A Comparison Between Elderly and Adolescents Regarding Their Knowledge About Cholesterol and Lifestyle Choices by Gretchen L. Bettua Submitted in Partial Fulfillment of the Requirements for the Master of Science in Nursing Degree, Edinboro University of Pennsylvania THESIS HURS 1998 B565c c.2 Bettua, Gretchen L. Approved by: JUdith Schilling, CRNP, PhD f Committee Chairperson Edinboro University of Pennsylvania A comparison between elderly and adolescents 1998. Date Alice Conway, RN, PhD7 Committee Member Edinboro University of Pennsylvania fevelyn Hamming, RN, PhD Committee Member Department of Nursing, Thiel College Date A Comparison Between Elderly and Adolescents Regarding Their Knowledge About Cholesterol and Lifestyle Choice Abstract The goal of this research was to compare and contrast the elderly and adolescent populations’ knowledge about cholesterol and their lifestyle choices. Data for this study were gathered via a researcher-written survey that was given to elderly and adolescent sample populations in a rural area of western Pennsylvania. Each group consisted of 36 participants. The survey concerned demographics, lifestyle, and knowledge about cholesterol. Quantitative data were analyzed using descriptive statistics for demographics, level of knowledge, and lifestyle comparison. A knowledge deficit was found in both sample populations. The elderly were able to answer only an average of 9% of the questions about cholesterol and the adolescents answered an average of 34% of these correctly. The data also showed that the sample populations had several risk factors for developing high blood cholesterol. For example, 58% of the adolescent’s and 31% of the elderly used tobacco products. Thirty- five percent of the elderly population is overweight. The adolescent population was 8% overweight. The median time the elderly exercised four times per week was only 20 minutes whereas the adolescents ii exercised a median of 45 minutes six times per week. Of those that smoke and are sedentary only 6% were in the elderly population but 14% of the adolescent population fall into this category. More than 41% of the adolescents and only 14% of the elderly did not want additional education about cholesterol. Teaching about cholesterol is recommended using an adaptation of the American Heart Association’s “Cardiovascular Risk Factor Education Program”. Smoking cessation also needs to be addressed. iii Acknowledgements Heart felt thanks to Dr. Judith Schilling for all of the information she supplied, all of the editing and suggestions, and for pushing and encouraging me. To Dr. Alice Conway, thank you very much for all of the time you dedicated to me even in the middle of your own midterms and finals, you have been an excellent role model. Dr. Evelyn Ramming, has been my mentor for a long time (whether she knew it or not) and an inspiration; thank you for your support and time. To my husband, Larry, thank you for always believing in me and for your patience, support, and dedication to the end. iv Table of Contents Content Page Abstract ii Acknowledgements iv List of Tables viii Chapter I: Introduction 1 Background of the Problem 1 Research Questions 4 Theoretical Framework 5 Assumptions 6 Limitations 6 Summary 7 8 Chapter II: Review of Literature The Physiology of Cholesterol 8 The Problem of Hypercholesterolemia 9 Factors that Affect Blood Cholesterol 13 Diet 14 Exercise 17 Obesity 20 Cigarette Smoking 21 22 Summary v Content Page Chapter III: Research Methodology 23 Research Hypothesis 23 Operational Definitions 23 Research Design 24 Procedures 24 Sample 25 Informed Consent 25 Instrumentation 26 Analysis of Data 27 Summary 28 29 Chapter IV: Results Demographics 29 Lifestyle Choices 30 Knowledge of Cholesterol 32 Summary 32 Chapter V: Discussion 34 Summary 34 Conclusions 34 Recommendations 37 39 References vi Content Page Appendixes 44 A. Introduction Script 45 B. Cover Letter for Questionnaire 46 C. Cholesterol Knowledge Survey 47 D. Letter of Permission - High School 51 E. Letter of Permission - Senior Center 52 F. Adolescent Raw Data 53 G. Elderly Raw Data 68 H. Facts about Blood Cholesterol 83 vii List of Tables Table Page 1. Demographics 30 2. Lifestyle Choices 31 3. Knowledge of Cholesterol Survey Summary 33 viii 1 Chapter I Introduction This chapter presents the research problem and the purpose for conducting this research. Dorothea Orem’s (1995) self-care theoiy was the theoretical framework for this study. Assumptions and limitations of this study are also discussed. Background of the Problem The American Heart Association (AHA) has estimated that 52.1% of all American adults, totaling 97.2 million people, have blood cholesterol values of 200mg/dL and higher. In addition, the AHA also reported that approximately 38.3 million, or 20.5% American adults, have levels of 240 or above (Cholesterol Statistics, 1997). An estimated 36.5% of American youth age 19 and under, which equals 27.4 million children, have serum cholesterol levels of 170 mg/dL or higher. A Cholesterol level of 170 mg/dL in the adolescent is comparable to a level of 200 mg/dL in adults (Cholesterol Statistics, 1997). Blood cholesterol plays an important part in deciding a person’s risk for coronary heart disease (CHD). The higher the blood cholesterol levels the greater the risk. One aspect of the role of the nurse practitioner (NP) is teaching prevention of disease; therefore, the NP is impacted by this statistical information regarding 2 hypercholesterolemia. Knowledge of cholesterol enables the NP to recognize those populations at risk and take appropriate measures to prevent, postpone, or control associated diseases. As a naturally occurring substance in the body, cholesterol contributes to such vital bodily functions as building new cells, insulating nerves, and producing hormones (Cholesterol Problems, 1997). The liver makes all the cholesterol the body normally needs, but because this waxy substance is found in all animal tissues, it is ingested in diets that include meat and dairy products (Cholesterol Problems, 1997). High cholesterol in the blood can be a risk factor for angina, atherosclerosis, heart disease, high blood pressure, stroke, and other circulatory ailments (Cholesterol Problems, 1997). The risk of developing these conditions is complex and depends not only on total cholesterol, but also on what kind of cholesterol predominates. Generally, low-density lipoprotein cholesterol (LDL) is associated with an increased risk of atherosclerosis-associated diseases. High-density lipoprotein cholesterol (HDL) is associated with decreased risk (Cholesterol Problems, 1997). Cardiovascular disease happens over decades, but it may begin before person is bom. According to a press release by the European Society of Cardiology, hypercholesterolemia-related lesions can 3 actually begin in the womb (Napoli, 1996). A study was conducted on fetuses that were spontaneously aborted and on premature newborns that died shortly after birth. Results demonstrated that fatty streaks began to occur during fetal development. The size of these lesions was greatly increased in fetuses whose mothers had elevated plasma cholesterol levels (Napoli, 1996). By the time people start thinking about their heart health, some damage may already have been done. Lifestyle modification strategies such as lowering serum cholesterol by reducing dietary fat, maintaining a normal weight, smoking cessation, and regular exercise appear to slow the insidious progression of disease. One such lifestyle modification is the Step II Diet, a low fat, low-cholesterol diet intended to lower serum cholesterol. The National Cholesterol Education Program (NCEP), a federally appointed panel of cholesterol experts, advocates this diet. However, a study, funded by the National Heart, Lung, and Blood Institute, tested the efficacy of the Step II Diet (Stefanick, 1996). The Stanford study, as it is called, investigated the effect of this diet with and without exercise. It was found that diet alone was not enough to lower LDL significantly in those with both low HDL and high LDL. But if the study subjects also exercised, their LDL cholesterol showed a clinically important drop (Stefanick, 1996). 4 Dr. Dean Ornish (Ornish, et al., 1990) developed another lifestyle approach. Ornish devised a controversial lifestyle modification that he claimed reverses damage done by high serum cholesterol, obesity, smoking, and a sedentary lifestyle. Ornish suggested a plan that consisted of a vegetarian diet, just 10 % of calories from fat, moderate aerobic exercises, and smoking cessation (Ornish, et al., 1990). He included regular group support meetings, which provided a sense of community and connection. Dr. Ornish believed that all of these modifications were critical to the healing process. Reversal of atherosclerotic plaques was documented by the use of the positron emission tomography scan (Gould et al., 1995). The problem of hypercholesterolemia effects the NP directly. The responsibility of the NP is to teach diet modification, exercise, and lifestyle changes such as smoking cessation and weight loss. NPs support the fight against high cholesterol and heart disease by teaching and encouraging patients to take part in their own health and then by monitoring their progress. Research Questions This study was designed to determine and compare what elderly persons and high school students, in neighboring small western Pennsylvania communities, actually knew about cholesterol. 5 The following research questions were asked: 1. Is there a relationship between lifestyle choices and knowledge concerning cholesterol? 2. Is there a difference between the elderly and adolescents with respect to their level of knowledge and their lifestyle choices? Theoretical Framework According to the nursing theorist Dorothea Orem (1995), selfcare agency is a complex, acquired ability to meet a person’s continuing need to regulate his/her life process, functioning, human development, and to promote well-being. The self-care agency of individuals varies over a range with respect to its development from childhood through old age. Orem believed that humans discover, develop, and transmit ways to take care of themselves and their loved ones. Knowledge about cholesterol can stimulate the discovery and development of ways for caring for one’s self and others. The prevention of hypercholesterolemia should begin at an early age and continue throughout the life of the individual. The pursuit of knowledge to better one’s self increases one s power to act deliberately, and care for self and others. Orem proposed that humans need continuous self-care maintenance and regulation in order to be to be healthy. Knowledge 6 about cholesterol en.ables purposeful action toward self-care activities that maintain life, health, and well-being. By increasing and applying knowledge of cholesterol, lifestyle, and diet, people take better care of themselves. A role of the NP is to be a self-care facilitator. To enhance self- care, the NP assesses the patient’s need and desire to learn through observation, a detailed history, and physical examination. Then the NP carries out the appropriate teaching and monitoring of changes made. Assumptions This research study is based on the assumption that the information in the survey supplied by self-report is accurate and honest. In addition, it is assumed that all of those in the research sample populations were mentally competent and capable of reading and comprehending the instructions and the survey questions. Limitations Research subjects in this study were a convenience sample from two small neighboring western Pennsylvania communities. The size of the sample effects the ability of these research findings to be applied generally to other populations. An additional limitation of this study is that the survey tool was researcher-developed. 7 Summary This research was a study of the level of knowledge regarding blood cholesterol in adolescent and elderly populations. More specifically, this study was intended to evaluate and compare the knowledge level of these two distinctly different sample populations concerning cholesterol. In this chapter the problem of hypercholesterolemia was described. The purpose of the study was discussed and the theoretical framework was presented. Assumptions and limitations were also identified. 8 Chapter 2 Review of Literature In this chapter a brief overview of the physiology of cholesterol is presented and the problem of hypercholesterolemia is discussed. Selected studies that researched the impact of lifestyle and diet on serum cholesterol are also reviewed. The Physiology of Cholesterol Cholesterol circulates in the bloodstream in association with lipoproteins containing triglycerides, phospholipids, and proteins. There are four main classes of these lipoprotein complexes: chylomicrons, veiy-low-density lipoproteins (VLDL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL) (Witztum & Steinberg, 1996). Chylomicrons appear in the bloodstream after a meal and transport dietary triglycerides from the gut to sites where the triglycerides are used or stored. VLDL transports triglycerides and cholesterol that are synthesized by the liver to similar sites for utilization or storage (Witztum & Steinberg, 1996). When chylomicrons and VLDL reach capillary beds in tissues such as muscle or fat, an enzyme breaks down the triglycerides into fatty acids and glycerol. The remaining chylomicron remnants continue to circulate until the liver takes them up and converts them 9 primarily to LDL. LDL is removed from the circulation by being absorbed into liver cells. For liver cell absorption of LDL to occur, the LDL must bmd to the LDL receptor on the hepatic cell surface. The LDL-cholesterol complex is small and dense compared to chylomicrons and VLDL. When it is present in high concentrations it tends to deposit inside arterial blood vessel walls. This contributes to the plaque deposits associated with atherosclerosis (Witztum &' Steinberg, 1996). HDL has a different function in the body. It removes excess cholesterol from cells and helps transport it back to the liver. High HDL levels are associated with a reduced risk of heart disease and low HDL levels with an increased risk of early heart disease (Witztum & Steinberg, 1996). The Problem of Hypercholesterolemia Coronary heart disease (CHD) is the leading cause of illness and death in the United States (Collins, 1988). The National Institutes of Health (Steinberg et al., 1984) reported that coronary heart disease (CHD) is responsible for more than 500,000 deaths in the United States each year. According to the classic study, The Framingham Heart Study, there are over 5.4 million Americans with symptomatic CHD and a large number of others with undiagnosed coronary disease, many of them young (Kannel, Castelli, Gordon, & McNamara, 10 1971). CHD is a slowly progressive disease of the large arteries that begins early in life but rarely produces symptoms (such as angina, atherosclerosis, heart disease, high blood pressure, or stroke) until middle age. Often the disease goes undetected until the time of a first heart attack (Steinberg et al., 1984). In the United States, children have been found to have fatty streaks of preatherosclerosis in their arteries and there is evidence that people should begin to modify their risk factors for heart disease early in life. A study called Pathobiological Determinants of Atherosclerosis in Youth (PDAY), a multicenter research project that began in 1985, performed autopsies on 1,443 young people, between the ages of 15 and 34, who died from violent or accidental causes (McGill, McMahan, Malcom, Oalmann, & Strong, 1997). The researchers defined atherosclerosis of the aorta and right coronary artery by the extent of intimal surface involvement in fatty streaks and raised lesions. They also analyzed postmortem blood serum for lipoprotein cholesterol and thiocyanate as an indicator of smoking (McGill et al., 1997). The PDAY researchers found that the extent of intimal surface involved with both fatty streaks and raised lesions increased with age in ah arterial segments for both sexes and all racial groups. In addition, they found that VLDL and LDL cholesterol concentrations were associated positively, and HDL cholesterol was 11 associated negatively, with the extent of fatty streaks and raised lesions in the aorta and right coronary arteiy. Smoking was associated with more extensive fatty streaks and raised lesions in the abdominal aorta. The researchers also reported that the distinctions between subjects with high and low cholesterol levels were detected in people as young as 15 years of age (McGill et al., 1997). The PDAY researchers concluded that it is important for people to begin modifying their diets and eating habits by their late teens in order to delay the buildup of fatty deposits in the arteries, and ultimately delay the onset of coronary heart disease later in life. Two of the most important studies that have shown a link between cholesterol and the number one killer CHD, are the Framingham Heart Study (Kannel et al., 1971), and the Multiple Risk Factor Intervention Trial (MRFIT) (Multiple Risk Factor Intervention Trial [MRFIT] Research Group, 1982). The Framingham Heart Study, which began 40 years ago and is still ongoing today, provided