CHAPTER ONE
INTRODUCTION OVERVIEW
Rapid changes in demography and social and economic development play an important role in the emergence of noncommunicable diseases (NCDs) as a public health problem.1 The growing burden of NCDs represents a major challenge, not only for developed countries but also for developing countries. The risk factors underlying major NCDs (heart disease, stroke, diabetes, cancer and respiratory disease) have been well documented and are well known.2 Cardiovascular diseases (CVDs) is a major cause of disability and premature death throughout the world. The underlying pathology is atherosclerosis, which develops over many years and is usually advanced by the time symptoms occur, generally in middle age. Acute coronary events (heart attacks) and cerebrovascular events (strokes) frequently occur suddenly, and are often fatal before medical care can be given. Risk factor modification can reduce clinical events and premature death in people with established cardiovascular disease as well as in those who are at high cardiovascular risk due to one or more risk factors.3 According to World Health Organization (WHO) data, 17.5 millions of death each year are due to CVD. Of these, 7.6 million are attributed to coronary heart disease(CHD) and 5.7 million to stroke.4 Although cardiovascular diseases typically occur in middle age or later, risk factors are determined to a great extent by behaviors' learnt in childhood and continued into adulthood, such as dietary habits and smoking. Throughout the world, these risks are starting to appear earlier.5 Findings of various studies worldwide suggested that adolescents lacked knowledge
2 regarding the risk of cardiovascular diseases and did not perceive themselves at risk for cardiovascular diseases.6 Adolescence is a life phase where nutrient intake is particularly important and may also change because of hormonal, cognitive, and emotional changes and an accelerating growth rate.7 Since adolescents are becoming less dependent on the food choices and purchases of their parents, dietary habits may change in this stage of life.8,9 Nutrition early in life has an impact on long term health, especially concerning CVDs.10 This is probably related to the fact that food and taste preferences develop during childhood and adolescence and often persist into adulthood.11 The role of diet is crucial in the development and prevention of cardiovascular disease. Research makes it clear that abnormal blood lipid (fat) levels have a strong correlation with the risk of coronary artery disease, heart attack and coronary death. In turn, abnormal blood lipids are related to what you eat. A diet high in saturated fats (e.g. cheese) and trans fats leads to high levels of cholesterol. Saturated fats are found in animal products. Trans fats are oils that have been hydrogenated to turn them into semi-hard fats. Hydrogenated fat is found in processed food. Saturated and trans fats raise cholesterol levels in the blood, which in turn can lead to atherosclerosis.28 Atherosclerosis are fatty deposits that can clog arteries. These buildups are called plaque. They’re made of cholesterol, fatty substances, cellular waste products, calcium and fibrin (a clotting material in the blood).15
