School Control
Resume:
Research Journal of Medicine and Medical Sciences, 6(2): 69-72, 2011
ISSN 1995-0748
This is a refereed journal and all articles are professionally screened and reviewed
ORIGINAL ARTICLES
A Study of the Dietary Pattern of Rheumatic Heart Children
Fawzia M. El- Matraffy
Assistant Professor in Aum El Kora University Makka El Mokarama Suadi Arabian Kingdom.
ABSTRACT
The dietary pattern and average daily intake of protein and calories were studied in 600 rheumatic heart
cases between 6 - 20 years age and 400 matched controls. The diet falls within the pattern characteristic of
the Saudi diet. The intake of protein and calories increased with advancement of age in the diseased and
control groups but the rheumatic heart cases were always at a lower level except in the age group below 10
years enrolled in school and the boys of age group (10 years) not educated where the intake was higher than
the corresponding controls It appears that diet is involved in growth retardation associated with rheumatic heart
disease but it is not the sole factor playing.
Key words:
Introduction
Has been stated that in patients with advanced cardiac disease a triad of asthenias, anorexia and loss of
weight often develops as a part of the clinical picture of inanition Keysser, (2001).
It was therefore aimed in this work to study the dietary pattern and intake in a group of rheumatic heart
cases between 6 - 20 years of age compared to a matched control group.
Materials and Methods
600 cases of rheumatic heart disease of both sexes were sampled at random from MAKKA their ages
ranged from 6-20 years presenting the growth during school education. Another group of 400 apparently normal
children were taken by stratified random methods from the public primary, preparatory and secondary schools.
This group served as controls matched as regards age, sex, social standard and education. Both boy and girls
were then subdivided into 3 age groups, below 10 years, 10- years and 15 years and above. Study of the
dietary history was adopted to illustrate the dietary pattern and to give a semi quantitative estimation of the
dietary intake. The use of house hold measures was practical in estimating the quantities of food consumed
which were expressed in units. As an example a glass of milk 220 ml was considered a unit.
The number of units consumed from each food commodity week was determined for each individual by
questionnaire. The total units of each food consumed by the group / week were commutated. The average daily
consumption for the individual was taken calculated and expressed in the corresponding numerical value. This
was then analyzed into its protein and caloric content using the food composition tables. (2) These two
nutrients are the main elements involved in growth.
The total protein and total calories obtained from different food commodities was then- calculated by
summation of all figures of either as the dietary history depends on the memory and cooperation of the
surveyed individuals and as estimation of quantities of food consumed was only possibly by applying house-
hold measures it would appear that the computed figures are semi quantitative and are only of value in
comparing different groups together.
Corresponding Author: Fawzia M. El- Matraffy Assistant professor in Aum El Kora University Makka El Mokarama
Suadi Arabian Kingdom
E-mail: *-***@*******.***
Res. J. Medicine & Med. Sci., 6(2): 69-72, 2011 70
Results:
(Table 1) shows the average daily intake of protein and calories by the controls and the rheumatic heart
cases classified by age educational status in boys. Comparison was made mainly between them and rheumatic
heart cases enrolled in school because they were matched in every respect including the educational status.
Further comparison was also made among the rheumatoid subgroups of different ages and educational status.
It is observed from table 1 that in the group of boys below 10 years of age the average daily intake of
protein and caloriesfor the controls and the rheumatic heart cases enrolled in school was 38 gram and 900
calories; and 45 gram and 1050 calories, respectively. In the age group (10 years) the average daily intake was
52 gram and 1310 calories by the controls compared to 47 gram and 1200 calories by the rheumatic heart
cases enrolled in school.
With advancement of age to 15 years and above the corresponding figures were 72 gram and 1940 calories
for the controls compared to 59 gram and 1470 calories for the rheumatic heart cases enrolled in school.
It can be observed that there is an increased intake of protein and calories with advancement of age in
both the controls and the rheumatic heart children. But the latter remained at a lower than the corresponding
control group except in the group of boys below 10 years of age whose consumption was higher than the
controls.
Further comparison of the rheumatic heart subgroups shows that below 10 years of age the highest protein
and calorie intake was noticed in the rheumatic heart children enrolled in school.
The reverse was seen in the rheumatic heart boys not educated, where the consumption was higher in the
two older age groups.
Similar observations were recorded for girls (Table 2). The average daily intake of protein and calories
below 10 years of age was 31 gram and 790 calories for the controls compared to 35 gram and 868 calories
for the rheumatic heart girls enrolled in school.
In the group aged l0 -years the corresponding figures are 42 gram and 1016 calories for the controls
compared to 39.1 gram and 1080 calories for the rheumatic heart group enrolled in school. In age group 15
years + the figures obtained are 47 gram and 1270 calories for the controls and 40.1 gram and 1020 calories
for therheumatic heart group enrolled in school.
Table l: Average daily intake of protein and calroies by the control and rheumatic heart children classified by age and educational status
(Boys).
Group Nutrient Age groups
Rheumatic heart cases Below 10 yrs 10 yrs 15 yrs
Control Protein (gm) calories 38 52 72
Enrolled in school Protein 45 47 59
Calories 105*-****-****
Educated but not in school Protein - 44.8 56.2
Calories - 1183 1446
Not educated Protein 32.7 52.8 60
Calories 839-****-****
Table 2: Average intake of protein and control and rheumatic heart children classified age and educational status (Girls).