early epidemiologic evidence that elevated serum cholesterol is a risk factor for CHD (Kannel et al., 1971). In 1971, investigators reported the cholesterol and coronary histories of 2,282 men and 2,845 women in Framingham, Massachusetts, over a period of 14 years. During this study, almost all of the Framingham participants had total serum cholesterol levels between 150 and 300 mg/dL. Investigators found a 12 positive correlation between serum cholesterol levels and CHD rates across the range of cholesterol measurements. Low levels of serum cholesterol were associated with low rates of CHD, while high levels of serum cholesterol were associated with high rates of CHD (Kannel et al., 1971). MRFIT was a randomized, primary prevention trial that looked at the effects of blood pressure, smoking, and serum cholesterol on the development of CHD. Subjects were selected from a cohort of 316,099 men, ages 35 to 57 (MRFIT Research Group, 1982). The serum cholesterol levels of the cohort were measured and the CHD death rates at 6 and 12 years were observed (Neaton et al., 1992). This has provided extraordinary epidemiologic data on the relationship between higher cholesterol levels and increased risk of CHD. In addition, it was reported that an association between elevated serum cholesterol and increased CHD mortality began with serum cholesterol levels as low as 180 mg/dL (MRFIT Research Group, 1982; Neaton et al., 1992). Evidence from the following study suggested that lowering cholesterol would decrease the risk of expei iencing or dying from a coronary event. The Scandinavian Simvastatin Survival Study (4S) definitively demonstrated that people with high cholesterol who decreased their cholesterol had a 25% reduction in heart attack and 13 death from heart disease (Scandinavian Simvastatin Survival Study [4S] Group, 1994). Although this study used medication to lower cholesterol, the study’s findings may also be applied to lifestyle and dietary changes that lower total cholesterol. The 4S group studied 4,444 patients, 35 to 70 years of age, who were recruited from 94 centers in Scandinavia. This was a double­ blind study where patients, with a fasting cholesterol level of 212 to 310 mg/dL, were randomized to receive simvastatin 20 mg or a placebo. This study was stopped early because the results comparing the intervention group to the placebo group were becoming statistically significant. It was found that after only 5 years of lowering the serum cholesterol, the need for angioplasty and coronary artery bypass surgery was decreased by 26% and strokes were decreased by 31% (4S Group, 1994). It has been shown through the 4S research that lowering cholesterol levels with medication will lower risk of heart disease. These findings may be generalized to lowering serum cholesterol through lifestyle modifications, such as exercise, a low fat diet, smoking cessation, and normalizing body weight. Factors that Affect Blood Cholesterol Blood cholesterol levels are influenced by many factors; some can be controlled and some cannot. The factors that Impact blood 14 cholesterol that cannot be changed are sex, age, and heredity. Discussed below are those factors that may be modified, controlled, and/or changed such as diet, sedentary lifestyle, obesity, and smoking. Diet. The Western Electric Study (Shekelle et al., 1981) was one of the prominent epidemiological studies that showed a strong, independent correlation between consumption of dietary cholesterol and risk for CHD. This study began in 1958 with dietary and clinical examinations of more than 1,900 middle-aged men. During the study, the men were reexamined annually for 19 years. Correlation was found between average daily consumption of dietary cholesterol and the rates of CHD. The follow-up of these men indicated that a dietary reduction of 200 mg cholesterol/1,000 kcal was associated with 37% reduction in total mortality, and an increase in life expectancy of 3.4 years. Ornish (Ornish et al., 1990) conducted another study to determine if a comprehensive program of intensive lifestyle changes could have a positive impact on the progression of CHD. The lifestyle modifications used for the intervention group were a vegetarian diet, with less than 10% of calories from fat and with minimal amounts of saturated fat, an exercise program, and stress management techniques. Ornish also supplied a smoking cessation program for 15 those who smoked, group support, and psychological counseling. The intervention group did not use any medications to lower their lipid levels. A control group of 20 patients followed conventional dietary guidelines, averaging 30% of calories from fat and an intake of 200 mg cholesterol per day. In addition, the control group did not receive prescribed exercise programs, group support, counseling, instruction in stress reduction, or smoking cessation as in the intervention group. Unlike the intervention group, the control group was not asked to make lifestyle changes, but they were free to do so (Ornish et al., 1990). Ornish reported that a group of 28 patients following his treatment program for 1 year showed a measurable reversal of coronary arteriosclerosis (Gould et al., 1995). CHD in the patients in the control group, on the average, got worse instead of better. By use of the proton emission tomography scan it was shown that 45% of those in the control group had worsening defects, 50% showed no change, and 5% showed improvement. By comparison, all but 1% in the experimental group showed improvement or no changes. The American Heart Association (AHA) and the National Cholesterol Education Program (NCEP) have recommended the Step I and Step II Diet’s for the treatment of hypercholesterolemia (Stone, 16 Nicolosi, Kris-Etherton, Ernest, & Krauss, 1996). Primarily, the aim of this dietary therapy is to reduce the risk of CHD. These diets were designed to help decrease intake of saturated fat and cholesterol, restore healthy calorie intake and, at the same time, to promote overall balanced nutrition (Stone et al., 1996). The Step I and Step II Diets were designed to be carried out in a medical setting. For those patients who had not reduced their fat and cholesterol intake prior to treatment, the Step I Diet was the initial therapy (Stone et al., 1996). The Step II Diet suggested additional reductions in saturated fat (from 8% or 10% to less than 7%) and cholesterol (from 300 mg to 200 mg per day) and was initiated to achieve additional cholesterol lowering. Patients whose cholesterol levels were in the high-risk range (240 mg/dL and higher), or who had had a heart attack, may be encouraged to use the Step II Diet. These changes in diet should be carried out along with regular physical activity in all patients and weight reduction in the overweight (Stone et al., 1996). A follow-up to the Framingham Heart Study was recently published (Gillman, Cuppies, Millen, Ellison, & Wolf, 1997). During this 20-year follow-up the researchers examined the association of stroke incidence with intake of fat and type of fat among middle-aged American men. There were a total of 832 men, aged 45 through 65 17 years, who were free of cardiovascular disease at the baseline. Ischemic stroke occurred in 61 subjects during the follow-up period (Gillman et al., 1997). The authors of this study examined the dietary histories of men in the Framingham Heart Study and related the intake of fat of those men to their subsequent risk for ischemic stroke. In the subsequent 18 to 20 years of follow-up, the risk of ischemic stroke declined with the increase in fat in the diet. This suggested that there is an inverse relationship between the dietary risk factors for ischemic stroke and coronary heart disease. Thus, although fat intake can predispose to atherosclerosis of larger vessels, fat may protect against altering the integrity of smaller intracranial vessels. The research data indicated that total polyunsaturated fat intake may have little impact on stroke risk, but component fatty acids may be important (Gillman et al., 1997). This creates an interesting dilemma when teaching about diet modifications. This new research data suggests that the Step II Diet and Dr. Ornish’s approach, while decreasing blood cholesterol, may also be increasing the risk of ischemic stroke (Sherwin & Price, 1997). The NP must learn to teach diet modification with discretion and monitor progress carefully. Exercise. The Step II Diet, recommended by the NCEP since 1988, was designed to lower LDL cholesterol levels. A study funded by 18 the National Heart, Lung, and Blood Institute, called the Stanford Study, investigated the effect of the Step II Diet on cholesterol with and without exercise. People selected for this study had unhealthy cholesterol profiles, defined as high levels of LDL cholesterol coupled with low levels of HDL cholesterol (Stefanick, 1996). To study the effects of diet and exercise on cholesterol levels, researchers divided the subjects into four groups: dieters only, exercisers only, a group that followed both the diet and exercise program, and a control group that made no lifestyle change. The researchers compared the four groups’ cholesterol levels after 1 year of participation. The Stanford researchers found that the Step II Diet alone was not enough to lower LDL significantly in those people with both low HDL and high LDL. But, if these people also exercised, their LDL cholesterol dropped an average of 7.5% to 10% below that of the control group (Stefanick, 1996). It was found that relatively moderate amounts of physical activity and levels of physical fitness gave a protective benefit against both all-cause and cardiovascular mortality. To evaluate the relationship between changes in physical fitness and risk of mortality, a prospective study (Blair et al., 1995) was conducted to assess change or lack of change in physical fitness associated with risk of mortality. This study included 9,777 men. They were given two 19 medical examinations, approximately 5 years apart, each of which included assessments of physical fitness by maximal exercise tests, and evaluation of overall health status. It was found during this study that the highest age-adjusted all-cause death rate was observed in subjects who were unfit at both examinations. The lowest death rates occurred among the subjects who were physically fit at both examinations. Those who improved from unfit at the first examination to fit at the second examination had an age-adjusted death rate that reflected a reduction in mortality risk of 44% when compared to the men who were unfit at both examinations. For each minute increase in maximal treadmill time between examinations, there was a corresponding 7.9% decrease in risk of mortality. The researchers concluded that those who maintained or improved adequate physical fitness were less likely to die from all causes and from cardiovascular disease (Blair et al., 1995). The United States Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) recently issued guidelines and recommendations on the amount and frequency of physical activity necessary to encourage health benefits in those who are predominantly sedentary (Pate et al., 1995). It was recommend that adults should accumulate 30 minutes or more of 20 moderate-intensity physical activity on most, preferably all, days of the week. Obesity. Obesity in childhood may be an important predictor of future heart disease (Rona, Qureshi, & Chinn, 1996). A study was conducted at St. Thomas’ Hospital in London with approximately 1,700 9 year-old children. The researchers found that obese children had both higher blood pressure and cholesterol levels than 9 yearolds of normal weight (Rona et al., 1996). They concluded that childhood obesity is a permanent risk factor throughout life. The researchers made the recommendation that, to aid in the prevention of heart disease in adulthood, it is important to reduce the incidence of obesity in children. The Centers for Disease Control (CDC) and Prevention’s Third National Health and Nutritional Examination Survey (NHANES III) (1988-1994) provided the most recent national estimates of overweight among children ages 6 toll, adolescents ages 12 to 17, and adults ages 18 and older (Centers for Disease Control [CDC] and Prevention, 1997). NHANES III survey was a stratified, multistage, probability cluster sample representative of the US civilian, non-institutionalized Population. The survey was designed as a 6 year survey, with Phase I conducted from 1988 through 1991 and Phase 2 from 1992 through 21 1994. Estimates from both phases were combined in order to decrease variability (CDC, 1997). Stature and weight were measured as part of a standardized physical examination in a mobile examination center (CDC, 1997). Body Mass Index (BMI) was used as measure of weight adjusted for stature. Children and adolescents were categorized as overweight when their BMI was at or above the 95th percentile for their gender and age. Adults were classified as overweight when their BMI was in the 85th percentile. This latest analysis from NHANES III showed that approximately 14% of children, 12% of adolescents, and 35% of adults are overweight. This represented significant increases in all age groups since NHANES II was conducted from 1976-1980 (CDC, 1997). Cigarette Smoking. According to a recent study conducted at the Boston Children’s Hospital, exposure to second-hand cigarette smoke can have a detrimental effect on children who already have high cholesterol by lowering their HDL levels by 10% (Neufeld, MietusSnyder, Beiser, Baker, & Newburger, 1997). The 103 children who participated in this study were between the ages of 2 and had been referred to the Boston Children's Hospital for evaluation of elevated cholesterol levels (above 200 mg/dL), low HDL levels, or a family history of heart disease. Twenty-eight ehddren lived with at least one smoker in the home. All children in this study had below 22 average levels of HDL, but those living with a smoker had the lowest HDL levels. In conclusion, this study suggested that eliminating cigarette smoke from their homes could improve the HDL levels of many children who were regularly exposed to passive smoke. Summary This chapter reviewed the physiology of cholesterol in the body and the problem of cholesterol as a risk factor for developing CHD. Supporting research was referenced in this chapter to demonstrate the impact that diet, exercise, smoking, and obesity can have on serum cholesterol. 23 Chapter 3 Research Methodology The purpose of this survey research was to determine the level of knowledge regarding cholesterol in both an elderly and an adolescent population. The research subjects lived in two neighboring small western Pennsylvania communities. The information gathered was analyzed to determine the differences and similarities between these two generations of subjects regarding their levels of knowledge about cholesterol and their lifestyles. Research Hypothesis The study was expected to show that the elderly population was more knowledgeable regarding cholesterol than their counterpart, the adolescent, due to their disease histories and life experiences. However, the adolescent population was expected to have a better lifestyle profile due to the nature of youth and recent increases in national awareness and education. Operational Definitions The following terms were defined as they were used in this study: 1. Adolescents were male and female high school students ranging from grades 9 through 12. 2. The elderly were males and females who were 65 or older. 24 3. Obesity is an increase in body weight of 20% or more above desirable level (Metropolitan Life Insurance Company, 1983). 4. Extreme obesity corresponds to a weight of twice the desirable weight or 45 kg (100 pounds) over the desirable body weight (Metropolitan Life Insurance Company, 1983). Research Design This research was conducted using a non-experimental design. It was a quantitative study using a researcher-designed survey. Procedure Data for this research study were gathered on two different days in April, 1998. The first day 1 hour was spent gathering data at a Senior Center in a small community in western Pennsylvania. Seniors did not arrive at the center at one time; they came in individually and in small groups. Using a prepared script, the researcher addressed each individual and small group, introduced herself and explained the goal and purpose of the survey (Appendix A). There were 36 volunteers from the Senior Center who agreed to fill out the survey. After each subject completed the survey a copy of “Facts about Blood Cholesterol” (National Institutes of Health [NIH], 1996) was given (see Appendix F). The second day, the researcher spent 1 hour at a high school in a small community in western Pennsylvania. Teaching staff 25 introduced the researcher who explained the purpose and goal of the survey. The survey was then distributed, with pens supplied by the researcher for the high school students to keep. A box was positioned at a front table to collect the completed surveys. There were 36 surveys distributed and 36 surveys were returned completed. After the participants returned the surveys, M&M candy was given and a copy of “Facts about Blood Cholesterol” (NIH, 1996) was offered. Seven copies were distributed. Sample Participants in this study came from two neighboring communities in western Pennsylvania. The adolescent population consisted of adolescents in grades 9 through 12, with an average age of 16. The elderly population consisted of members of a Senior Center, with an average age of 73. A convenience sample of 36 high school students and 36 participants at a senior center were given the survey. All of surveys distributed were completed and returned. Informed Consent Permission to conduct this research was granted by the Principal at the associated high school (Appendix D). The Director of the senior center also granted permission to conduct the survey (Appendix E). 