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PUBLIC HEALTH NUTRITION:POSSIBLE RISK REDUCTION INATHEROSCLEROSIS1.0 IntroductionResearchers and policymakers worldwide have demonstrated longstanding interest in healthinequality. Why are they interested in health inequality? Just as in any other scientific pursuit,some of them may simply be interested in describing how health is distributed. Others may beinterested in understanding the mechanism of health inequality so they can improvepopulation health. The interest in health inequality, however, is not always limited todescribing and understanding it. Some health inequalities are of moral concern because of thevalue we place on health (Whitehead, 1992). Inequalities and inequities in health care andhealth outcomes continue to be in the center stage of health policy in many countries. Theinequivality issues can be observed in nutrition, socioeconomic status, poverty and education.Such inequalities in cardiovascular disease mortality are a major public health problem inmost industrialized countries (Mackenbach et al., 2000). Therefore, the gaps shall beindentified between the group of people who are associated with low and high nutrition andsocioeconomic groups too. This is to reduce the cardiovascular disease mortality. Accuratemeasurement of inequalities and inequities is indispensable to track progress or to identifyneeds for policy interventions (Truman et al., 2011). Regular reporting and monitoring ofhealth inequalities and inequities are needed based on the available data and methodologicalimprovement. Based on the evidences, the impact can be assessed on health to support theorganisations for the possible consequences. The system facilitates the organizations indeveloping and implementing an integrated policies and programmes. The development anduse of health impact assessment will contribute to the ongoing development andimplementation of local health, social care and wellbeing strategies, which is a joint statutory1
responsibility for Local Health Boards and local authorities. It can also contribute toCommunity Strategies which, given their overarching nature and breadth and depth, canaddress social, economic and environmental determinants of health, and to theimplementation of communities (Dannenberg et al., 2006). In addition, the inequality issuesinfluence the health of population in general and over 50 years due to associated defects inphysiology. Lack of adequate diet with nutrients, habituation towards drinks and defects inphysiology can contribute for the 'inequity' related issues. Hence focus has to be giventowards identification the gaps by conducting surveys in the society and to implementstrategies to overcome the issues.The present paper describes salient features of health inequality, strategies of estimation,recommendations followed by a survey related to the nutrition that influences cardiovasculardisease. A model disease, atherosclerosis is selected as it is a progressive diseasecharacterized by the accumulation of lipids and fibrous elements in the large arteries (Lusis,2000).Diverse fruits (Kalanuria, Nyquist & Ling, 2012)and drinks have cardio protectiveproperty by controlling the low density lipoproteins. Hence a systematic evaluation is carriedout to assess the effect of fruits and drinks in reducing atherosclerosis.2.0 Role of nutrition on atherosclerosis2.1. PathophysiologyPrior to discuss the nutrition role on atherosclerosis, it is required to understand thepathophysiology of the disease. The major underlying inflammatory risk factor for thepathogenesis is the destruction of endothelium. It leads to loss of (i) antithrombic andfibrinolytic factors; (ii) increase in the production of vasoconstrictors (thromboxane A2 andprostaglandins) and (iii) an increase in intracellular calcium-derived vasoconstriction factors.Some of the actions are mediated via nitrous oxide. The events propels the aggregation of2
platelets causing monocytes to enter the intima. Intracellular lipid peroxidation leads toformation of lipoperoxides, which are toxic to plasma membranes and combine withapolipoprotein (apo) B and phospholipids to prevent low-density lipoprotein (LDL) frombinding to the LDL receptor (Fleming, 2002). In addition, the following also contributes forpathogenicityoDisruption of inherent protective mechanisms leads to the formation of plaque andthrombosis. Coronary artery occlusion is the direct effect of thrombus formation onruptured and unruptured plaques at the site of atherosclerosis. Inflammation-mediatedneovascularization and intra-plaque hemorrhage, along with necrosis in the lipid coreare the cause of thrombogenesis (Shah, 2007)oPlaque formation is a zone of absence of shear stress, which occurs mostly at arterialbifurcations due to the absence of elastin and the presence of collagen-proteoglycancomplexes. Eventually leads to the retention and accumulation of LDL (Sanz, Moreno& Fuster, 2009)2.2. Preventive measures: Role of dietThe major cause for the atherosclerosis is uncontrolled diet in terms of diet with high lipids,cholesterol and low proportion of antioxidants and fruits. It is estimated thathypercholesterolemia, familial hypertriglyceridemia, or familial combined hyperlipidemiacontributes for atherosclerosis (Glueck & Connor, 1979). The accumulation of VLDL andLDL took place for years together, if the individual do not take adequate nutrition can pose torisk to the life. The following are the generalized recommendations to reduce the risk ofcardiovascular diseases (Gidding, et al., 2009)oAchieve and maintain a healthy body weightoBalance calorie intake and adequate physical activitiesoDiet should be rich in vegetables and fruits3
oChoose whole-grain, high-fiber dietoFish oil or food containing fish should be consumed at least twice a weekoDiet with saturated fat (should be <7%, trans fat to <1%, and cholesterol to <300 mg/d); lean meats and vegetables should be preferred; skimmed milk products (1% fat);restriction for the intake of partially hydrogenated fatsoIntake of products with added sugars should be minimizedoLittle or no salt should be used to cook foodoAlcohol should be consumed in moderation2.3. Reduction of risk: Possible mechanismsFruits and vegetables are the main sources of bioactive and antioxidant compounds. Thepresence of antioxidant vitamins, enzymes, and some poly-phenolic compounds comprise thehuman's total antioxidant defence system (Niki, & Noguchi, 2002).Certain fruits such ascitrus fruits contain flavonoids (hesperidin, naringenin and eriocitrin) as one of the importantbioactive components contribute towards protection against the diseases by enhancing thehuman immune system (Hirano et al., 2001). Pectin, a component of grapefruit showsinhibition of hypercholesterolemia and thus atherogenesis (Boshtam et al., 2013). Thecomponents of berries such as blackberry, mulberry are anthocyanins exhibited antioxidativeand antiatherogenic effects by inhibiting the oxidation of LDL (Liu et al., 2008). Theevidences indicate that the components offruits and vegetables can reduces the risk ofatherosclerosis by inhibiting lipid peroxidation and improving the elasticity of vessels3.0 MethodsExtensive literature search was done for the sources in terms of methods utilized for theinvestigation of 'fruits' effect on atherosclerosis. Adequate precautions were taken to filter theresearch question in order to sort relevant source. The outcome of the literature is shown in4
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