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Evaluation of national dietary habits and physical activity level monitoring as basis for a new health promotion strategy of Republic of Macedonia

Evaluation of national dietary habits and physical activity level monitoring as basis for a new health promotion strategy of Republic of Macedonia

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THE XI INTERNATIONAL CONFERENCE „SERVICE SECTOR IN THE VARIABLE ENVIRONMENT CONDITIONS “
27 - 29 october 2011, OHRID
University St. Kliment Ohridski - Bitola, Faculty of Tourism and Hospitality - Ohrid
Kej Marsal Tito 95, Ohrid

Republic of Macedonia

The theme of the Conference concerning research
- Modern trends in nutrition and gastronomy

Submission of abstracts and papers on email address:
Contact: ftu.conference@uklo.edu.mk
THE XI INTERNATIONAL CONFERENCE „SERVICE SECTOR IN THE VARIABLE ENVIRONMENT CONDITIONS “
27 - 29 october 2011, OHRID
University St. Kliment Ohridski - Bitola, Faculty of Tourism and Hospitality - Ohrid
Kej Marsal Tito 95, Ohrid

Republic of Macedonia

The theme of the Conference concerning research
- Modern trends in nutrition and gastronomy

Submission of abstracts and papers on email address:
Contact: ftu.conference@uklo.edu.mk

More info:

Published by: Ass. Prof. Vera Simovska, MD., PhD. on Aug 19, 2011
Copyright:Attribution Non-commercial

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Evaluation of dietary habits and physical activity levelMonitoring as basis for a new health promotion strategy of Republic of Macedonia
Vera P. Simovska-Jarevska, Dragan Damjanovski, Valentina Pavlova and Sasko MartinovskiUniversity “St. Clement of Ohrid” – BitolaFaculty of Technological and Technical Sciences – VelesPetre Prlicko 14, Veles, Republic of Macedoniavera.simovska@uklo.edu.mk  
1
 
Abstract
Introduction:
The epidemiological andexperimental evidence on health determinants haveled to numerous initiatives to develop nationalstrategy for health promotion through diet and physical activity in Republic of Macedonia. TheWHO HEPA (Health-Enhancing Physical Activity)Europe focused on developing a national strategy todevelop health by publishing European physicalactivity recommendations. Also, the WHO adoptedthe Global Strategy on Diet, Physical Activity andHealth in 2004 (WHA, 2004) in order to reducemortality from chronic noncommunicable diseases(NCD). An implementing act on European HealthInformation System (EHIS) is expected to comeinto force in 2014 as a useful tool for determining priorities in health policy.
With the aim
to develop a national strategy for health promotion and NCD prevention, we havemade analysis and evaluation of the results obtainedfrom the new “cross-sectional” study for dietaryhabits and physical activity levels (PALs)monitoring conducted in May 2011.
Methods:
The survey was comprised of a self-administered questionnaire. Dietary habits weremonitored by using the questionnaire to examinethe frequency of consumption of various foodsduring the week (“Food frequency questionnaire”,FFQ). Leisure-time physical activity (LTPA) wasthe preferred measure in the study because thecategories include a comprehensive list of examplesof organized sport, brisk walking and cycling withmoderate intensity as well as walking, householdduties, gardening and other activities recognized as physical activity with low intensity level. The studywas conducted in five regions in the republic of Macedonia. The total sample was 800 participantsaged 10 to 65 years, divided into three age groups.The results were presented in percentages (%) of total numbers of the participants in the study by ageand sex groups.
Results
: Results showed that 20% of the populationconsumed bread enriched with whole grainespecially participants over 50 years old.Approximately 74% of the population regularlyconsumed vegetables and fruits of which over 50%every day. 19% of the participants consumed fish inaccordance with the recommendation. 34% of all participants prepared boiled food while 66% of study participants older than 50 years old preparedfried foods, including fast food. 11% of all participants bought food based on health effects. Amain factor was usually the taste and food price.59% of Macedonian children and adolescentyounger than 19 years and 28% of participants,from 19 to 49 years have moderate or vigorous physical activity level such as organized sports.28% of young people had low levels physicalactivity, especially girls. Also, half of adult participants in the study had low physical activitylevel. In term of gender differences, 18% men and26% women of all participants were physicalinactive, of which 35% were adults older than 50years.
Conclusion:
It’s known that mortality from NCDscan be prevented by changes in behavioural risk factors associated with lifestyle of the population, primary through the reduction of unhealthy eatinghabits and decreased physical activity. The firstcomplex results of our study indicate that the actionfor health through improving physical activitylevels and dietary habits should be focused onyounger age groups, especially girls and adult population over 50 years, particularly women.Concerning the changes in dietary habits, the mostimportant is radical change in the food market andchanges in food production including availability of whole grain bread, fresh fish and eliminating “fastfood.”
Index terms
: health promotion strategy, prevention, dietary habit, physical activity level,noncommunicable disease, lifestyle intervention.
INTRODUCTION
1.1.Background 
Significant fundamental conditions andresources to improve population health are nutritioneducation, then finance and stable eco-system under the "Declaration on the promotion of health" of theWorld Health Organization (Ottawa declaration,WHO, 1986). The WHO HEPA (Health-EnhancingPhysical Activity) European network is focused ondeveloping a national strategy and program by publishing European physical activityrecommendations. Also, the WHO adopted theGlobal Strategy on Diet, Physical Activity andHealth in(WHA, 2004) in order to reducenoncommunicable diseases (NCD) mortality. Animplementing act on European Health InformationSystem (EHIS) is expected to come into force in2014 as a useful tool for determining priorities inhealth policy (1).The epidemiological and experimental evidenceon health determinants have led to numerousinitiatives to develop national strategy for health promotion through diet and physical activity inRepublic of Macedonia. Numerous studies andexperiences have confirmed the role of nutritionand physical activity in preventing main NCD suchas cardiovascular diseases (2), type 2 diabetes,cancer, obesity and co-morbidities. NCD areincluded in category of nutrition-related diseasesand represent the enormous public health problem.The presence of total NCD mortality was 75%,while cardiovascular disease morbidity, accordingto the State Institute for Statistic of Republic of Macedonia amounted to 57% of the total morbidity
2
 