26 The subjects were orally given the option to decline filling out the survey with no penalty. Completing the survey was considered to constitute consent, and the subjects were advised not to put their names anywhere on the questionnaire in order to ensure anonymity and confidentiality. These instructions were also attached to the front of each survey (Appendix B). The survey was completed anonymously and in this way confidentiality was maintained. Only grouped data were reported. Instrumentation The instrument utilized in this research was a series of 11 multiple choice questions developed by the researcher. The survey included three categories: demographics, lifestyle choices, and knowledge of cholesterol (Appendix C). The first section, “demographics”, included spaces to indicate sex, height, weight, age, and education level. The risk factor that was considered in this section was the overweight status of the sample populations. In the second section, “lifestyle choices”, the researcher first asked questions about exercise, duration of exercise, and number of times each subject exercised per week. The second set of questions in this section addressed tobacco use including age when the subjects may have started and/or stopped and whether or not the subjects 27 lived with others who use smoke tobacco. The final question in this section asked the subjects whether or not they were interested in learning more about cholesterol. The last section in this survey was “knowledge of cholesterol”. This section consisted of 11 general knowledge, multiple choice questions designed by the researcher. The intent of the questions was to decipher what the subjects knew about cholesterol. A pilot study was done in order to establish clarity of the questions prior to administering it to the selected sample populations. The researcher gave the survey to a group of home schooled adolescents, and to five patients at a local hospital who fit the definition of elderly established for this research. Changes were made based on these individuals’ suggestions regarding the clarity, format, and content of the survey. The survey took approximately 15 minutes to complete. Analysis of Data The data that was gathered via the surveys was entered individually onto a spreadsheet using Microsoft Exel97. These data were grouped and then ranges, means and percentages were calculated (Appendix G and H). Descriptive statistics were utilized to analyze the data gathered in the survey. Means and percentages described and compared the 28 data. Because knowledge deficits regarding cholesterol were found, a teaching plan was proposed. The proposed curriculum was an adaptation of the American Heart Association’s ^Cardiovascular Risk Factor Education Program” (Allen et al., 1996). Summary The purpose of this study was to compare knowledge levels of the elderly and high school students regarding cholesterol, and to compare aspects of their lifestyles. To accomplish this a researcher- written survey was given. The survey was validated for content and ease of comprehension prior to administering it to the selected sample populations. The data were then analyzed for similarities and differences between the two generations. Knowledge deficits were found and a teaching plan was proposed. 29 Chapter 4 Results There were three sections to the survey* demographics, lifestyle choices, and knowledge of cholesterol. This chapter discusses the results gathered and compares the two populations. Only grouped data is reported. Demographic Data Demographic data from the research subjects included sex, height, weight, age and level of education. Of the 36 high school students 23 were male and 13 were female; the seniors were divided into 6 males and 30 females. The average age of the adolescent group was 16 years and the elderly group averaged 73 years. The average education level of the high school subjects was 10th grade and the elderly had an average of 11th grade education. The self-reported heights and weights of the subje compared to the Metropolitan Life Insurance Company Weight Tables (Metropolitan Life Insurance Company, determine the overweight status of the groups. • onH 35.3% of the elderly group adolescents, 8.3% were overweight hie data are summarized in Table . were overweight. These demographic 30 Table 1 Demographics Elderly Adolescent 6 23 Number of females 30 13 Total (n) 36 36 Average age 73 16 Average grade 11 10 Overweight 12 3 Number of males Lifestyle Choices Data from the second section of the survey, lifestyle choices, covered exercise frequency and duration, tobacco use, and desire to learn more about cholesterol. Seventy-five percent of the adolescents claimed to exercise an average of 6 times per week. The adolescents reported that they exercised from 3 minutes to 150 minutes each time they exercised, for an average of 82 minutes each time. The median time exercised for the adolescent population was 45 minutes. Sixty-nine percent of the elderly population claimed to exercise an average of 4 times per week. The elderly sample population 31 reported that they exercised from 5 minutes to 240 minutes each time, also for an average of 82 minutes each session. However, the median time exercised for the elderly population was 20 minutes Twenty-one or 58% of the adolescents admitted to using tobacco products and 17 (47%) said that they lived with others who used tobacco. Among the elderly surveyed, 11 (31%) admitted to using tobacco and none lived with others who used tobacco. Twenty-one (58%) of the students reported that they were interested in learning more about cholesterol. Of the elderly, 26 or 72% said that they wanted to learn more about cholesterol. These data gathered from lifestyle choices are summarized in Table 2. Table 2 Lifestyle Choices Adolescent n % Sample population Elderly n % Those that exercised 25 69% 27 75% Those that used tobacco 11 31% 21 58% Live with others who used tobacco 0 0% 17 47% Wanted to learn more 26 72% 21 58% 32 Knowledge of Cholesterol Knowledge of cholesterol was the third and final section of the survey. It consisted of 11 multiple choice questions that dealt with the subjects knowledge of foods that are low in cholesterol, general questions about blood cholesterol limits, and risk factors that contribute to high cholesterol. Table 3 summarizes the responses of each group to these lifestyle questions. It shows a comparison between the percentage of elderly and adolescents who correctly answered each question. The adolescents answered an average of 34% of the questions correctly, which is an average of four questions correct out of the possible 11 questions. The elderly answered an average of only 9% of the questions correctly, or one out of the possible 11 questions. Summary Chapter IV has summarized all data that were collected in the survey. The survey was comprised of three sections: demographics, lifestyle choices, and knowledge of cholesterol. The results of each of the sections were discussed. 33 Table 3 Knowledge of Cholesterol Question summary Elderly % correct Adolescent % correct 1. Where does cholesterol come from? 6% 25% 2. Foods that contain saturated fats. 56% 50% 3. Foods low in saturated fats. 33% 28% 4. Foods that have water-soluble fiber. 22% 0% 5. Vitamin that lowers cholesterol. 14% 19% 6. The age cholesterol damage starts? 11% 11% 7. Lifestyle risk factor recognition. 53% 61% 8. Total blood cholesterol level. 42% 69% 9. HDL blood cholesterol level. 17% 8% 10. LDL blood cholesterol level. 3% 39% 11. What will reduce risk of CAD? 56% 58% Average % of Questions Correct 9% 34% 34 Chapter 5 Discussion This chapter discusses the results of this research study and conclusions are drawn. Recommendations are made for further research and for education of the public. Summary This research was intended to answer two questions. The questions concerned the relationships between lifestyle choices and knowledge regarding cholesterol and the difference between the elderly and adolescents with respect to their level of knowledge about cholesterol and their lifestyle choices. This was a nonexperimental and quantitative study using a researcher-written survey. Descriptive statistics were used to analyze the data gathered. The two sample populations, the elderly and adolescents, were residents of small communities in weste Pennsylvania. Orem’s self-care theory was used as the the framework for this research study. Conclusions This study was designed to determine and compare what elderly Persons and high school students, in neighboring small western Pennsylvania communities, actually knew about cholesterol. 35 The following research questions were asked: 1. Is there a relationship between lifestyle choices and knowledge concerning cholesterol? 2. Is there a difference between the elderly and adolescents with respect to their level of knowledge and their lifestyle choices? In response to the first research question, no relationship was found between lifestyle choices and knowledge concerning cholesterol in the sample populations. In response to the second research question, it was expected that the elderly would be more knowledgeable regarding cholesterol and the adolescent population was expected to have a better lifestyle. Neither of these expectations proved to be true. Orem’s theory was not supported by the survey results. The survey data revealed that the elderly knew less abo cholesterol than the adolescent population. Only an average of 9% of the questions that concerned cholesterol were answered correctly by the elderly sample population and 34% by the adolescent sample population. It may be speculated that the elderly were not in the practice of taking tests and this may be a reason why they dtd not answer as many questions correctly as did the adolesce p P Some of the elderly subjects had only a sixth grade education. 36 Even considering the above speculation, the lifestyle risk factors of smoking, overweight, and lack of exercise found among the research participants may indicate that many members of these communities do not know enough about cholesterol. Many may have risk factors for developing high blood cholesterol. It has been found that relatively moderate amounts of physical activity and levels of physical fitness gave a protective effect against all-cause and cardiovascular mortality. The CDC recommended that adults should accumulate 30 minutes or more of moderate-intensity physical activity most days of the week (Pate el al., 1995). The median time spent exercising reported by the elderly in this study was 20 minutes four times per week and the adolescent median was 45 minutes six times per week. The Boston Children’s Hospital researched the effect of second hand smoke on HDL levels. Second hand smoke was found to lower the HDL levels of children by 10% (Neufeld et al., 1997). Twenty-one or 58% of the adolescents surveyed reported that they themselves smoke. In addition, 17 or 48% reported that they lived with others who smoke. Eleven or 31% of the elderly in this study admitted that they used tobacco, however, none of the elderly claimed to live with others who used tobacco. 37 NHANES III showed that approximately 12% of adolescents and 35% of adults nationwide are overweight (CDC, 1997). The overweight status of the adolescent sample population was 8% or 3 students. This is lower than the national average reported. The elderly sample population survey data showed 35%, or 12 of the elderly, were overweight which is the same as the national average. Orem (1995) proposed that people need knowledge to act purposefully toward self-care in order to maintain a healthy life. Due to the lack of knowledge about cholesterol found in these communities, the NP educative/ supportive role becomes very important. Recommendations It is the recommendation of the researcher that a similar study be carried out with a larger research sample, in different locations, and with different racial groups. All of those that participa study were Caucasian due to the population in these communities, not by exclusion or the intention of the resear It is recommended that further education be provided concerning cholesteroi and healthy lifestyle choices, especiahy smoking cessation. The researcher proposes that an adaptahon of the ’Cardiovascular Risk Factor Education Program fo>r Healthcare - , . a. accommodate the general Professional “” (Allen et al., 1996) be made to acco: 38 public. Then, teaching needs to be encouraged at the high school level and the senior center to increase the knowledge levels in these communities. 39 References Allen, J., Burke, L„ McBride, P„ Cunningham, S„ HoustonMiller, N„ McManus, K., Somelofski, C., Stoy, D„ & Thomas, T. (1996) Cardiovascular risk factor education program for healthcare professionals. Dallas: American Heart Association. Blair, S., Kohl, H., Barlow, C., Paffenbarger, R., Jr., Gibbons, L., & Macera, C. (1995). Changes in physical fitness and all-cause mortality: A prospective study of healthy and unhealthy men. JAMA, 273, 1093-1098. Centers for Disease Control and Prevention (1997). Update: Prevalence of overweight among children, adolescents, and adults in the United States, 1988-1994. MMWR, 46 (9), 199-202. Cholesterol Problems (1997). The New England Journal of Medicine, HealthNews. [Online], (1 p.). Available: http://www. americanheart. org Cholesterol Statistics (1997). American Heart Association. 1997 heart and stroke A-Z Guide [Online], (1 p.). Available: http://www. ericanheart.org. Collins, J.G. (1988). National Center for Health Statistics: Prevalence of selected chronic conditions, United States, 1983-1985. 40 Advance data from vital and health statistics. Hyattsville MD: US Public Health Service. National Institutes of Health (1996). Facts about blood cholesterol. (No. 96-2696). Bethesda: U.S. Department of Health and Human Services. Gillman, M., Cuppies, A., Millen, B., Ellison, R. C., & Wolf, P. (1997). Inverse association of dietary fat with development of ischemic stroke in men. JAMA, 278, 2145-2150. Gould, K. L., Ornish, D., Scherwits, L., Brown, S., Edens, R. P., Hess, M., Mullani, N., Bolomey, L., Dobbs, F., Armstrong, W., Merritt, T., Ports, T., Sparler, S., & Billings, J. (1995). Changes in myocardial perfusion abnormalities by positron emission tomography after long­ term, intense risk factor modification. JAMA Abstracts, 274, 894-901. Kannel W., Castelli, W., Gordon, T., & McNamara, P. (1971). Serum cholesterol, lipoproteins, and the risk of coronary heart disease: The Framingham study. Annals of Internal Medicine, 74, 112. McGill, H., McMahan, A., Malcom, G., Oalmann, M., & Strong, J., for the PDAY Research Group (1997). Effects of serum lipoproteins and smoking on atherosclerosis in young men and women. Arteriosclerosis, Thrombosis and Vascular Biology, 17, 95-106. 41 Metropolitan Life Insurance Company (1983). Height/weight Chart. [Online], (3 p.). Available: http://www.aomc.org. Multiple Risk Factor Intervention Trial (MRFIT) Research Group (1982). Multiple risk factor intervention trial: Risk factor changes and mortality results. JAMA, 248, 1465-1477. Napoli, C. (1996). Maternal hypercholesterolemia induces early atherosclerotic lesions containing oxidation-specific epitopes in human fetal aortas. European Society of Cardiology. [Online], (2 p.). Available: http://www.esc.be/Press97/PR97napoli.html. Neaton, J., & Wentowrth, D., for the Multiple Risk Factor Intervention Trial Research Group (1992). Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease. Archives of Internal Medicine, 152, 56-63. Neufeld, E., Mietus-Snyder, M., Beiser, A., Baker, A., & Newburger, J. (1997). Passive cigarette smoking and reduced HDL cholesterol levels in children with high-risk lipid profiles. Circulation, 96(5), 1403. Orem, D. (1995). Nursing: Concepts of practice (5th ed.). St. Louis: Mosby-Year Book, Inc. Ornish, D„ Brown, S., Scherwitz, L„ Billings, J., Armstron, W., Ports, T., McLanahan, S„ Kirkeeida, R„ Brand, R„ & Gould, K. (1990). 42 Can lifestyle changes reverse coronary heart disease? The lifestyle heart trial. Lancet, 336, 129-133. Pate, R„ Pratt, M„ Blair S„ Haskell, W„ Macera, C., Bouchard, C., Buchner, D., Ettinger, W., Heath, G., & King, A. (1995). Physical activity and public health: A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA, 273, 402-407. Rona, R., Qureshi, S., & Chinn, S. (1996). Childhood obesity is a risk for future heart disease. Journal of Epidemiology and Community Health, 50(2), 512-518. Scandinavian Simvastatin Survival Study (4S) Group (1994). Randomized trial of cholesterol lowering in 4,444 patients with coronary heart disease: The Scandinavian simvastatin survival study (4S). Lancet, 344, 1383-89. Shekelle, R., Shyrock, A., Paul, O., Lepper, M., Stamler, J., Liu, S., 8s Raynor, W. (1981). Diet, serum cholesterol, and death from coronary heart disease: The Western Electric Study. New England Journal of Medicine, 304, 65-70. Sherwin, R„ & Price, T. (1997). Fat chance: Diet and ischemic stroke (Editorial). JAMA, 278, 2185-2186. 