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

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Cardiovascular risk factor education program for healthcare

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& Macera, C. (1995). Changes in physical fitness and all-cause

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Centers for Disease Control and Prevention (1997). Update:
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Cholesterol Problems (1997). The New England Journal of
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Cholesterol Statistics (1997). American Heart Association. 1997

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T., Ports, T., Sparler, S., & Billings, J. (1995). Changes in myocardial

perfusion abnormalities by positron emission tomography after long­
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Arteriosclerosis, Thrombosis and Vascular Biology, 17, 95-106.

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Metropolitan Life Insurance Company (1983). Height/weight

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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.
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Ornish, D„ Brown, S., Scherwitz, L„ Billings, J., Armstron, W.,
Ports, T., McLanahan, S„ Kirkeeida, R„ Brand, R„ & Gould, K. (1990).

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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
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Scandinavian Simvastatin Survival Study (4S) Group (1994).
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coronary heart disease: The Scandinavian simvastatin survival study
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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
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Sherwin, R„ & Price, T. (1997). Fat chance: Diet and ischemic
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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
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3391.

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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