Nursing Essay Example
Nursing Project Assignment 1 (2000 words 45%)
PLEASE DO NOT RE-FORMAT THIS TEMPLATE
Please note: 2,000 word count includes in-text references but excludes the Reference List.
Background (300 words)
State your research question (RQ) and provide background and rationale about why you developed the RQ. Explain how your RQ is important and relevant (useful) for the development of clinical practice or professional knowledge at a local and/or international level.
Cardiovascular disease ranks as a leading cause of mortality worldwide, with the condition blamed for more than 17 million deaths, or 29% of all mortalities (Nordet et al. 2013, p. 36). There exist variations in disease incidence, where around 80% of cardiovascular mortalities occurred in low and middle-income countries, with a majority of the incidences affecting persons of above 60 years (Nordet et al. 2013, p. 36). Among the risk factors for cardiovascular disease, only smoking is without dietary influence, with the other three, including hypertension, hypercholesterolemia, and diabetes all have epidemiologically proven dietary influence. Hypercholesterolemia, for instance, is modulated by factors such as family history, ethnicity and importantly, diet, where consuming a healthy diet that is low in unsaturated fats is among the modifiable risk factors for high blood cholesterol (Kendall, Esfahani & Jenkins 2010, p. 42). Medical conditions and age may have an impact on an individual’s mobility, which may affect their ability to exercise (Bibbins-Domingo et al. 2010). Using anti-hypercholesterolemia drugs has been proven to help reduce the amount of cholesterol in the body. The drug however has negative side effects including muscle pain and increased liver damage; therefore, resulting in a need for non-pharmacologic ways of reducing high body cholesterol (Bibbins-Domingo et al. 2010). Understanding the relationship between dietary interventions in controlling cholesterol may improve nurses’ abilities to assess, implement, evaluate and deliver the alternative care in mitigating against cardiovascular disease (Nickless 2011).
This examination assesses the efficacy of diet in cholesterol control by answering the research question; What is the role of diet in preventing cardiovascular disease amongst individuals with high cholesterol?
Summarize Your Four Primary Research Articles (1000 words)
Alipoor, B, Haghighian, M, Sadat, B & Asghari, M 2012, ‘Effect of sesame seed on lipid profile and redox status in hyperlipidemic patients,’ International journal of food sciences and nutrition, vol. 63, no. 6, pp. 674.
This article examines the effects of sesame seeds on serum lipid reduction about perceived beneficial changes associated with cardiovascular disease (CVD) risk factors. The study involved 38 hyperlipidemic patients randomly placed into two groups. All patients were subjected to a uniform drug regime for the 60-day period. However, the intervention group patients were required to supplement their diet with 40 g white sesame seeds, with less 240 kcal in their diet. At the beginning of the study, height, weight as well as BMI index measurements were taken, as well as an assessment of lipid profile and oxidative stress indicators. Further, dietary education was provided for the patients before the study, with measures in place against alcohol consumption, supplements as well as commercial health foods within the study period. The study found sesame enhanced to reduce serum total cholesterol levels (TC), as well as low-density lipoprotein cholesterol (LDL-C). Studies on the rat
show that the cholesterol inhibiting the effect of sesame derives from intestinal inhibition of cholesterol absorption, accelerated cholesterol excretion as well as reduced action of the 3-hydroxy-3-methylglutaryl coenzyme. Nonetheless, findings from this study are limited given that the study group consisted of 8 men and 30 women, providing a potential gender bias in the results gathered. Further, the limitation on sample size as well as the duration of the study may be insufficient in deriving conclusive evidence on the effect of sesame on hyperlipidemia. This study is relevant to the research question since it investigates the mitigating effect of sesame on total cholesterol levels, as a risk for CVD.
Estruch, R, Martínez-González, M, Corella, D, Salas-Salvadó, J & Al, E 2006, ‘Effects o f a Mediterranean-Style Diet on Cardiovascular Risk Factors: A Randomized Trial,’ Annals of Internal Medicine, vol. 145, no. 1, pp. 1-11.
The article reports on results of an extensive feeding trial in predisposed cardiovascular patients in the assessment of the outcomes following consumption of two Mediterranean diets as well as a low-fat diet. The diets will consist of Mediterranean diet with mixed nuts, Mediterranean diet with virgin olive oil, with the third being a low-fat diet. Eligible participants to the study were community-living men aged 55-80 and women aged 60-80 each satisfying a minimum of one of two criteria. Participants were required to be type 2 diabetics, or to show more than three cardiovascular disease risk factors; including current smoking, hypertension or high levels of low-density lipoprotein. The selected patient’s etiology makes them the highest predisposed individuals to the occurrence of CVD, with both the advanced age, type II diabetes or a combination of risk factors maximizing chances of CVD occurrence. Body weight, as well as body fat measures, declined in the three study groups, whereas only in the Mediterranean diets did the systolic as well as diastolic blood pressure subside. Further, blood glucose, cholesterol to HDL cholesterol proportion as well as increased HDL cholesterol levels. The study outcomes observed in patients taking the Mediterranean diets supports evidence of the beneficial cardiovascular outcomes related to high-monounsaturated diets such as olive oil. The study’s limitations were that clinical outcome was not the main focus of the study, and the less- intense dietary education provided to the low-fat group. This study is relevant in answering the research question by reducing cholesterol, a cardiovascular disease risk factor, through dietary intervention.