43 Stefanick, M. (1996). Cholesterol-regulating diet works only when combined with exercise. [On-line] Doctor’s Guide to Medical and Other News. Available, http://www.pslgroup. com/elevchol.htn. Steinberg, D., Blumenthal, S., Carleton, R., Chasen, N., Dalen, J., Fitzpatrick, J., Hulley, S., Mahley, R., O’Keefe, G., Remington , R., Saunders, E., Shank, R., Spector, A., & Wissler, R. (1984). Lowering blood cholesterol to prevent heart disease. National Institutes of Health consensus statement 1984, 5(7): 1-11. Stone, N., Nicolosi, R., Kris-Etherton, P., Ernest, N., 8s Krauss, R. (1996). Summary of the scientific conference on the efficacy of hypocholesterolemic dietary interventions. Circulation, 94, 3388- 3391. Witztum, J., & Steinberg, D. (1996). The hyperlipoproteinemias. In Bennett, J.C., & Plum, F. (Eds.), Cecil textbook of medicine (20th ed.) (pp. 1086-1095). Philadelphia: W.B. Saunders Company. 44 Appendixes 45 Appendix A Introduction Script My name is Gretchen Bettua. I am a student in Edinboro University’s nurse practitioner program. I live and work in Greenville. Today, I am conducting a research study of people’s knowledge about cholesterol. I will be gathering information from both high school students and from adults over the age of 65. The information that is gathered from these two groups will be compared and their knowledge levels analyzed to see if teaching is needed regarding cholesterol. Would you please answer this questionnaire and help me with my study? It should take no more than 15 minutes to complete. You are not expected to know the answers to all of the questions. Just make your best guess on the ones that you are not sure of Your answers will remain confidential and anonymous. Whether or you choose to participate or not you will not be rewarded or penalized. Please do not sign the questionnaire. There is a box by the door for you to leave the questionnaires in, whether or not they are completed. Thank You. 46 Appendix B Cover Letter for Questionnaire Please do NOT remove this cover sheet from the survey. Please do NOT put your name anywhere on the survey. All forms will remain confidential (whether you fill them out or not). You are not expected to know the answers to all of the questions. If you do not know the answer, just make your best guess. This survey is only to be completed voluntarily. Whether or not you complete this questionnaire, you will not be either rewarded or penalized. Completion of the survey will be considered informed consent. Results will be made available to you. THANK YOU! 47 Appendix C Cholesterol Knowledge Survey CHOLESTEROL KNOWLEDGE SURVEY Demographics: I am male female (check one). My height is feet inches. My weight is approximately I am lbs. years old. My level of education is Lifestyle Choices: 1. I exercise regularly... yes no (circle one). If “yes” (fill in the blank): • I usually exercise times per week (this is in addition to my normal daily activities). • I exercise for each time (average length of time). 2. I currently smoke... yes no (circle one). If “yes”: • What type of tobacco product do you use?-------- pipe cigarettes cigars--------- chewing tobacco • I started smoking/chewing at age -------- • • I would like to quit smoking------- yes------- no. 3. no. • Others in my home smoke tobacco----- yes I am interested in learning more about cholesterol... yes no (Put a check b 48 Knowledge of Cholesterol: (Read the questions carefully and choose the answers that you believe to be correct.) 1. The cholesterol in our bodies comes from (pick one): a. all types of fates we eat b. mostly animal fats c. our own bodies and all types of fates we eat d. our own bodies and mostly animal fats 2. These foods all contain saturated fats except: a. meats b. butter c. olive oil d. cheeses 3. Foods that are low in saturated fat are considered to be good foods. Which two of the following are low in saturated fat? a. olives b. nuts c. lard (animal fat) d. coconut oil 4. Two of the following foods contain water-soluble fiber that help the body to remove cholesterol. Which two are they? a. Fruit b. oat meal c. beans d. wheat bran 49 5. Which one of the following vitamins is helpful in lowering the total cholesterol level in the blood? a. Vitamin E b. Vitamin C c. Niacin (Vitamin B-3) d. Vitamin K 6. When can cholesterol start to damage blood vessels? (pick one) a. in the womb b. in infancy c. in childhood d. in adulthood e. in old age 7. People who are most likely to develop high cholesterol levels (pick one): a. are inactive b. smoke c. are overweight d. eat high fat diets e. all of the above 8. f. none of the above The most desirable total blood cholesterol level is: a. 100 mg/dL b. 180 mg/dL c. 200 mg/dL d. 240 mg/dL 50 9. Which of the following types of blood cholesterol is considered good when the blood level is greater than 35 mg/dL (pick one): a. high density lipoprotein (HDL) b. low density lipoprotein (LDL) c. very low density lipoprotein (VLDL) d. triglycerides 10. Which of the following types of blood cholesterol is considered bad when the blood level is greater than 130 mg/dL (pick one): d. high density lipoprotein (HDL) e. low density lipoprotein (LDL) f. veiy low density lipoprotein (VLDL) d. triglycerides 11. Heart disease is the #1 killer of men and women in the United States, and is partly caused by high cholesterol in the blood. It is one of the diseases that we can do something about, however. Which of the following do you believe will reduce the risk of heart disease (pick one). a. increase dietary soluble fiber b. reduce dietary saturated fats c. increase activity levels d. maintain normal body weight e. do not smoke f. all of the above g. none of the above r Appendix D - Letter of Permission, High School favilo"”' Jl"a Jamestown Area School (District 51 P.O. Box 217, Jamestown, PA 16134 DAVID F. SHAFFER, Superintendent 412-932-5557 > SANDRA S. FRY, Business Manager 412-932-5152 MARY REAMES. Elementary Principal l 412-932-3186 412-932-3181 FAX 412-932-5632 BRIAN J. KEYSER, Guidance Counsehlor NANCY YAUGER, Psychologist April 3, 1998 Dear Gretchen Bettua: Permission has been granted for you to conduct a survey in our school on April 3, 1998. Sincerely, Mi cnael T. Krepps, H. S. Principal Mrs. Robin Sasse, Health Teacher MTK/RLS/bm An Equal Opportunit^mployer 412-932-3186 412-932-3186 Appendix E - Letter of Permission, Senior Center Mercer County Area Agency on Aging, Inc./Creenville Area Senior Center 339 East Jamestown Road. Greenville, Pennsylvania 16125 724/588-3155, 724/588-3156 March 23,1998 Mrs. Gretchen Bettua 43 Cavis Street, #5 Greenville, PA 16125 Dear Gretchen, You are welcome to conduct your research survey at the Greenville Area Senior Center. As we agreed, you will be here Wednesday, April 1,1998, between 9:00 am and 10:00 am. I understand that you will obtain verbal consent from no less than 30 volunteers to take part in your survey and that the survey will be kept anonymous. You may also bring someone with you to help with your project. Ifl may be of any further help, just let me know. Best of luck. Si merely, Carmella Ansinger, Director Carmella Ansinger, Director MCAAA, Inc. Creerwille, Area Senior Serrig Center Appendix F Adolescent Raw Data 1 2 3 4 53 5 PEWEOGRAPHICS: male 1 1 1 female male height 70 68.5 73 female height male weight 150 155 160 female weight number of overweight male age 17 15 16 female age male level of education 11 10 10 female level of education 1 6 7 8 9 1 1 1 1 69 67 72 76 1 71 64 190 135 150 165 160 125 17 16 15 17 17 11 11 1 1 1 4 45 1 15 1 3 5^ 1 1 1 1 1 16 1 15 11 10 9 LIFESTYLE CHOICES yes no number of times per week? length of time? 2 ) Do/did you use tobacco? yes no # that smoke & do not exercise type of product used? pipe cigarettes cigars chewing tobacco age when started tobacco age when stopped tobacco would like to quit? yes no others at home use tobacco? yes no yes 3.) Want to learn more? 1. ) I exercise regularly? no KNOWLEDGE of CHOL. 1- The cholesterol in our bodies comes from... a. all types of fats we eat b. mostly animal fats c. our own bodies and all types of fats we eat d. our own bodies & mostly animal fats 2. These foods all contain saturated fats except... a. meats b. butter c. olive oil d. cheeses 1 1 1 1 1 1 4 7 3 1 1 7 90 1 5 6 120 1 1 1 1 1 1 1 11 1 15 1 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 1 1 Appendix F Adolescent Raw Data 10 54 11 12 13 14 15 16 17 18 DEMOGRAPHICS: male female male height female height male weight female weight number of overweight male age female age male level of education female level of education LIFESTYLE CHOICES 1.) I exercise regularly? yes no number of times per week? length of time? 2 ) Do/did you use tobacco? yes no # that smoke & do not exercise type of product used? pipe cigarettes cigars chewing tobacco age when started tobacco age when stopped tobacco would like to quit? yes no others at home use tobacco? yes no yes 3.) Want to learn more? 1 1 1 73 1 59 71 67 97 175 115 15 17 17 9 11 11 1 1 1 5 8 1 7 150 1 3 30 1 66 180 145 115 150 140 1 17 15 9 9 1 1 8 10 15 15 10 9 16 15 10 7 60 1 1 68 63 190 ■ 1 1 1 73 62 1 1 2 30 1 10 1 1 30 1 1 1 1 1 1 1 1 1 9 10 1 1 13 15 1 1 1 1 14 13 15 1 1 1 1 no 1 1 1 1 1 13 15 1 1 1 1 1 1 15 1 1 1 1 1 1 1 1 1 1 1 1 KNOWLEDGE of CHOL. 1. The cholesterol in our bodies comes from... a. all types of fats we eat b. mostly animal fats c. our own bodies and all types of fats we eat d. our own bodies & mostly animal fats 2. These foods all contain saturated fats except... a. meats b. butter c. olive oil d. cheeses 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Appendix F Adolescent Raw Data 55 19 20 21 22 23 24 25 26 27 DEMOGRAPHICS; male female, male height female height male weight female weight number of overweight male age female age male level of education female level of education 1 1 1 1 1 69 72 1 68 66 66 145 145 17 1 15 15 9 9 no 1 1 1 1 68 73 135 16 16 10 11 1 3 45 1 154 155 18 14 12 9 1 1 1 6 120 3 21 150 1 1 6 5 120 120 1 1 101 11 10 LIFESTYLE CHOICES 1. ) I exercise regularly? yes 1 no number of times per week? 6 length of time? 60 2. ) Do/did you use tobacco? yes no 1 # that smoke & do not exercise type of product used? pipe cigarettes cigars chewing tobacco age when started tobacco age when stopped tobacco would like to quit? yes no others at home use tobacco? yes no yes 1 3.) Want to learn more? 64 16 16 10 64 200 120 140 1 1 1 1 1 1 1 II 1 1 16 1^ 1 1 2 2 2 14 15 14 14 8 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 KNOWLEDGE of CHOL. 1. The cholesterol in our bodies comes from... a. all types of fats we eat b. mostly animal fats c. our own bodies and all types of fats we eat d. our own bodies & mostly animal fats 2. These foods all contain saturated fats except... a. meats b. butter c. olive oil d. cheeses 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Appendix F Adolescent Raw Data 56 22 29 30 31 32 33 34 35 36 DEMOGRAPHICS; male 1 female male height 66 female height male weight 120 female weight number of overweight male age 17 female age male level of education 10 female level of education LIFESTYLE CHOICES 1. ) I exercise regularly? yes 1 no number of times per week? 6 length of time? 1 2. ) Do/did you use tobacco? yes no # that smoke & do not exercise type of product used? pipe cigarettes 1 cigars chewing tobacco age when started tobacco 16 age when stopped tobacco 16 would like to quit? yes no others at home use tobacco? yes no yes 1 3.) Want to learn more? no 1 1 66 68 1 65 1 1 1 1 1 71 65 64 66 63 170 130 130 150 102 105 215 120 1 16 16 10 10 15 9 1 1 18 14 18 15 14 12 9 12 9 9 1 1 1 1 1 20 1 3 60 1 1 1 1 1 1 1 1 12 10 10 14 2 2 1 1 1 1 5 90 1 7 60 1 1 1 1 5 120 4 30 1 1 1 1 1 1 1 1 1 1 1 1 1 1 KNOWLEDGE of CHOL. 1. The cholesterol in our bodies comes from... a. all types of fats we eat b. mostly animal fats c. our own bodies and all types of fats we eat d. our own bodies & mostly animal fats 2. These foods all contain saturated fats except... a. meats b. butter c. olive oil d. cheeses 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Appendix F Adolescent Raw Data Row Totals 57 Row Average DMTOGRAPfflCS: male I female I male height I female height I male weight I female weight number of overweight I male age I female age I male level of education I female level of education § 23 __13_ H 593.5 843_ ~3506 "l 728 Z •370 3 p i '"224 "t28 LIFESTYLE CHOICES 1. ) I exercise regularly? yes _ 27 no 9 number of times per week? _ 151 length of time? _ 1591 2. ) Do/did you use tobacco? yes _ 21 no _ 15 # that smoke & do not exercise _ 5 5 type of product used? pipe _ cigarettes _ 18 cigars __ 7 chewing tobacco __ 7 age when started tobacco __ 272 age when stopped tobacco _ 90 would like to quit? yes _ 8 no _ 9 others at home use tobacco? yes _ 17 no _ 7 3.) Want to learn more? yes _ 21 no _ 15 69.3 64.8 152.4 132.9 8,3% 16 16 9.74 9.85 75% 25% 6 82 58% 42% 13.9% 13.9% 50.0% 19.4% 19.4% 13 15 22.2% 25.0% 47.2% 19.4% 58.3% 41.7% KNOWLEDGE of CHOL. 1. The cholesterol in our bodies comes from... a. all types of fats we eat b. mostly animal fats c. our own bodies and all types of fats we eat d. our own bodies & mostly animal fats 2. These foods all contain saturated fats except... a. meats b. butter c. olive oil d. cheeses I 18 6 50% 17% i L 9 25% 3 8% 5 0 18 13 14% 0% 50% 36% _ _ _ total # surveys__________ completed = I » total average height = total average weight = I 3 total average age = total average grade = a Appendix F Adolescent Raw Data Foods that are Sow m saturated fats are considered to be good foods. Which two of the following are Sow in saturated fat? a. olives b. nuts (# of correct answers) c. lard d. coconut oil 4. Two of the following foods contain water-soluble fiber that helps the body to remove cholesterol. Which two are they? a fruit b. oat meal c. dried beans (# of correct answers) d. wheat bran 5. Which one of the following vitamins is helpful in lowering the total cholesterol level in the blood? a. Vitamin E b. Vitamin C c. Niacin (Vitamin B-3) d. Vitamin K 6. When can cholesterol start to damage blood vessels? a in the womb b. in infancy c. in childhood d. in adulthood e. in old age 7. People who are most likely to develop high cholesterol... a. are in active b. smoke c. are overweight d. eat high fat diets e. all of the above f. none of the above 8. The most desirable total blood cholesterol level is... a. 100 mg/dL b. 180 mg/dL c. 200 mg/dL d. 240 mg/dL 1 2 1 1 3 58 4 5 6 7 1 1 1 1 1 8 9 1 2 2 1 1 i 1 1 1 1 1 2 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Appendix F Adolescent Raw Data 1© 11 3. Foods thait are Sow in saturated fats are considered to be good foods. Which two of the following are Sow in saturated fat? a. olives b. nuts (# of correct answers) c. lard d. coconut oil 4. Two of the following foods contain water-soluble fiber that helps the body to remove cholesterol. Which two are they? a. fruit b oat meal c. dried beans (# of correct answers) d. wheat bran 5. Which one of the following vitamins is helpful in lowering the total cholesterol level in the blood? a. Vitamin E b. Vitamin C c. Niacin (Vitamin B-3) d. Vitamin K 6. When can cholesterol start to damage blood vessels? a. in the womb b. in infancy c. in childhood d. in adulthood e. in old age 7. People who are most likely to develop high cholesterol... a. are in active b. smoke c. are overweight d. eat high fat diets e. all of the above f. none of the above 8. The most desirable total blood cholesterol level is... a. 100 mg/dL b. 180 mg/dL c. 200 mg/dL d. 240 mg/dL 2 1 n 59 12 13 14 15 16 17 18 1 1 1 1 2 1 2 1 2 1 1 1 11 1 1 1 1 1 1 1 11 1 1 1 1 K 11 1 1 I 1 1 1 1 1 1 1 1 1 1 11 1 11 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 5 Appendix F Adolescent Raw Data 60 19 20 21 22 23 24 25 26 27 3. Foods that are Bow in saturated fats are considered to be good foods. Which two of the following are Bow in saturated fat? a olives b. nuts (# of correct answers) c. lard d. coconut oil 4. Two of the following foods contain water-soluble fiber that helps the body to remove choBesteroi. Which two are they? a. fruit b. oat meal c. dried beans (# of correct answers) d. wheat bran 5. Which one of the following vitamins is helpful in towering the total choBesteroi Bevel in the blood? a. Vitamin E b. Vitamin C c. Niacin (Vitamin B-3) d. Vitamin K 6. When can choBesteroi start to damage blood vessels? a. in the womb b. in infancy c. in childhood d. in adulthood e. in old age 7. People who are most likely to develop high cholesterol... a. are in active b. smoke c. are overweight d. eat high fat diets e. all of the above f. none of the above 8. The most desirable total blood cholesterol level is... a. 100 mg/dL b. 180 mg/dL c. 200 mg/dL d. 240 mg/dL 2 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1! 