(2001). In terms of risk factors for NCD,overweight and obesity were prevalent among58.3% of the
 
 population in Republic of Macedonia(2001) (3).It is recognized that balanced nutrition and physical activity (4) are the basic interventionmeasures in the concept of an integrated approachfor prevention of NCD. From a public health perspective, investments in organized work in thefield of food, nutritional education primarily at theuniversities are multiple investments which arereturned to the existing policy and community (5).On the other hand, specialized medical professionals in the field of nutrition and medicaldietetics is highly deficient, as well as researchersin the clinical nutrition. Nutritionists/dietitians witha completed undergraduate and graduate study arestill missing. Ministry of Health has no componentin developing national public health strategy, in part: "Health promotion through nutritionrecommendations based on traditional food and balanced nutrition."Because of the above facts are imposed, it’snecessary to develop and implement a nationalstrategy for health promotion through balanced dietand increased physical activity level, includingdirectional transfer of system knowledge fonutrition. The need for higher education of health professionals in the field of nutrition and medicaldietetics was emphasized by the experts in theCommittee for Advancement of Health SystemReform in the Ministry of Health of the Republic of Macedonia (Simovska V, 2009). First cycle(undergraduate) study in nutrition have beenintroduced in 2010 year in order to create synergy between higher education and practice linking foodtechnology with medicine and health. Applicationof population-based prevention, acting on changesin dietary habits and other risk factors associatedwith the lifestyle of the whole population is themost stable and effective way to reduce the NCDand health promotion related to high risk strategy.
1.2 Purpose of the paper 
The purpose of the study was to performsituational analysis of dietary habits and level of physical activity among the population as a basisfor developing a new national strategy for healthpromotion in Republic of Macedonia.METHODS
The survey was conducted using self-designedquestionnaire. Dietary habits were surveyed using aquestionnaire to monitor the frequency of consumption of various foods during the wee(Food frequency questionnaire, FFQ). According tothe survey, regular consumption of certain foodsmean 5 and/or several times a week. Occasionalconsumption of certain foods mean 2-4 times aweek and the third group included respondents whowere once a week or do not consume certain foods.Leisure time physical activity (LTPA) was a priority measure in this study because thecategories include a comprehensive list of examplesof organized sports, brisk walking and cyclingknown as physical activity with moderate intensity,and walking, household activities, gardening andother activities known as activities with lowintensity.The study was conducted in five regions inRepublic of Macedonia, including 800 respondentsaged 10 to 65 years. They were divided into threeage groups: up to 18 years, from 19 to 49 years andthird category of respondents had over 50 years.Survey results were presented in percentages (%) of the total number of participants by age and sex.
RESULTS
Study results showed that 20% of the population consumed bread enriched with wholegrain especially participants over 50 years old,while 76% consumed white and/or semi-white bread. 82% of respondents from all age groupsregularly consume milk and/or yogurt.A good indicator is the fact that 71% of  participants in all age groups regularly or occasionally consumed fresh fruit and 82%regularly or occasionally consumed vegetables.Figure 1. Consumption of fruits by age of the study participantsFigure 2. Consumption of vegetables by age of thestudy participants Nearly 51% of the total population, 5 times a week and more consumed vegetables and fruit. Comparedwith the results obtained in other European
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