Faghihnia, N, Mangravite, L, Chiu, S, Bergeron, N & Krauss, R 2012, ‘Effects of dietary saturated fat on LDL subclasses and apolipoprotein CIII in men,’ European journal of clinical nutrition, vol. 66, no. 11, pp. 1299-1233.
The article presents results from a randomized, controlled crossover dietary intervention assessing plasma lipid and lipoprotein outcomes in high versus low saturated fat intake diets, with concern to the replacement of a carbohydrate diet to a protein diet derived chiefly from beef. The study included 14 male participants, with each participant having to consume a 50% carbohydrate, 13% protein, 38% total fat, as well as 15%, saturated fat diet over a three-week period. Further, the participants were put on either a low (8%) or a high saturated fat (15%). The patients were allowed two weeks’ recovery, where they returned to their normal diets as a (washout) measure. The study concluded that the consumption of low saturated fat, as well as low carbohydrate and beef protein, supplemented diet led to total cholesterol reduction, as well as reduced low-lipoprotein serum levels. In contrast, consumption of high levels of saturated fat, high beef protein as well as low carbohydrate level leads to an increase in total cholesterol level. The study findings indicate towards increased risk for cardiovascular disease following consumption of a diet rich in saturated fats. The efficacy of the study is reduced by a small sample size, with further studies necessary on the subject, given limited potential for multivariate adjustments on the available data. Nonetheless, this study is invaluable in answering the research question since it demonstrates the relationship between high unsaturated fat diets and total cholesterol levels. A high unsaturated fat, beef protein diet is predictive of CVD, given its elevating effect on cholesterol levels.
Guasch-Ferré, M, Babio, N, Martínez-González, M, Corella, D, Ros, E, Martín-Peláez, S, Estruch, R, Arós, F, Gómez-Gracia, E, Fiol, M 2015, ‘Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease’, American Journal of Clinical Nutrition, vol. 102, no. 6, pp. 1563-1573.
The report examines the hypothesis that dietary fat quality is of more importance to cardiovascular outcomes as compared to the total amount of fat consumed. The study was a randomized trial for primary prevention of CVDs, with participants chosen on the basis of high risk to cardiovascular disease. The participants were men aged 55-80 years, as well as women aged between 60-80 years, free of CVD at baseline. However, the participants must have a high predisposition to CVD either due to diabetes type II, or having more than three cardiovascular risk factors including current smoking, hypertension or hypercholesterolemia. Participants were randomly assigned to (MedDiet + EVOO oil), (MedDiet + Nuts) or assigned to a control group placed on a low-fat diet. The study found that individuals with a higher total fat dietary intake suffered reduced incidence of CVD, with saturated fatty acids as well as trans fats allied to increased cardiovascular risk. However, individuals benefitting from a total increase in fat consumption derived from polyunsaturated fatty acids as well as monounsaturated fatty acids, both having proven beneficial effects on health. The discussion espouses the biological mechanisms guiding improved cardiovascular outcomes, where MUFAs are credited with an improved lipid profile, reduction in blood pressure, insulin resistance modulation as well as enhanced endothelial function. This study is important in answering the research question, since it provided evidence of dietary interventions used in reducing cholesterol, consequently improving cardiovascular outcomes for predisposed individuals. The study, however, has several limitations which may include possible measurement errors in total fat and subtypes of fat intake due to the use of FFQ. Strengths noted in the study include the use of repeated dietary measurements during follow-up, the ability to control for potential confounders due to the recording of comprehensive data, and the accurate and blind assessment of incident cases of CVD and death.
Discussion (550 words)
Compare and contrast the findings of each primary research paper. Ensure that your analysis explains why your research papers are relevant and how the findings enable you to answer the research question. Identify any existing gaps in knowledge or practice. Additional relevant literature should support discussion.
This paper examines the efficacy of dietary interventions in mitigating cholesterol as a risk factor for CVD in people with high risk for CVD. In answering the research question, it explores four randomized controlled trials on the effectiveness of various diets on cholesterol levels in CVD exposed individuals. Each study exhibited unique characteristics including number of participants, geographical location, duration of study as well as dietary interventions employed, providing a wider pool of evidence on the possible benefits of diet in reducing cholesterol levels in CVD predisposed individuals (Faghihnia et al. 2012; Alipoor et al. 2012; Estruch et al. 2006; Guasch-Ferre et al. 2015).