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Appendix F Adolescent Raw Data 3. Foods that are low in saturated fats are considered to he good foods. Which two of the following are low in saturated fat? a. olives b. nuts (# of correct answers) c. lard d. coconut oil Two of the following foods contain water-soluble fiber that helps the body to remove cholesterol. Which two are they? a. fruit b. oat meal c. dried beans (# of correct answers) d. wheat bran 5. Which one of the following vitamins is helpful in lowering the total cholesterol level in the blood? a. Vitamin E b. Vitamin C c. Niacin (Vitamin B-3) d. Vitamin K 6. When can cholesterol start to damage blood vessels? a. in the womb b. in infancy c. in childhood d. in adulthood e. in old age 7. People who are most likely to develop high cholesterol... a. are in active b. smoke c. are overweight d. eat high fat diets e. all of the above f. none of the above 8. The most desirable total blood cholesterol level is... a. 100 mg/dL b. 180 mg/dL c. 200 mg/dL d. 240 mg/dL 28 29 30 1 2 1 1 1 61 31 32 33 1 2 2 1 1 1 34 35 36 1 2 2 2 1 1 1 1 1 2 1 1 U 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1! 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 Appendix F Adolescent Raw Data 3. Foods that are Sowin saturated fats are considered to (be good foods. Which two of the following are low in saturated fat? a. olives b. nuts (# of correct answers) c. lard d. coconut oil 4. Two of the following foods contain water-soluble fiber that helps the body to remove cholesterol. Which two are they? a. fruit b. oat meal c. dried beans (# of correct answers) d. wheat bran 5. Which one of the following vitamins is helpful in lowering the total cholesterol level in the blood? a Vitamin E b. Vitamin C c. Niacin (Vitamin B-3) d Vitamin K & When can cholesterol start to damage blood vessels? a. in the womb b. in infancy c. in childhood d. in adulthood e. in old age 7. People who are most likely to develop high cholesterol... a. are in active b. smoke c. are overweight d. eat high fat diets e. all of the above f. none of the above 8. The most desirable total blood cholesterol level is... a. 100 mg/dL b. 180 mg/dL c. 200 mg/dL d. 240 mg/dL Row Tofcafe Row Average 26 72% 19 10 3 15 53% 28% 8% 42% 23 19 4 0 21 64% 8 18 7 3 22% 50% 4 5 10 10 7 11% 14% 1 1 13 1 3% 3% 36% 3% 61% 0% 22 0 4 25 5 2 53% 11% 0% 58% 19% 8% 28% 28% 19% 11% 69% 14% 6% 62 Appendix F Adolescent Raw Data 1 Which of the following tfypes of blood cholesterol is considered good when the blood level is greater than 35 mg/dL? a. HDL b. LDL c. VLDL d. triglycerides 1&. Which of the following types of blood cholesterol is considered bad when the blood level is greater than 130 mg/dL? a. HDL b. LDL c. VLDL d triglycerides 11. Heart disease is the #1 killer of men and women in the United States, and is partly caused by high cholesterol in the blood. It is one of the diseases that we can do something about, however. Which of the following do you believe will reduce the risk of heart disease? a. increase dietary soluble fiber b. reduce dietary satruated fats c. increase activity levels d. maintain normal body weight e. do not smoke f. all of the above g. none of the above Total # Correct 2 3 1 1 4 63 7 5 8 9 1 1 1 1 U 1 1 1 1 1 1 1 1 5 6 1 1 1 3 | 6 j 4 { 0 | 4 | 4 nn Appendix F Adolescent Raw Data 64 10 11 12 13 14 15 16 17 13 S’. Which of following types of blood cholesterol! is considered good when the blood level! is greater than 35 mg/dL? a. HDL b. LDL c. VLDL d triglycerides 10. Which of the following types of blood cholesterol is considered bad when the blood level is greater than 130 mg/dL? a. HDL b. LDL c. VLDL d. triglycerides 11. Heart disease is the #1 killer of men and women in the United States, and is parity caused by high cholesterol in the blood, it is one of the diseases that we can do something about, however. Which of the following do you believe will reduce the risk of heart disease? a. increase dietary soluble fiber b. reduce dietary satruated fats c. increase activity levels d. maintain normal body weight e. do not smoke f. all of the above g. none of the above Total # Correct 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1! 1 1 1 1 L 1 1 1 1 1! 1 2 1 5 | 4 j 2 j 2 1 1 1 4 | 3 j 5 | 7 2 Appendix F Adolescent Raw Data 65 19 20 21 22 23 24 25 26 27 9. Which of the following types of blood cholesterol is considered good when the blood level is greater than 35 mg/dL? a. HDL b. LDL c. VLDL d. triglycerides HO. Which of the following types of blood cholesterol is considered bad when the blood level is greater than H30 mg/dL? a. HDL b. LDL c. VLDL d. triglycerides HI. Heart disease is the #1 killer of men and women in the United States, and is partly caused by high cholesterol in the blood. It is one of the diseases that we can do something about, however. Which of the following do you believe will reduce the risk of heart disease? a. increase dietary soluble fiber b. reduce dietary satruated fats c. increase activity levels d. maintain normal body weight e. do not smoke f. all of the above g. none of the above Total # Correct 1 1 1 1! 1 1 1 1 11 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 4 j 0 1 4 j 6 | 4 4 1 1 3 4 2 66 Appendix F Adolescent Raw Data 23 29 30 31 32 33 34 35 36 9. Which of the following types of blood cholesterol is considered good when the blood level is greeter than 35 mg/dL? a. HDL b LDL c. VLDL d triglycerides HO. Which of the following types of blood cholesterol is considered bad when the blood level is greater than H30 mg/dL? a HDL b. LDL c. VLDL d triglycerides 1H. Heart disease is the #1 killer of men and women in the United States, and is partly caused by high cholesterol in the blood. It is one of the diseases that we can do something about, however. Which of the following do you believe will reduce the risk of heart disease? a. increase dietary soluble fiber b. reduce dietary satruated fats c. increase activity levels d. maintain normal body weight e. do not smoke f. all of the above g. none of the above Total # Correct 1 1 1 1 1 Zi 1 1 1 1 1 1 1 D 1 1 1 1 1 1 1 1 1 1 1 F < I 5 | 3 | 3 | 5 1 ±H 1 3 5 Appendix F Adolescent Raw Data 9. Which of the following types of blood cholesterol is considered good when the blood level is greater than 35 mg/dL? a HDL b LDL c. VLDL d triglycerides 10. Which of the following types of blood cholesterol is considered bad when the blood level is greater than 130 mg/dL? a HDL b LDL c. VLDL d. triglycerides 11. Heart disease is the #1 killer of men and women in the United States, and is partly caused by high cholesterol in the blood. It is one of the diseases that we can do something about, however. Which of the following do you believe will reduce the risk of heart disease? a. increase dietary soluble fiber b. reduce dietary satruated fats c. increase activity levels d. maintain normal body weight e. do not smoke f. all of the above g. none of the above Total # Correct Row Totals Row Average 3 8% 47% 17 5 11 14% 31% 12 33% 14 4 39% 11% 17% 6 2 5 5 2 2 6% 14% 14% 6% 3% 58% 6% 4 T 34% 1 21 67 Appendix G Elderly Raw Data 1 68 2 3 4 1 1 1 5 6 7 8 9 1 1 1 1 62 66 65 67 DEMOGRAPHICS: male female 1 male height female height 60 male weight female weight 128 number of overweight male age female age 78 male level of education female level of education 14 LIFESTYLE CHOICES 1 1. ) I exercise regularly? yes no number of times per week? 7 length of time? 60 2. ) Do/did you use tobacco? yes no 1 # that smoke & do not exercise type of product used? pipe cigarettes cigars chewing tobacco age when started tobacco age when stopped tobacco would like to quit? yes no others at home use tobacco? yes no 1 yes 1 3.) Want to learn more? no 1 68.5 62 64 61.5 172 118 163 140 260 1 1 150 210 140 1 1 85 69 78 83 12 11 82 82 12 12 8 1_ 3 1 4 20 82 8 12 1 1 1 1 7 20 1 2 15 1 3 30 1 1 1 1 1 1 1 1 1 1 1 14 78 1 40 50 2 1 1 1 1 1 1 1 1 KNOWLEDGE of CHOL. 1. The cholesterol in our bodies comes from... a. all types of fats we eat b. mostly animal fats c. our own bodies and all types of fats we eat d. our own bodies & mostly animal fats 2. These foods all contain saturated fats except... a. meats b. butter c. olive oil d. cheeses 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 Appendix G Elderly Raw Data 10 11 69 12 13 14 15 16 17 18 DEMOGRAPHICS: male female 1 male height female height 60 male weight female weight 120 number of overweight male age female age 68 male level of education female level of education 12 LIFESTYLE CHOICES 1)1 exercise regularly? yes no 1 number of times per week? length of time? 2.) Do/did you use tobacco? yes no 1 # that smoke & do not exercise type of product used? pipe cigarettes cigars chewing tobacco age when started tobacco age when stopped tobacco would like to quit? yes no others at home use tobacco? yes no yes 3.) Want to learn more? no 1 1 I 1 1 72 63 64 194 1 1 1 65 65 68 62 142 219 1 182 1 1 66 69 163 121 156 120 1 69 75 78 64 73 74 77 8 8 16 12 12 9 1 1 1 1 6 35 3 5 10 2 1 1 1 1 4 3 30 1 1 1 1 1 1 5 1 1 1 1 18 54 21 42 1 1 1 1 1 1 1 1 1 1 1 1 KNOWLEDGE of CHOL. 1. The cholesterol in our bodies comes from... a. all types of fats we eat b. mostly animal fats c. our own bodies and all types of fats we eat d. our own bodies & mostly animal fats 2. These foods all contain saturated fats except... a. meats b. butter c. olive oil d. cheeses 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Appendix G Elderly Raw Data DEMOGRAPHICS: 70 19 20 21 22 23 24 25 26 27 male female 1 male height female height 62 male weight female weight 135 number of overweight male age female age 73 male level of education female level of education 12 1 1 1 1 1 1 1 70 62 1 60.5 60 67 62 61 180 67 160 140 145 150 128 1 65 79 74 72 65 77 18 12 149 1 73 72 9 11 12 12 1 1 1 10 12 LIFESTYLE CHOICES 1 )! exercise regularly? yes no number of times per week? length of time? 2.) Do/did you use tobacco? yes no # that smoke & do not exercise type of product used? pipe cigarettes cigars chewing tobacco age when started tobacco age when stopped tobacco would like to quit? yes no others at home use tobacco? yes no yes 3.) Want to learn more? no 1 1 1 2 30 7 15 1 1 7 45 1 5 20 1 3 30 1 3 60 1 5 240 1 3 20 1 1 1 1 1 1 22 27 1 1 12 40 25 18 1 15 62 1 1 1 _1 1 1 1 1 1 1 1 1 KNOWLEDGE of CHOL. 1. The cholesterol in our bodies comes from... a. all types of fats we eat b. mostly animal fats c. our own bodies and all types of fats we eat d. our own bodies & mostly animal fats 2. These foods all contain saturated fats except... a. meats b. butter c. olive oil d. cheeses 1 1 1 1 1 1 1 1 1 1 1 1 Appendix G Elderly Raw Data 71 28 29 30 31 32 33 34 35 36 DMOGRAPfflCSs male female 1 male height female height 63 male weight female weight 162 number of overweight 1 male age female age 85 male level of education female level of education LIFESTYLE CHOICES 1)1 exercise regularly? yes no number of times per week? length of time? 2 ) Do/did you use tobacco? yes no # that smoke & do not exercise type of product used? pipe cigarettes cigars chewing tobacco age when started tobacco age when stopped tobacco would like to quit? yes no others at home use tobacco? yes no yes 3.) Want to learn more? no 1 1 1 1 1 1 1 1 67 65 60 61 63 67 66 63 180 150 114 107 141 200 1 130 1 75 76 78 75 74 69 72 80 12 14 14 8 10 14 8 1 1 1 1 1 1 3 6 5 15 2 1 1 1 1 1 1 1 1 7 10 7 1 1 1 1 1 1 1 1 1 22 55 17 31 1 1 1 j 1 1 1 1 1 1 1 KNOWLEDGE of CHOL. 1. The cholesterol in our bodies comes from... a. all types of fats we eat b. mostly animal fats c. our own bodies and all types of fats we eat d. our own bodies & mostly animal fats 2. These foods all contain saturated fats except... a. meats b. butter c. olive oil d. cheeses 1 1 1 1 1 1 1 1 1 1 1 1 1 JI 2 Appendix G Elderly Raw Data Row 72 Row Totals Averages DEMOGRAPHICS: male female male height female height male weight female weight number of overweight male age female age male level of education female level of education LIFESTYLE CHOICES 1. ) I exercise regularly? yes no number of times per week? length of time? 2. ) Do/did you use tobacco? yes no # that smoke & do not exercise type of product used? pipe cigarettes cigars chewing tobacco age when started tobacco age when stopped tobacco would like to quit? yes no others at home use tobacco? yes no 3.) Want to learn more? yes no 6 ' 30 ~ 404 W3.5 4241 12 436 2184 ~ 35 319 67.3 63-5 171.3 141.4 35.3% 73 73 11.67 11.39 25 10 109 716 11 25 2 1 8 0 2 224 439 2 2 0 19 26 5 69% 28% 4 36 31% 69% 5.6% 3% 22% 0% 6% 20 49 4% 6% 0% 53% 72% 14% 9 12 25% 33% 2 6% 3 22% 7___ _ 11 19% 31% 56% 17% KNOWLEDGE of CHOL. 1. The cholesterol in our bodies comes from... a. all types of fats we eat b. mostly animal fats c. our own bodies and all types of fats we eat d. our own bodies & mostly animal fats 2. These foods all contain saturated fats except... a. meats b. butter c. olive oil d. cheeses 20 e total # surveys completed = total average height = total average weight = total average age = total average grade = Appendix G Elderly Raw Data 3. Foods that are Sow in saturated tats are considered to be good foods. Which two of the following are low in saturated fat? a. olives b. nuts (# of correct answers) c. lard d. coconut oil 4. Two of the following foods contain water-soluble fiber that helps the body to remove cholesterol. Which two are they? a. fruit b. oat meal c. dried beans (# of correct answers) d. wheat bran 5. Which one of the following vitamins is helpful in lowering the total cholesterol level in the blood? a. Vitamin E b. Vitamin C c. Niacin (Vitamin B-3) d. Vitamin K 6. When can cholesterol start to damage blood vessels? a. in the womb b. in infancy c. in childhood d. in adulthood e. in old age 7. People who are most likely to develop high cholesterol... a. are in active b. smoke c. are overweight d. eat high fat diets e. all of the above f. none of the above 73 1 2 3 4 2 2 1 2 2 11 5 1 1 6 7 2 2 1 8 9 1 1 11 1 2 1 2 2 2 1 1 2 1 2 2 1 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Appendix G Elderly Raw Data 74 10 11 12 13 14 15 16 17 18 3. Foods that are low in saturated fats are considered to be good foods. Which two of the following are low in saturated fat? a. olives b. nuts (# of correct answers) c. lard d. coconut oil 4. Two of the following foods contain water-soluble fiber that helps the body to remove cholesterol. Which two are they? a. fruit b. oat meal c. dried beans (# of correct answers) d. wheat bran 5. Which one of the following vitamins is helpful in lowering the total cholesterol level in the blood? a. Vitamin E b. Vitamin C c. Niacin (Vitamin B-3) d. Vitamin K 6. When can cholesterol start to damage blood vessels? a. in the womb b. in infancy c. in childhood d. in adulthood e. in old age 7. People who are most likely to develop high cholesterol... a. are in active b. smoke c. are overweight d. eat high fat diets e. all of the above f. none of the above 1 2 1 1 1 1 1 1 2 2 1 1 1 1 1 1 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Appendix G Elderly Raw Data 75 19 20 21 22 23 24 25 26 27 3. Foods that are low in saturated fats are considered to be good foods. Which two of the following are low in saturated fat? a. olives b. nuts (# of correct answers) c. lard d. coconut oil 4. Two of the following foods contain water-soluble fiber that helps the body to remove cholesterol. Which two are they? a. fruit b. oat meal c. dried beans (# of correct answers) d. wheat bran 5. Which one of the following vitamins is helpful in lowering the total cholesterol level in the blood? a. Vitamin E b. Vitamin C c. Niacin (Vitamin B-3) d. Vitamin K 6. When can cholesterol start to damage blood vessels? a. in the womb b. in infancy c. in childhood d. in adulthood e. in old age 7. People who are most likely to develop high cholesterol... a. are in active b. smoke c. are overweight d. eat high fat diets e. all of the above f. none of the above 2 2 1 1 2 2 1 1 1 2 2 2 2 1 1 1 1 2. 