including muscle and fat loss due to energy intake. Also, hair loss and change in hair color will be checked since diet is one of the risk factors for CVDs. Also, family history and other risk factors for diseases such as alcohol use, smoking, and overweight will be investigated.
Finally, the dietary assessment of food and fluid intake is important for nutritional assessment. Most lifestyle diseases such as CVDs are caused by poor diet. Hence, the study will determine the food and beverages quantity consumed by the participants in the study (Nieman, 2019). In this regard, the 24-hour dietary recall form will be used to collect the data from the patients. The form can be accessed and filed online to help track the food and beverages consumed within 24 hours. This method is appropriate since it will help to determine patients’ calorie intake per day and compare it with the recommended quantity. A sample form can be accessed from the Nutrition Assessment, Counseling, and Support (NACS) website (Nutrition Assessment, Counseling, and Support (NACS), 2016).
Data acquired due to the application of the ABCD technique should be processed and interpreted to formulate conclusions. In the study, the information about patients will be analyzed by comparing it with the existing norms and standards that indicate the healthy state of patients. In other words, data interpretation will be conducted by reviewing the relevant showings acquired due to the application of the selected method. It will help to assess patients’ states more effectively and accurately and conclude about the effects of malnutrition on selected populations and their health status. Moreover, it will help to prove or refute the offered hypotheses.
Statistical Analysis
Regarding the cross-sectional nutrition survey of 1,000 cardiac patients, daily data collected from the re-productivity of each measurement procedure will be calculated as the coefficient of variation (CV%). The identified CV% would help to confirm the correlation between HDV level of cardiac patients and nutrient intakes. The nutrition surveillance approach would record the food data from six categories of the target population in 30 days. The collected data would be used for statistical analysis to identify the relationship between obesity, high C-reactive protein, uncontrolled diabetes, and CVDs. The statistical analysis would provide numerical data based on calculations to discuss relevant findings of the study, approving or disapproving the hypotheses.
Ethical Considerations
Since the sampling includes humans, ethics considerations are particularly necessary for the study to ensure that all steps strictly follow relevant codes of conduct and ethics. The research proposal would be submitted to the national agencies and the university in the UAE for approval. The submission needs should provide information, such as details of the nature and procedures of the study, associated potential risks and benefits, confirmation of voluntary participation, confirmation of freedom to withdraw from participation, legal access of medical records, the confidentiality of information, and medical records, and vulnerability assessment. A sample consent form is provided in the appendix.
Reference List
Center for Disease Prevention and Control 2004, Laboratory procedure manual. Web.
Gibson, RS 2005, Principles of nutritional assessment, Oxford, Oxford University Press.
Mata, D 2014, Cardiovascular Disease in UAE. Web.
Nieman, DC 2019, Nutritional assessment. 7th Edition, McGraw Hill.
Nutrition Assessment, Counseling, and Support (NACS) 2016, Module 2. Nutrition Assessment and Classification. Web.
Sánchez-GarcÃa, S, GarcÃa-Peña, C, Duque-López, MX, Juárez-Cedillo, T, Cortés-Núñez, A R, & Reyes-Beaman, S 2007, ‘Anthropometric measures and nutritional status in a healthy elderly population,’ BMC public health, Vol. 7, No. 2. Web.
Zaman, S 2017, 30 percent of all deaths in UAE due to cardiovascular diseases. UAE Health. Web.
Appendix 1