Alipoor et al. (2012) examine the beneficial alterations in risk factors leading to cardiovascular disease following consumption of a diet enhanced with white sesame seeds. The researchers sought to explore the effects of sesame in serum lipid levels while improving antioxidant properties in the participating individuals. The results indicated that the group on a sesame diet had markedly reduced the serum total cholesterol levels, as well as low-density lipoprotein cholesterol, (LDL-C). The study mirrors results observed in a sesame diet group of knee osteoarthritis patients, where serum total cholesterol (TC), as well as LDL-C, were significantly reduced in the treatment group (Haghighian et al. 2014, p. 94). However, a sample size, as well as the duration of the study, may be insufficient in deriving conclusive evidence on the effect of sesame on hyperlipidemia, supplementation with sesame could lead to positive cardiovascular outcomes in patients with high cholesterol levels.
Estruch et al. (2006) explore the effects of a Mediterranean diet on intermediate cardiovascular disease risk factors. The study is a large, randomized, parallel-group, multicenter controlled clinical trial assessing the effects of a Mediterranean diet on cardiovascular outcomes. The study seeks an estimated 9000 cardiovascular disease predisposed participants, assigned to 3 intervention groups made up of, Mediterranean diet with virgin oil, Mediterranean diet with mixed nuts, with the control group being on a low-fat diet. Study results indicated that high-risk individuals who improved their baseline Mediterranean diet enjoyed low blood pressure, enhanced lipid profiles, reduced insulin resistance as well as controlled levels of inflammatory molecules in comparison to the low-fat diet category. The findings of this study validate findings of a systematic review and meta-analysis on the effects of a Mediterranean diet on cardiovascular outcomes (Liyanage et al. 2016), who affirmed beneficial outcomes following a Mediterranean diet. However, choosing another control group aside from low-fat diet might be more accurate to compare as all participants were from Mediterranean environment and culture where virgin olive oil and mixed nuts are part of the habitual diet, especially when considering the less intense dietary education provided to the control group (Gillingham, Harris-Janz & Jones 2011).
Faghihnia et al. (2012) discuss the effects of dietary saturated fat on small, dense low-density lipoprotein elements, as well as (apo) CIII as cardiovascular risk factors. The authors report on a randomized, controlled crossover dietary intervention assessing plasma lipid and lipoprotein levels in high versus low saturated fat intake diets, with concern to the replacement of a carbohydrate diet to a protein diet derived chiefly from beef. The study found the consumption of low saturated fat, as well as low carbohydrate and beef protein, supplemented diet, led to total cholesterol reduction, as well as reduced low-lipoprotein serum levels. In contrast, consumption of high saturated fat levels led to elevated cholesterol levels. This article is in line with (Siri-Tarino et al. 2015) who found improved cardiovascular outcomes following dietary replacement of saturated fatty acids with polyunsaturated fatty acids as well as mono fatty acids.
The study’s main limitation was the small sample size.
Guasch-Ferre et al. (2015) assess the idea that dietary fat quality is of more importance to cardiovascular outcomes as compared to the total amount of fat consumed. The researchers randomly assigned participants to (MedDiet + EVOO oil), (MedDiet + Nuts) or a control group placed on a low-fat diet. The researchers established a lower risk of CVD for persons with a high total fat dietary intake, while saturated fatty acids, as well as trans fats, were associated with higher risk for CVD. De Souza et al. (2015) found no relation between saturated fat intake to adverse health outcomes but related increase in cardiovascular deaths is owing to consumption of unsaturated fats. This study illustrates the beneficial outcomes on cholesterol levels, as well as cardiovascular health, related to consumption of particular types of fats as opposed to others.
Conclusion (150 words)
Summarize the major points in a synthesized non-repetitive manner and identify clear future directions for research.
High blood cholesterol remains a major predisposing risk factor for cardiovascular disease, where mitigating against blood cholesterol levels leads to reduced risk for CVD. Dietary interventions remain a major unexplored dimension in reducing blood cholesterol, informing formulation this paper’s research question. The four dietary interventions assessed indicate towards possible efficacy for blood cholesterol dietary controls, in a bid at reducing negative cardiovascular outcomes in predisposed patients. While some diets such as sesame seed and Mediterranean diet emphasize on dietary composition, quality of fats consumed is also an important variable determining cardiovascular outcomes.
The four up-to-date studies chosen for this
review shows the efficacy of dietary interventions in reducing cholesterol levels as a CVD risk factor.
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