1 1 1 1 1 1 2 2 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Appendix G Elderly Raw Data 76 28 29 30 31 32 33 34 35 36 3. Foods that are low in saturated fats are considered to be good foods. Which two of the following are low in saturated fat? a. olives b. nuts (# of correct answers) c. lard d. coconut oil 4. Two of the following foods contain water-soluble fiber that helps the body to remove cholesterol. Which two are they? a. fruit b. oat meal c. dried beans (# of correct answers) d. wheat bran 5. Which one of the following vitamins is helpful in lowering the total cholesterol level in the blood? a. Vitamin E b. Vitamin C c. Niacin (Vitamin B-3) d. Vitamin K 6. When can cholesterol start to damage blood vessels? a. in the womb b. in infancy c. in childhood d. in adulthood e. in old age 7. People who are most likely to develop high cholesterol... a. are in active b. smoke c. are overweight d. eat high fat diets e. all of the above f. none of the above 1 2 2 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Appendix G Elderly Raw Data Row Row Totals Averages 3. Foods that are low in saturated fats are considered to be good foods. Which two of the following are low in saturated fat? a. olives b nuts (# of correct answers) c. lard d. coconut oil 4. Two of the following foods contain water-soluble fiber that helps the body to remove cholesterol. Which two are they? a. fruit b. oat meal c. dried beans (# of correct answers) d. wheat bran 5. Which one of the following vitamins is helpful in lowering the total cholesterol level in the blood? a. Vitamin E b. Vitamin C c. Niacin (Vitamin B-3) d. Vitamin K 6. When can cholesterol start to damage blood vessels? a. in the womb b. in infancy c. in childhood d. in adulthood e. in old age 7. People who are most likely to develop high cholesterol... a. are in active b. smoke c. are overweight d. eat high fat diets e. all of the above f. none of the above 14 12 13 16 20 12 8 78% 39% 33% 3% 36% 44% 56% o>'33%. f, 22% 13 36% 12 33% 25% 14% 6% 9 5 2 4 3 10 9 1 11% 2 0 7 10 6% 0% 19% 28% 53% 0% 19 8% 28% 25% 3% 77 Appendix G Elderly Raw Data 1 8. The most desirable total blood cholesterol level is... a. 100 mg/dL b. 180 mg/dL c. 200 mg/dL d. 240 mg/dL 9. Which of the following types of blood cholesterol is considered good when the blood level is greater than 35 mg/dL? a. HDL b. LDL c. VLDL d. triglycerides 10. Which of the following types of blood cholesterol is considered bad when the blood level is greater than 130 mg/dL? a. HDL b. LDL c. VLDL d. triglycerides 11. Heart disease is the #1 killer of men and women in the United States, and is partly caused by high cholesterol in the blood. It is one of the diseases that we can do something about, however. Which of the following do you believe will reduce the risk of heart disease? a. increase dietary soluble fiber b. reduce dietary satruated fats c. increase activity levels d. maintain normal body weight e. do not smoke f. all of the above g. none of the above Total # Correct 2 3 78 4 5 6 7 8 9 1 1 1 1 2 1 1 1 1 1 2 1 1 1 1 1 1 1 1 0 1 2 0 1 1 1 1 0 Appendix G Elderly Raw Data 79 10 11 12 13 14 15 16 17 18 8. The most desirable total blood cholesterol level is... a. 100 mg/dL b. 180 mg/dL c. 200 mg/dL d. 240 mg/dL 9. Which of the following types of blood cholesterol is considered good when the blood level is greater than 35 mg/dL? a. HDL b. LDL c. VLDL d. triglycerides 10. Which of the following types of blood cholesterol is considered bad when the blood level is greater than 130 mg/dL? a. HDL b. LDL c. VLDL d. triglycerides 11. Heart disease is the #1 killer of men and women in the United States, and is partly caused by high cholesterol in the blood. It is one of the diseases that we can do something about, however. Which of the following do you believe will reduce the risk of heart disease? a. increase dietary soluble fiber b. reduce dietary satruated fats c. increase activity levels d. maintain normal body weight e. do not smoke f. all of the above g. none of the above Total # Correct 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 0 1 1 1 1 1 Appendix G Elderly Raw Data 80 19 20 21 22 23 24 25 26 27 8. The most desirable total blood cholesterol level is... a. 100 mg/dL b. 180 mg/dL c. 200 mg/dL d. 240 mg/dL 9. Which of the following types of blood cholesterol is considered good when the blood level is greater than 35 mg/dL? a. HDL b. LDL c. VLDL d. triglycerides 10. Which of the following types of blood cholesterol is considered bad when the blood level is greater than 130 mg/dL? a. HDL b. LDL c. VLDL d. triglycerides 11. Heart disease is the #1 killer of men and women in the United States, and is partly caused by high cholesterol in the blood. It is one of the diseases that we can do something about, however. Which of the following do you believe will reduce the risk of heart disease? a. increase dietary soluble fiber b. reduce dietary satruated fats c. increase activity levels d. maintain normal body weight e. do not smoke f. all of the above g. none of the above Total # Correct 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 2 1 1 0 1 1 2 2 Appendix G Elderly Raw Data 81 28 29 30 31 32 33 34 35 36 8. The most desirable total blood cholesterol level is... a. 100 mg/dL b. 180 mg/dL c. 200 mg/dL d. 240 mg/dL 9. Which of the following types of blood cholesterol is considered good when the blood level is greater than 35 mg/dL? a. HDL b. LDL c. VLDL d. triglycerides 10. Which of the following types of blood cholesterol is considered bad when the blood level is greater than 130 mg/dL? a. HDL b. LDL c. VLDL d. triglycerides 11. Heart disease is the #1 killer of men and women in the United States, and is partly caused by high cholesterol in the blood. It is one of the diseases that we can do something about, however. Which of the following do you believe will reduce the risk of heart disease? a. increase dietary soluble fiber b. reduce dietary satruated fats c. increase activity levels d. maintain normal body weight e. do not smoke f. all of the above g. none of the above Total # Correct 1 1 1 1 1 1 1 1 0 1 1 1 2 1 1 1 2 1 0 0 | 1 rtppenaix (j Elderly Raw Data 8. The most desirable total blood cholesterol level is... a. 100 mg/dL b. 180 mg/dL c. 200 mg/dL d. 240 mg/dL 9. Which of the following types of blood cholesterol is considered good when the blood level is greater than 35 mg/dL? a. HDL b. LDL c. VLDL d. triglycerides 10. Which of the following types of blood cholesterol is considered bad when the blood level is greater than 130 mg/dL? a. HDL b. LDL c. VLDL d. triglycerides 11. Heart disease is the #1 killer of men and women in the United States, and is partly caused by high cholesterol in the blood. It is one of the diseases that we can do something about, however. Which of the following do you believe will reduce the risk of heart disease? a. increase dietary soluble fiber b. reduce dietary satruated fats c. increase activity levels d. maintain normal body weight e. do not smoke f. all of the above g. none of the above Total # Correct 82 Row Row Totals Averages 16 44% 42% 8% 0% 15 3 0 6 8 3 4 17% 22% 8% 11% 10 1 1 6 28% 3% 3% 17% 1 6 2 3 . • 2 20 0 F - -K | ■ , | ■ 3% 17% 6% 8% 6% 56% __ 0% ~~ 9%7n cr> CO —1 Why Blood Cholesterol Matters lood cholesterol plays an important part in deciding a persons chance or ■ risk of getting coronary heart disease (CUD). The higher your blood cholesterol level, the greater your risk. That’s why high blood cholesterol is called a risk factor for heart disease. Did you know that heart disease is the number one killer of men and of women in the United States? About a half million people die each year from heart attacks caused by CUD. Altogether 1.25 million heart attacks occur each year in the United States. Even if your blood cholesterol level is close to the desirable range (see page 3), you can lower it and reduce your risk of getting heart disease. Eating in a heart-healthy way, being physically active, and losing weight if you are overweight are things everyone can do to help lower their levels. This fact sheet will show you how. But first, a few things you ought to know... The Blood Cholesterol— Heart Disease Connection When you have too much cholesterol in your blood, the excess builds up on the walls of the arteries that carry blood to the heart. This buildup is called “atherosclerosis” or “hardening of the arteries.” It narrows the arteries and can slow down or block blood flow to the heart. With CONTENTS less blood, the heart gets less Guidelines For oxygen. With not Heart-Healfhy Living. Page 4 enough oxygen to the heart, there Cholesterol may be chest pain Page 12 and Children. (“angina” or Fats and Food “angina pectoris”), .Page 14 Tables.............. heart attack (“myocardial infarction”), or even death. Cholesterol buildup is the most common cause of heart disease, and it happens so slowly that you are not even aware of it. The higher your blood cholesterol, the greater your chance of this buildup. Other Risk Factors for Heart Disease A high blood cholesterol level is not the only thing that increases your chance of getting heart disease. Mere is a list of known) risk factors: I I Factors You Can Do Something About j' I ib1 dBlood fc jSjONAL HAJJES OE Normal artery wall Abnormal narrowed artery opening • Cigarette smoking o High blood cholesterol (high total and LDL-cholesterol) o Low HDL-cholesterol • High blood pressure • Diabetes • Obesity/overweight • Physical inactivity I Factors You Cannot Control e Age: % 45 years or older lor men 55 years or older for women ° Family history of early heart disease (heart attack or sudden death): % father or brother stricken before the age of 55 % mother or sister stricken before the age of 65 aw -■ Page 2 cholesterol your body needs. Dietary cholesterol comes from animal foods like meats, whole milk daily foods, egg yolks, poultry; and fish. Eating too much dietaiy cholesterol can make your blood cholesterol go I up. Foods from plants, like vegetables, fruits, grains, and cereals, do not have any dietaiy cholesterol. LDL- and HDL-Cholesterol: The Bad and The Good The more risk factors you have, the greater your chance of heart disease. Fortunately, Just like oil and water, cholesterol and blood most of these risk factors are things you can do i do not mix. So, for cholesterol to travel something about. through your blood, it is coated with a layer of : protein to make a "lipoprotein.” Two Who Can Benefit From : lipoproteins you may have heard about are low Lowering Blood Cholesterol? density lipoprotein (LDL) and high density i lipoprotein (LIDL). LDL-choIesterol carries Almost everyone can benefit from lowering his i most of the cholesterol in the blood. or her blood cholesterol. Lowering cholesterol Remember, when too much LDL-cholesterol slows the fatty buildup in the arteries, is in the blood, it can lead to cholesterol and in some cases can help reduce the X/H buildup already there. And, if you have j buildup in the arteries. That is why LDL; cholesterol is called the "bad” cholesterol. two or more other risk factors lor heart I IDL-cholesteroI helps remove cholesterol disease or already have heart disease, from the blood and helps prevent the fatty i you have a great deal to gain from buildup. So 1 IDL-cholesteroI is called the lowering your high blood cholesterol. In “good” cholesterol. tins case, lowering your level may greatly reduce your risk of any more Things That Affect Blood Cholesterol heart problems. Many Americans have had success in : Your blood cholesterol level is influenced by lowering their blood cholesterol levels. many factors. These include: From 1978 to 1990, the average blood cholesterol level in the U.S. dropped from 213 Y hat you eat—High intake of saturated fat. mg/dL to 205 mg/dL. c ietary cholesterol, and excess calories eading to overweight can increase blood Cholesterol—In Your Blood, In Your Diet c lolesterol levels. Americans eat an average ? 12 percent of their calories from saturated Cholesterol is a waxy substance found in all at, and 34 percent of their calories from parts of your body. It helps make cell total fat. These intakes membranes, some hormones, and vitamin D. is recommended for the health of your heart. Cholesterol comes from two sources: your The average daily intake of dietaiv dietaiy body and the foods you eat. Emuu Blood unoiesterol cholesterol i > avera ge ^ily Cro1 ooA vvni;pn all(1 cholesterol is 220-260 mg for women a is made in your liver. Your liver makes all the 360 mg for men. PSLKXXX> TOTAL A ND BLOOD CHOLESTEROL HDL-CHOLESTEROL CATEGORIES n ii I____ nni • Overweight—Being overweight can make your LDL-cholesterol level go up and your HDL-cholesterol level go down. • Physical activity—Increased physical activity lowers LDL-cholesterol and raises HDLcholesterol levels. Total Cholesterol Less than 200 mg/dL .Desirable 200 to 239 mg/dL Borderline-High 240 mg/dL or greater High HDL-Cholesterol Less than 35 mg/dL .Low HDL-chalesterol Note: These categories apply to adults age 20 and above. Heredity—Your genes partly influence how your body makes and handles cholesterol. • Age and Sex—Blood cholesterol levels in both men and women begin to go up around age 20. Women before menopause have levels that are lower than men of the same age. After menopause, a womans LDLcholesterol level goes up—and so her risk for heart disease increases. Have Your Blood Cholesterol Checked All adults age 20 and over should have their blood cholesterol (also called “total” blood cholesterol) checked at least once every7 5 years. If an accurate I IDL-cholesterol measurement is available. HDL should be checked at the same time. If you do not know your total and HDL levels, ask your doctor to measure them at your next visit. Total and I IDL-cholesterol measurements require a blood sample that is taken from your arm or finger. You do not have to fast for this test. If you have had your total and HDLcholesterol checked, check the chart to see how they measure up. Blood cholesterol levels of under 200 mg/dL ; are called “desirable” and put you at lower risk for heart disease. Any cholesterol level of 200 mg/dL or more increases your risk; over half the adults in the United States have levels of 200 mg/dL or greater. Levels between 200 and ; 239 mg/dL are “borderline-high.” A level of 240 mg/dL or greater is “high” blood cholesterol. A person with this level has more than twice the risk of heart disease compared to someone whose cholesterol is 200 mg/dL. About one out of every five American adults has a high blood cholesterol level of 240 mg/dL or greater. Unlike total cholesterol, the lower your HDL, the higher your risk for heart disease. An HDL level less than 35 mg/dL increases your risk for heart disease. The higher your HDL level, the better. In certain cases, it may be necessary to have your LDL-cholesterol checked, too, because it is a better predictor of heart disease risk than your total blood cholesterol. You will need to fast. That means you can have nothing to eat or drink but water, coffee, or tea, with no cream or sugar, for 9 to 12 hours before the test. If your doctor has checked your LDL level, use the chart below to see how it measures up. Less than 130 mg/dL .Desirable 130 to 159 mg/dL Borderline-High Risk 160 mg/dL and above....High Risk Note: These categories apply to adults age 20 and above. Page 3 J____ _______ If your LDL-cholesterol level is high or borderline-high and you have other risk factors for lieart disease, your doctor will likely plan a treatment program for you. Following an eating plan low in saturated fat and cholesterol and increasing your physical activity is usually the first and main step of treatment . Some people will also need to take medicine. (If you have high blood cholesterol and would like more details on what it means and what you should do about it, see the ordering information on page 13.) Guidelines For Heart-Healthy Living Whatever your blood cholesterol level, you can make changes to help lower it or keep it low and reduce your risk for heart disease. These are guidelines for heart-healthy living that the whole family (including children ages 2 and above) can follow: 1) Choose foods low in saturated fat. All foods that contain fat are made up of a mixture of saturated and unsaturated fats. Saturated fat raises your blood cholesterol level more than anything else you eat. The best way to reduce blood cholesterol is to choose foods lower in saturated fat. One way to help your family do this is by choosing foods such as fruits, vegetables, and whole grains—foods naturally low in total fat and high in starch and fiber. ;■'_______________ _____ -c___________ fat will also help you eat fewer calories. Eating fewer calories can help you lose weight—and, if you are overweight, losing weight is an important part of lowering your blood cholesterol. (Consult your family doctor if you have a concern about your child’s weight.) 3) Choose foods high in starch and fiber. Foods high in starch and fiber are excellent substitutes for foods high in saturated fat. These foods—breads, cereals, pasta, grains, fruits, and vegetables—are low in saturated fat and cholesterol. They are also lower in calories than foods that are high in fat. But limit fatty toppings and spreads like butter and sauces made with cream and whole milk daily products. Foods high in starch and fiber are also good sources of vitamins and minerals. When eaten as part of a diet low in saturated fat and cholesterol, foods with soluble fiber—like oat and barley bran and dry peas and beans—may help to lower blood cholesterol. 4) Choose foods low in cholesterol. Remember, dietary cholesterol can raise blood cholesterol, although usually not as much as saturated fat. So its important for your family to choose foods low in dietary cholesterol. * 4 <• JT Q 1 2) Choose foods low in total fat. 0 Since many foods high in total fat are also high in saturated fat, eating foods low in total fat * will help your family eat less saturated fat. When you do eat fat, substitute unsaturated fat—either polyunsaturated or monounsaturated—for saturated fat. Fat is a rich source of calories, so eating foods low in Page 4 3 Mg NW i I I THE NATIONAL EDUCATION CHOLESTEROL PROGRAM recommendations The National Cholesterol Education Program (NCEP) recommends that all healthy Americans ages 2 and above adopt an eating pattern lower in saturated fat and cholesterol to lower their blood cholesterol. The recommended eating pattern for everyone in the family over 2 years old is: ° less than 10 percent of calories from saturated fat. ® an average of 30 percent of calories or less from total fat. e less than 300 mg a day of dietary cholesterol. These goals are to be averaged over several days. Refer to table 3 on page 20 for guidance on the recommended intakes of saturated fat and cholesterol. Dietary cholesterol is found only in foods that come from animals. And even if an animal food is low in saturated fat, it may be high in cholesterol; for instance, organ meats like liver and egg yolks are low in saturated fat but high in cholesterol. Egg whites and foods from plant sources do not have cholesterol. 