Group Nutrient Age groups
Below 10 yrs 10 yrs 15 yrs
Control Protein (gm) calories 31 42 47
790 1016+ 1270
Enrolled in school Protein 35 39.1 40.1
Calories 868-****-****
Educated but not in school Protein - 40.4 41.6
Coloires - 1069 1123
Not educated Protein 29.1 42.3 44.4
Calories 749-****-****
It is also observed that below 10 years of age the consumption of protein and calories was higher in the
rheumatic heart group, enrolled in school than the diseased group not educated. But in the two older age
groups the protein and caloric intake was higher in the non educated groups compared to the other rheumatic
heart groups of the same age.
Res. J. Medicine & Med. Sci., 6(2): 69-72, 2011 71
Moreover, by matching (Table 1) for boys with (Table 2) for girls; it is noticed that the consumption of
both nutrients was higher in boys than girls in all corresponding groups.
Discussion:
In the present study the children included in the sample belonged to lower social strata and their diet was
observed to fall within the pattern characteristic of the Saudi diet Koopman and Moreland, (2005):
It were stated that about 70% of calories and protein of the national diet of Saudian are derived mainly
from cereals.
It was observed from study the dietary history of the surveyed groups that bread is the staple food and
together with sugar supplied most of the calories. The diet was poor in animal foods as meat, poultry, fish and
eggs and thus the protein was derived mainly from bread and legumes specially broad beans. Milk intake was
low, vegetable intake was moderate but the consumption of fruits was negligible. It can be deduced that the
pattern of the studied sample is characterized by being poor in animal protein and the main source of protein
and calories are the cereals.
This is different from the diet in western communities which is characterized by being rich in animal foods
which constitute the main source of protein and a considerable amount of calories is derived from fasts Martin,
(1998):
It was observed that in all rheumatic heart cases and controls and in both sexes the intake of protein and
calories increased with advancement of age but the increase was more evident and regular in the controls. It
was also seen that in the two age groups (l0-years and 15 years +) the average daily intake of both nutrients
was lower in the rheumatic heart cases enrolled in school than the corresponding control groups of the same
age and sex. However, the reverse was noticed in the youngest age group (blew 10 years of age) where the
consumption of protein and calories was higher by the rheumatic heart boys and girls enrolled in school than
the corresponding control groups.
This could be explained by better nutritional care given to this young age group by their parents. But at
an older age (l0-years and 15 years +) less amount of food could be consumed because of more advanced
cardiac lesion with possible encroachment on the capacity of the gastro-intestinal tract. Comparison of the
rheumatic subgroups at different educational status showed that below 10 years of age lower intake of protein
and calories was seen in the non educated boys and girls compared to those enrolled in school. At this young
age the child cannot take care of himself and is only under the care of his parents.
It seems logical that the parents of the non-educated children are carless and ignorant as reflected in not
sending their children to school and not taking care of their diet. When however these children grow older they
probably start to work and earn money, become more conscious about their health status but being uneducated
their main concept about health is consumption of more food.
This could explain the higher intake of protein and calories by the two older rheumatic heart groups not
educated than those enrolled in school.
In the age group 15 years + the intake of both nutrient was far less in all rheumatic heart groups than the
controls, especially calories as they are derived mainly from bulky food. This finding may be related to a more
profound and established cardiac lesion with program of age. Attributed the reduction in food intake to a
compensatory mechanism to prevent the additional strain on the failing myocardium. They related anorexis to
venous engorgement and oedema of viscera. They also spiculated that the hypertrophied heart, liver together
with ascitis encrosch on the stomach limiting its capacity. (McDougall, et al., 2002)
It is concluded from the present study that the diet of rheumatic heart children surveyed fall within the
pattern characteristic of lower social strata in MAKKA in Saudi Arabia. The role of diet in growth retardation
of these children cannot Ignored. Most of the diseased groups showed a lower intake of protein and calories
than their matched controls. However a decreased food intake cannot be the sole factor involved in growth
retardation in rheumatic heart disease. It was seen in the age group below 10 years that the diseased group
enrolled in school showed higher intake than their controls.
References
Keysser, G., 2001. Are there effective dietary recommendations for patients with rheumatoid arthritis? Z
Rheumatol., 60(1): 17.
Karatay, S., T. Erdem, A. Kiziltune, M.A. Melikoglu, K. Yildirim, E. Cakir, M. Ugur, A. Aktas and K. Senel,
2006. General or personal diet: the individualized model for diet challenges in patients with rheumatoid
arthritis. Rheumatol Int., 26(6): 556.
Koopman, W.J. and L.W. Moreland, 2005. Arthritis, 15th edition: 1249.
Res. J. Medicine & Med. Sci., 6(2): 69-72, 2011 72
Martin, R.H., 1998. The role of nutrition and diet in rheumatoid arthritis. Proceeding of the Nutrition Society,
57: 231.
McDougall, J., B. Bruce, G. Spiller, J. Westerdahl and M. McDougall, 2002. Effect of a very Low-Fat, Vegan
Diet in Subject with Rheumatoid Arthritis. The Journal of Alternative and complementary Medicine, 8(1):
71.
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