5) Be more physically active. Being physically active helps improve blood cholesterol levels: it can raise IIDL and lower LDL. Being more active also can help you lose weight, lower your blood pressure, improve the fitness of your heart and blood vessels, and reduce stress. And being active together is great for the entire family. 6) Maintain a healthy weight, and lose weight it you are overweight. People who are overweight tend to have higher blood cholesterol levels than people of a healthy weight. Overweight adults with an “apple” shape—bigger (pot) belly—tend to have a higher risk for heart disease than those with a “pear” shape—bigger hips and thighs. Whatever your body shape, when you cut the fat in your diet, you cut down on the richest source of calories. A family eating pattern high in starch and fiber instead of fat is a good way to help control weight. Do not go on crash diets that are very low in calories since they can be harmful to your health. If you are overweight, losing even a little weight can help to lower LDL-cholesterol and raise HDL-chol esterol. Making The Guidelines Work: Eat the Heart-Healthy Way Look at how your family eats now ;and begin to plan. You don't have to cut out all high saturated fat, high cholesterol foods. Just substitute one or two low saturated fat or low cholesterol foods XJUl >4 xd each day, and soon Fju \7\AX7 LIVING THE / you will reach HEART-HEALTHY your goal of WAT heart-healthy j eating for you To lower your blood cholesterol, and your remember to: family. By I making the Choose foods low in saturated fat changes slowly, | and cholesterol. you are more Be more physically active. likely to stick with your new Lose weight, eating plan. if you are overweight. \ Choose hearthealthy foods from different food groups—meat, poultry, fish, and shellfish; dairy' foods; eggs; fruits and vegetables; breads, cereals, pasta, rice and other grains, and dry peas and beans; fats and oils; and sweets and snacks. Choose the number and size of portions to help you reach and stav at your desirable weight. Eating a variety of foods each day will help your whole family get the nutrients you need. Use these tips to choose foods low in saturated fat and cholesterol: Rlh TT U h 1 Page 5 IE AN ’ CUTS Beef © F ME AT Eye of the round, Top round Shoulder, Ground veal, Cutlets, Sirloin Veal Pork Tenderloin, Sirloin, Top loin Lamb Leg, Shank "Lean defined as less than 10 grams of fat and 4.5 grams or less of saturated fat in 3 cooked ounces, as currently used on food labels. Meat, poultry, fish, and shell fish Buying tips: • Choose lean cuts of meat. Choose fish and skinless poultiy more often; they are generally lower in saturated fat than meat. Eat moderate portions—no more than about 6 ounces a day (a 3-ounce portion is about the size of a deck of cards). • Look for meats labeled “lean” or “extra lean.” — • Choose shellfish occasionally. Shellfish has little saturated fat in general, but its cholesterol content varies—some (like squid, shrimp, and oysters) are fairly high while others (like scallops, mussels, and clams) are low. Buy canned fish packed in water, not oil. FISH OILS You moy have heard that- a type of unsaturated fat called "omega-3 fatty acids" found in fish and shellfish is good for your heart. Health benefits have not been proven. Still, any fresh or frozen fish is a • Limit organ meats like liver, sweetbreads, and kidneys. Organ meats are high in cholesterol, even though they are fairly low in fat. • Limit high fat processed meats like bacon, bologna, salami, hot dogs, and sausage. • Remember that some chicken and turkey hot dogs are lower in saturated fat and total fat than pork and beef hot dogs. There are also “lean” beef hot dogs that are low in fat and saturated fat. Usually, processed poultry products have more fat and cholesterol than fresh poultry. To be sure, check the nutrition label on deli products such as hot dogs and luncheon meats to find those that are lowest in fat and saturated fat. ? • 1 ly fresh ground turkey or chicken made from white meat, like the breast. • Limit use of ( ~ goose and duck. They are higher in saturated fat,, even with the skin removed. Page 6 good food choice because it is low in saturated fat. Avoid fish oil pills because they are high in fat and calories, and they may have long-term side effects. Preparation tips: ° Trim fat from meat and remove skin from poultiy before eating. ° Bake, broil, microwave, poach, or roast instead of frying. When you do fry, use a nonstick pan and nonstick cooking spray 01 a small amount nt of vegetable oil to reduce the fat. • When you roast, place the meat on a rack so the fat can drip away. • Brown ground meat and drain well befoic adding other ingredients. • Use fat free ingredients like fruit juice. ’ or defatted broth to baste meats and pou try I Daily foods Buying tips • Drink skim or 1 percent milk rather than 2 percent and whole milk. • When looking for hard cheeses, go for versions that are “fat free,” “reduced fat,” “low fat," “light," or “part-skim.” These have less lat per ounce than the regular versions. • When shopping for soft cheeses, choose low fat (1 percent) or nonfat cottage cheese, farmer cheese, pot cheese, or part-skim or “light” ricotta. These cheeses have less fat per ounce than the whole milk versions. • Use low fat or nonfat yogurt; try it in recipes or as a topping. • Tiy low fat or non Git sour cream or cream cheese blends for spreads, toppings, or in recipes. Preparation tips: • Tiy low fat cheese in casseroles, or tiy a sharp-flavored regular cheese and use less than the recipe calks for. Save most of the cheese for the top. ® Use skim, 1 percent, or evaporated skim milk for creamed soups white sauces. Eggs Buying tips: o Eggs are included in many­ processed foods and baked goods. Look at the nutrition label to check the cholesterol Preparation tips: ® Egg whites have no cholesterol, so trv substituting them for whole eggs in recipes; two egg whites are equal to one whole egg. Or, use egg substitutes. Fruits and vegetables Buying tips: ° Buy fruits and vegetables often—fresh, frozen, or canned. They have no cholesterol and most are low in saturated fat. Also, most fruits and vegetables, except avocados, coconut, and olives are low in total fat. Preparation tips: ® Use fruits as a snack or dessert. 0 Prepare vegetables as snacks, side dishes, and salads. Season with herbs, spices, lemon juice, or fat free or low fat mayonnaise. Limit use of regular mayonnaise, salad dressings, and cream, cheese, or other fatty sauces. content. • Try egg substitutes. Page 7 r You may have heard that margarine has a type of unsaturated fat called "trans" fat. "Trans" fats appear to raise blood cholesterol more than other unsaturated fats, but not as much as saturated fats. "Trans" fats are formed when vegetable oil is hardened or "hydrogenated" to make margarine or Breads, cereals, pasta, rice and other grains, and dry peas and beans Buying tips: • Use whole-grain breads, rolls, and cereals o often. shortening. The harder the margarine or shortening, the more likely it is to contain more "trans" fat. Read the ingredient label to choose margarines containing liquid vegetable oil as the first ingredient rather than hydrogenated or partially hydrogenated oil. Use the nutrition label to choose margarines with the least Limit baked goods like these that are made with large amounts of fat, especially saturated fat: Croissants 4r Biscuits Doughnuts Butter rolls Muffins Coffee cake £ Danish pastiy Be aware that some baked goods contain palm, palm kernel, and coconut oils. These oils are high in saturated fats, even though they are vegetable oils. Choose ready-to-eat cereals often. Most are low in saturated fat, except for granola, muesli, or oat bran types made with coconut or coconut oil. • Buy diy peas and beans often. They are low in saturated fat and total fat and high in fiber. amount of saturated fat. Preparation tips: • Try pasta or rice in soups, or with low fat sauces as main dishes or casseroles. • Stretch meat dishes with pasta or vegetables for hearty meals. You can use less meat this wav and still have the flavor. Bake your own muffins and quick breads using unsaturated vegetable oils; substitute two egg whites for each egg yolk, or use egg substitutes. Experiment with substituting applesauce for oil or cut back the amount of oil in the recipe. For each two cups of Hour, you only need 1/4 cup of vegetable oil. •Use diy peas and beans as the main ingredient in casseroles, soups, or other onedish meals. They are excellent sources of protein and fiber. Fats and oils But/mg tips: • Choose liquid vegetable oils high in unsaturated fat for cooking and in salad dressings. Examples are canola, com, olim* peanut, safflower, sesame, soybean, and sunflower oils. • Buy light or nonfat mayonnaise instead of the regular kinds that are high in fat. Page 8 Preparation tips: • In cooking, limit butter, lard, fatback, and solid vegetable shortenings. ° When using fats and oils, use only small amounts and substitute those high in unsaturated fat for those high in saturated fat. For a spread, use tub or liquid margarine, or vegetable oil spread instead of butter. Flavor cooked vegetables with herbs or o butter-flavored seasoning. Sweets and snacks (have only now and then) pretzels, no-oil baked tortilla chips; and plain, air-popped popcorn. Preparation tips: 0 Freeze grapes or banana slices for treats. • Make puddings with skim or 1 percent milk. • Top angel food cake with fruit puree or fresh fruit slices. • Cut up raw vegetables and serve with a low fat dip. • Make air-popped or “light” microwave popcorn. Read food labels Buying tips: 0 Choose these low fat sweets for a special treat: brownies, cakes, cheesecakes, cupcakes, and pastries labeled “fat free” or “low fat.” Even though they have less fat, they still may be just as high in calories. If you are trying to lose weight, read the label to compare; animal crackers, devil s food cookies, fig and other fruit bars, ginger snaps, graham crackers, and vanilla or lemon wafers; frozen low' fat or nonfat yogurt, fruit ices, ice milk, popsicles, sherbet, and sorbet; and •t gelatin desserts. • Try these low' fat snacks: bagels, bread sticks, melba toast, rice cakes, rye crisp, and soda crackers; unsweetened, ready-to-eat cereals; fresh fruit, fruit leather, or other dried fruit; Reading food labels can help you and your family eat the heart-healthy way. Food labels have two important parts: the nutrition label and the ingredients list. Also, some labels have claims like “low fat” or “light.” Look on the nutrition label for the amount of saturated fat, total fat, cholesterol, and total calories in a serving of the product. Use this information to compare similar products and find the ones with the smallest amounts. If there is no nutrition label, look for the list of ingredients. Here, the ingredient in the greatest amount is shown first and the ingredient in the least amount is shown last. So, to choose foods low in saturated fat or total fat, go easy on products that list fats or oil first—or that list many fat and oil ingredients. In addition to the nutrition information and ingredients list, some food packages have claims like “low fat,” “light,” or “fat free.” See page 19 for a list of these claims and wbat they mean. And for more detailed information on reading labels, order Step by Step: Eating To Lower Tour High Blood cholesterol (see page 13). Page 9 CALORIES BURNED PHYSICAL DURING ACTIVITIES* Activity Calories Burned in an Hour* Man** Woman** 300 240 Moderate activity: 460 Walking briskly (3.5 mph) 370 Light activity: Cleaning house Eat out the heart-healthy way Office work Playing baseball Whether your family is eating on the run or sitting down together to a full course meal, you can make choices that are low in saturated fat and cholesterol. These tips will help: Playing golf Gardening Cycling (5.5 mph) • Choose restaurants that have low fat, low cholesterol menu items. Don’t be afraid to ask for foods that follow your eating pattern: Its your light as a paying customer. Dancing Playing basketball Strenuous activity: 730 580 920 740 Jogging (9 min./mile) Playing football • Select poultry, fish, or meat that is broiled, grilled, baked, steamed, or poached rather than fried. Choose lean deli meats like fresh turkey or lean roast beef instead of higher fat cuts like salami or bologna. • Look for vegetables seasoned with herbs or spices rather than butter, sour cream, or cheese. Ask for sauces on the side. • Order a low fat dessert like sherbet, fruit ice, sorbet, or low fat frozen yogurt. Swimming Very strenuous activity: Running (7 min./mile) Racquetbail Skiing * May vary depending an a variety of factors including environmental conditions. ” Healthy man, 175 pounds; healthy woman, 140 pounds. Source: Dietary Guidelines far Americans, U.S. Department of Agriculture, U.S. Department of Health and Human Services, third edition, 1990 (adapted from McArdle, et ai., "Exercise Physiology," 1986). Control serving sizes by asking for a small serving, sharing a dish, or taking some home. LOSE BY WEIGHT KEEPING TRACK Here's a tip to help you control or change your eating habits: Keep track of what you eat, when you eat, and why, by writing it down. Note whether you snack on high fat, high calorie foods in front of the TV, or if you skip breakfast and then eat a large lunch. • At fast food restaurants, go for grilled chicken, and lean roast beef sandwiches or jean plain hamburgers (but remember to iold the fatty sauces), salads with low fat salad dressing, low fat milk, and low fat jozen yogurt. Pizza topped with vegetables is another good choice. Eat these less often: combination burgers, fried chicken and fish, french fries, milkshakes, and regular salad dressings. Once you see your habits, you can set goals for yourself: Cut back on TV snacks and, when you do Make Physical Activity Part of Your Routine snack, have low fat ones. If there's no time for breakfast at home, take a bagel, fruit, or cereal with you to eat at work. Changing your behavior will help you change your weight for the better. Page 10 Regular physical activity improves cholesterol evels: It helps to lower LDL and raise HDL•t can also help you lose weight, if you are overweight. But you don’t have to train like a long distance runner to benefit: Even doing any physical activity for just a few minutes each day is better than none at all. Try to build physical activity into your daily routine in ways like these: • Take a walk at lunch time or after dinner. • Use the stairs instead of the elevator. • Get off the bus one or two stops early and walk the rest of the way. • Park farther away from the store. • Ride a bike. • Work in the yard or garden. • Go dancing. Try to be active as a family: Take trips that include hiking, swimming, or skiing. Use your back yard or the park for games like badminton, basketball, football, or volleyball. Vigorous activities like brisk walking, running, swimming, or jumping rope are called “aerobic.” They are especially good for the health of your heart and can burn off extra calories. Aerobic activities can condition your heart if you do them for at least 30 minutes, three to four times a week. But even if you don’t have 30 minutes, three to four times a week, try to find two 15-minute periods or even three 10-minute periods. Most people do not need to see a doctor before they start being active, especially if they start off slowly and work up gradually to a sensible plan. But you should get advice from your doctor beforehand if any of these conditions apply to you: if you have a medical condition; if you have pains or pressure in the chest or shoulder area; if you tend to feel dizzy or hunt; if you get very breathless after a mild workout; and if you are middle-aged or older, have not been physically active, and plan a fairly strenuous exercise program. Lose Weight Sensibly If you are overweight, losing even 5 to 10 pounds can improve your blood cholesterol levels. But don’t go on a crash diet: The healthiest and longest-lasting weight loss happens when you take it slowly, losing 1/2 to 1 pound a week. If you cut 500 calories a day by eating less and being more active, you should lose 1 pound (which amounts to about 3,500 calories) in a week. (Overweight children and adolescents should not be put on strict weight loss diets; consult your familv doctor if this is a concern.) A heart-healthy eating plan can help you lose weight because cutting down on fat is a good way to cut down on calories. And, if you are overweight, you should take care to eat foods high in starch and fiber (like vegetables, fruits, and breads and cereals) instead of high fat foods. Choose low fat and low calorie items from each food group; the food chart in the back wall help. Finally, you’ll need to limit the amount—or serving sizes—as well. But there’s more to losing weight than just eating less. The most successful weight-loss programs are those that combine diet and increased physical activity. A low fat, low calorie way of eating combined with increased physical activity can help you lose more weight and keep it off longer than either way can achieve alone. See the box on page 10 for some ideas for physical activities. Page 11 ...How High Is a Child’s “High” Blood Cholesterol? K ...What About Cholesterol Levels in Children? Most children do not need to have their blood cholesterol checked. But, all children should be encouraged to eat in a heart-healthy way along with the rest of the family. Children who should be tested at age 2 or older include those who have any of these conditions: 0 at least one parent who has been found to have high blood cholesterol (240 mg/dL or greater), or o a family history of early heart disease (before age 55 in a parent or grandparent). Also, if the parent’s medical history is not known, the doctor may want to check the child’s blood cholesterol level, especially in children with other risk factors like obesity. TOTAL AND LDL-CHOLESTEROL levels 8 N CHILDREN AND TEENAGERS FROM FAMILIES WITH H S G H BLOOD CHOLESTEROL OR EARLY HEART Total Cholesterol Acceptable Borderline High Less than 170 mg/dL 170 to 199 mg/dL 200 mg/dL or greater DISEASE LDL-Cholesterol Less than 110 mg/dL 110'129 mg/dL 130 mg/dL or greater Note: These blood cholesterol levels apply to children 2 to 19 years old. If your child does need to have a cholesterol test, it can be part of a regular doctors visit. Your doctor will likely measure your child’s total cholesterol level first. However, if your family has a history of early heart disease, the doctor may measure the LDL-cholesterol level right from the start. Otherwise, your child’s LDL-cholesterol level should be measured if his or her total cholesterol level was checked and found to be 170 mg/dL or greater. The blood cholesterol categories for children from families with high blood cholesterol or early heart disease are shown in the box below. ...Should You Know Your Cholesterol Ratio? M hen you have your cholesterol checked, some laboratories may give you a number called a cholesterol ratio. This number is your total cholesterol or LDL level divided by your IIDL level. The idea is that combiningthe levels into one number gives you an overall view of your risk lor heart disease. But the latio is too general: It is more importantto know the value for each level separately because LDL- and HDL-cholesterol both predict your risk of heart disease. ...What Are Triglycerides? ^kJ.Vcerides are the form in which fit is r^U^h y°ur blood t0 the tissl,eS‘ lc ulk of your body’s fat tissue is in the 01111 ° tr,gh cerides. Your triglycerides a# measured whenever your LDL-cholester°l is cheeked. Triglyceride levels less than 200 aie considered normal. alnn? 1S nOt C,ear whether high triglycerides nrim Incre.asey°m* risk of heart disease. B’>t hiah’m V/P e b*Sb triglycerides also ha'1 LDL or low HDL levels, which do Page 12 ”Kleasetbe risk of heart disease. ...Will Lowering My Blood Cholesterol Help Me Live Longer? ' Many studies show that lowering cholesterol levels reduces the risk of illness or death from heart disease, which kills more men and women each year than any other illness. If you have heart disease, lowering your cholesterol level will probably help you to live longer. If you don’t have heart disease, the studies so far do not show that you will live longer, but you will definitely reduce your risk ol illness and death from heart attack. ...How Much Will Your Cholesterol Levels Change? Generally your blood cholesterol level should begin to drop a few weeks after you start eating the heart-healthy way. How much it drops depends on the amount of saturated fat you used to eat, how high your high blood cholesterol is, how much weight you lose if you are overweight, and how your body responds to the changes you make. Over time, you may reduce your cholesterol level by 5 to 35 mg/dL or even more. How To Find Out More The National Cholesterol Education Program (NCEP) has other booklets for the public and health professionals on lowering blood cholesterol. Most are free of charge. The NCEP has booklets for adults with high blood cholesterol, age-specific booklets for children and adolescents with high blood cholesterol and their parents, and a pamphlet on physical activity and how to get started. To order publications on cholesterol, weight and physical activity- or request a catalog, write to the address below: ...Is It Safe To Eat in a Heart-Healthy Way? Eating in a way that is lower in saturated fat and cholesterol is safe and can be more nutritious than an eating plan higher in saturated fat and cholesterol. It will even meet the higher needs that women, children, and teenagers have for nutrients like calcium, iron, and zinc, and an eating pattern lower in total fat will reduce the risk for other chronic diseases, such as cancer. And an eating pattern lower in saturated fat, total fat, and cholesterol can still provide enough calories for the proper growth and development of children ages 2 and above. Children younger than 2 years have special nutrient needs for fat. NHLBI Information Center P.O. Box 30105 Bethesda. MD 20824-0105 Page 13 This table gives the saturated fat, total fat, cholesterol, calories, and sodium for some basic foods. Remember, there are 9 calories in each gram of fat. The foods within each group saturated are ranked i ' 1 zfrom 1low-to-high 4 1 * i fat. Choose most often*^ ■....................................................................................... ■ the foods from the top part of each group; they are lower in saturated fat and cholesterol. The examples are meant to I show the differences in fat and cholesterol in select foods. _______ . zzzzzz Product Saturated Fat Cholesterol (grams) (mgs) Total Fat (grams) 2 3 3 5 6 7 7 331 60 73 77 71 74 51 4 8 8 13 14 16 17 8 9 9 86 70 88 5 7 8 Total Calories Sodium (mgs) Meat, Poultry, Fish, and Shellfish (3 ox., cooked) Beef (Fat trimmed to 1/8 in. unless otherwise noted) Liver, beef, braised’ Eye of round, roasted Top round, broiled Top sirloin, broiled 137 60 171 52 185 51 204 52 217 59 231 216 65 984 19 18 23 277 52 253 52 308 56 79 81 103 12 16 19 207 58 229 71 289 62 1 2 5 7 7 39 67 81 49 80 4 5 12 18 18 105 1,080 147 47 214 52 238 912 252 62 1 1 1 2 2 2 3 3 3 3 4 5 64 72 27 79 71 72 63 77 81 55 79 71 4 130 43 3 140 63 4 87 321 5 146 7 168 81 60 7 173 <1 71 77 Ground, extra lean, broiled medium Ground, lean, broiled medium Salami, cooked (3 oz. is about 4 slices, 4-in. around, 1/8 in. thick) Chuck, arm pot roast, braised Short loin, T-bone steak, broiled (1/4 in. trim) Chuck, blade roast, braised ’Liver and most organ meats are low in fat but high in cholesterol Lamb (Fat trimmed to 1/8 in.) Leg, whole, roasted Loin, broiled Shoulder, arm, braised Pork (fresh unless noted otherwise) (Fat trimmed to 1/4 in.) Cured, ham steak, boneless, extra lean, cooked, served cold Loin, tenderloin, roasted Leg (ham), rump half, roasted Cured, shoulder, arm picnic, roasted Ground pork, cooked Chicken Chicken, roasting, light meat without skin, roasted Breast, without skin (3 oz. is about 1 /2) Chicken roll, light meat, about 2 slices or 2 oz. Drumstick, without skin (3 oz. is about 2) Breast, with skin (3 oz. is about 1/2) Wing, without skin (3 oz. is about 4) Chicken, roasting, dark meat without skin, roasted Drumstick, with skin (3 oz. is about 1 1 /2) Thigh, without skin (3 oz. is about 1 1 /2) Chicken hot dog, about 1 Thigh, with skin (3 oz. is about 1 1/2) Wing, with skin (3 oz. is about 2 1/2) 7 152 10 184 9 178 11 142 13 210 17 247 <1 115 3 130 78 81 77 75 754 71 70 Turkey Breast, without skin Breast, with skin Page 14 <1 44 45 Product Wing, without skin Leg, without skin Turkey roll, light meat, about 2 slices or 2 oz. Leg, with skin Wing, with skin Ground turkey, meat and skin, cooked Turkey bologna, about 2 slices or 2 oz. Turkey hot dog, about 1 Saturated Fat (grams) Cholesterol (mgs) Total Fat (grams) Total Calories Sodium (mgs) 1 1 1 1 2 3 n/a n/a 87 101 23 60 98 87 54 59 3 3 4 5 8 11 8 10 139 135 81 145 176 200 125 66 69 269 68 62 90 483 785 <1 <1 1 2 63 35 42 74 <1 3 5 9 95 119 157 183 74 59 43 56 <1 <1 <1 <1 1 61 57 57 167 89 <1 2 2 1 4 83 126 126 85 116 323 95 95 192 359 <1 1 2 3 5 4 9 <1 2 3 5 8 86 99 102 121 150 126 257 123 122 120 <1 4 7 127 144 139 174 160 105 <1 1 5 5 8 41 82 86 117 108 189 459 78 457 52 <1 4 41 70 439 35 no Fish (baked, broiled, or microwaved) Haddock Halibut Bluefin tuna, fresh Sockeye salmon Shellfish (steamed, poached, or boiled) Northern lobster Clams Clams, canned, drained solids Shrimp Oyster Dairy Foods Milk (1 cup) Skim milk Buttermilk Low fat milk, 1% fat Low fat milk, 2% fat Whole milk, 3.3% fat 10 18 33 Yogurt (1 cup) 4 14 <1 2 5 29 Pot cheese or uncreamed dry curd cottage cheese, 1/3 cup <1 3 Plain yogurt, nonfat Plain yogurt, low fat Plain yogurt, whole milk Soft cheeses (1 oz.) Cottage cheese, low fat (1%), 1/2 cup Ricotta, part-skim (1 /4 cup) Cottage cheese, creamed, 1/2 cup <’ 3 $ Ricotta, whole milk, 1/4 cup 5 19 17 32 Hard cheeses (1 oz-) Fat free, low cholesterol imitation cheese <1 3 i 9 Swiss cheese, reduced fat Page 15 Product Saturated Fat Cholesterol Total Fat Total (grams) (mgs) (grams) Calories Sodium (mgs) Reduced fat and low sodium cheese—American, cheddar, colby, monterey jack, muenster, or provolone’* 3 18 4 71 88 Mozzarella, part-skim Reduced fat cheese—American, cheddar, colby, 3 16 5 72 132 monterey jack, muenster, provolone, or string cheese” 3 15 5 79 150 Mozzarella 4 22 6 80 106 Swiss American processed cheese, pasteurized 5 26 8 107 74 6 27 9 106 406 Cheddar 6 30 9 114 176 55 7 •* The nutrient values shown for these cheeses are averages of the different types and brands. Eggs Egg white (1) 0 0 0 17 Egg yolk (1) 2 213 5 59 Nuts and Seeds (1 ounce—about 1/4 cup—unless noted otherwise) (Note: All nuts and seeds are unsalted) Almonds 1 0 15 167 Sunflower seed kernels, roasted 2 0 14 165 Pecans 2 0 19 190 English walnuts 2 0 17 182 3 1 0 3 Pistachio nuts 2 0 14 164 2 Peanuts 2 0 14 159 Peanut butter, smooth, made with added salt, 2 Tbsp. Brazil nuts 3 0 16 190 5 0 19 186 5 149 0 <1 <1 <1 <1 <1 7 0 <1 0 1 0 1 56 134 195 70 123 232 Breads, Cereals, Pasta, Rice, and Dry Peas and Beans Breads Corn tortilla, 1 (6-7 in. around) English muffin, 1 muffin Bagel, plain, 1 (3 1/2 in.) Whole wheat bread, 1 slice Hamburger or hotdog bun, plain, 1 Croissant, butter, 1 medium (4 1/2x4 x 1 3/4 in.) 0 1 0 2 0 12 0 2 2 <1 17 298 i 2 212 40 265 379 149 241 424 Cereals Oatmeal, instant, (1 packet, 3/4 cup) Oatmeal, quick, cooked without salt, 1 cup Corn flakes, 1 cup Granola, 1 /2 cup <1 <1 n/a 3 0 0 0 108 145 98 Pasta (1 cup cooked) Spaghetti or macaroni Egg noodles Page 16 <1 0 <1 53 197 180 1 240 6 Product Saturated Fat (grams) Cholesterol (mgs) Total Fat (grams) Total Calories Sodium (mgs) Grains (1 cup cooked) White rice Brown rice <1 <1 0 0 <1 2 205 216 1 9 <1 <1 <1 <1 0 0 0 0 <1 1 1 <1 104 112 143 92 445**“ 2 359’*” 359-.. <1 <1 <1 0 0 0 0 0 <1 <1 <1 <1 5 37 62 81 105 54 0 0 1 1 4 <1 <1 <1 <1 0 0 0 0 <1 1 <1 <1 68 89 35 23 3 14 52 8 0 0 <1 <1 <1 <1 0 0 0 2 2 0 0 <1 <1 <1 <1 1 106 73 29 82 18 56 11 212 46 39 12 56 3 1/4x2 1/4 xl/4 in.) Popcorn, air popped without salt <1 0 1 108 486 (1 oz. is about 3 1/2 cups) Chocolate chip cookie, 1 (2 1/4 in. around) <1 <1 1 2 3 3 5 0 0 5 9 0 66 29 1 2 2 3 10 6 7 108 48 132 92 152 117 132 Dry Peas and Beans (1/2 cup cooked) Kidney beans, canned, solids, and liquid Kidney beans, dry Garbanzo beans/chickpeas, canned, solids, and liquid Black-eyed peas, canned, solids, and liquid *** Pasta cooked without salt. •••’Rinsing canned beans and peas with water will reduce the sodium content. Fruits and Vegetables Fruit, raw Peach, 1 Orange, 1 Apple, 1 Banana, 1 Avocado, 1/6 (or 2 Tbsp.) Vegetable, cooked (1/2 cup) Potato Corn Carrot Broccoli Sweets and Snacks Hard candy (1 oz.) Angel food cake, purchased, 1/12 of 9 in. cake Ginger snap, 1 (about l/4oz.) Frozen yogurt, fruit or vanilla, nonfat (1/2 cup) Vanilla wafer, 1 Fig bar, 1 (about 1/2 oz.) Pretzels, salted (1 ounce, about 5 twists, Sherbet, orange, (1/2 cup) Ice milk, vanilla, hard, (1/2 cup) Potato chips (1 oz.) Pound cake, purchased, 1/10 of 10.75 oz. cake Ice cream, vanilla, regular, (1/2 cup) 1 32 44 56 168 119 53 Page 17 Product Saturated Fat Cholesterol Total Fat Total (grams) (mgs) (grams) Calories Sodium (mgs) <1 7 3 14 12 12 15 23 18 15 30 31 44 32 288 140 346 235 275 242 431 290 320 515 457 706 53 758 336 792 124 387 671 615 542 500 957 999 1,149 Fast Foods Egg & bacon biscuit, 1 10 Cheeseburger, large, double patty with condiments 18 0 60 9 52 0 36 44 55 62 50 60 353 141 Saturated Fat Cholesterol Polyunsaturated Monounsaturated (grams) (mgs) Fat (grams) Fat (grams) 2 4 11 8 1 5 5 4 2 <1 3 9 2 4 10 4 4 5 6 3 Tossed salad, no dressing, 1 1/2 cup 0 Grilled chicken sandwich 1 Cheese pizza, 1/8 of 12 in. pizza Roast beef sandwich, plain 4 French fries, regular order 4 Hamburger, plain 4 Hot dog 5 Fish sandwich with tartar sauce 5 Chicken, breaded and fried, boneless pieces, 6 6 2 Cheeseburger, plain, single patty 7 Chicken fillet sandwich, plain 9 Fats and Oils (1 Tbsp.) Margarine, diet Canola oil Safflower oil Corn oil Olive oil Margarine, soft, tub Margarine, liquid, bottled Margarine, stick Lard Butter in. = inches < = less than oz. = ounces n/a = not available 1 1 1 2 2 2 2 2 5 7 0 0 0 0 0 0 0 0 12 28 Tbsp. = tablespoon Sources: Composition of Foods - Raw-Processed-Prepared, Agriculh ure Handbook 8. Series and Supplements. United States Departme of Agriculture, Human Nutrition Information Service. New beef and lamb nutrient data for cuts trimmed to I 1/8 in. external fat. United States Department of Agriculture, Human Nutrition Information Service, unpublished data, 1994. Minnesota Nutrition Data System (NDS) software, developed by the Nutrition Coordinating Center, University of Minnesota, Minneapolis, MN. Food Database version 5A, Nutrient Database version 20. Page 18 Here are the main label claims used on food packages— and what they mean: Sodium — Sodium free: Less than 5 mg sodium in a serving. Saturated Fat — ‘Saturated fat free: Less than 1/2 gram saturated fat in a serving; levels of trans fatty acids must be not more than 1 percent of total fat. ’Low sodium: 140 mg sodium or less in a serving. For a meal or main dish: 140 mg sodium or less in 100 grams of food. Very low sodium: 35 mg sodium or less in a serving. “Low saturated fat: 1 gram saturated fat or less in a serving and 15 percent or less of calories from saturated fat. For a meal or main dish (like a frozen dinner): 1 gram saturated fat or less in 100 grams of food and less than 10 percent of calories from saturated fat. Cholesterol — * Words that mean the same thing as free: "no/' "zero/' "without," "trivial source of," "negligible source of," and "dietarily insignificant source of." “ Words that mean the same thing as low: "contains a small amount of" and "low source of." ‘Cholesterol free: Less than 2 milligrams (mg) cholesterol in a serving; saturated fat content must be 2 grams or less in a serving. For a meal or main dish: 20 mg cholesterol or less in 100 Light ~ A product has been changed to have half the fat or one-third fewer calories than the regular product; or the sodium in a low calorie, low fat food has been cut by 50 percent; or a meal or main dish grams of food, with saturated fat content less than 2 grams is low fat or low calorie. “Low cholesterol: 20 mg cholesterol or less in a serving; saturated fat content must be 2 grams or less in a serving. in 100 grams of food. Fat — "Light" also may be used to describe things like the color or texture of a food, as long as the label explains this: for example, "light brown sugar" or ‘Fat free: Less than 1/2 gram fat in a serving. "light and fluffy." “Low fat: 3 grams total fat or less in a serving. For a meal or main dish: 3 grams total fat or less in 100 grams of food Reduced/Less/Lower/Fewer — A food (like a lowerfa? hot dog or a iower-sodium cracker) has at least 25 percent less of something like calories, fat, and not more than 30 percent calories from fat. saturated fat, cholesterol, or sodium than the Percent fat free — A food with this claim must also meet the regular food or a similar food to which it is low fat claim. compared. Calories — Lean and Extra Lean — Two terms—"lean" and "extra lean"—are used to describe the fat content of ’Calorie free: Less than 5 calories in a serving. meat, poultry, fish, and shellfish: “Low calorie: 40 calories or less in a serving. Lean - Less than 10 grams fat, 4.5 grams or less of saturated fat, and less than 95 mg cholesterol in a serving. Extra lean - Less than 5 grams fat, less than 2 grams saturated fat, and less than 95 mg cholesterol in a serving. Page 19 0 If you eat this many calories a day... 1,200 Calories 1,500 1,800 2,000 2,500 ...This is the recommended amount of fat for each day: Saturated Fat*, in grams 12 15 18 20 25 Total Fat’*, in grams 40 50 60 65 80 ’Amounts are equal to 9 percent of total calories; the recommendation is to eat less than 10 percent of total calories as saturated fat. Remember, 1 gram of fat is equal to 9 calories. ’’Amounts are equal to 30 percent of total calories (rounded down to the nearest 5); the recommendation is to eat this much or less. Note: On average, women consume about 1,800 calories a day and men consume about 2,500 calories a day. U.S DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service National Institutes of Health National Heart, Lung, and Blood Institute NIH Publication No. 96-2696 Originally Printed 1985 Previously Revised 1994 Reprinted August 1996 National Cholesterol Education Program NHLBI Obesity Education Initiative Coordinated by the National Heart, Lung, and Blood Institute