Assess the effectiveness of cocoa powder in reducing cholesterol level among the hypertensive clients at the rural area, Medavakkam, Chennai

 

Ms. Grace Jebakani Sweety

Associate Professor, Our Lady of Health College of Nursing, Thanjavur, Tamil Nadu, India

 

ABSTRACT:

 

 

INTRODUCTION:

A person is said to be Hypertensive when the Blood Pressure is above 140mm Hg systolic and 90mm Hg diastolic. Sedentary lifestyle, smoking, stress, visceral obesity, potassium deficiency, alcohol intake, aging, vitamin D deficiency are all the pre guides for the  incidence of Hypertension.

 

The Sentinel Surveillance Project documented 28% overall prevalence of Hypertension in urban and rural areas. Recent estimates suggests that approximately 1 Billion adults have Hypertension with progressive increase in the prevalence of age – specific and age- adjusted Hypertension with high cholesterol levels. Given that more than 80%of the world’s population lives in economically developing nations, it is very likely that the worldwide burden of illness due to Hypertension will continue to escalate unless measures are to be blunt the expected increase in prevalence of Hypertension.

 

Cardio vascular diseases account for a large population of all deaths globally where Hypertension and Hypercholestremia plays a major context. 5.2million Deaths are happening in developing countries. Meta – analysis of Indian prevalence studies has shown that there has been a significant increase in Hypertension in both urban and rural areas. Lifestyle modifications, such as smoking cessation, dietary therapy, and physical activity, with or without anti lipedimic drug therapy, are used to manage hypercholesterolemia and reduce risk of Coronary Heart Disease. Restricting total fat is less important than reducing the intake of saturated fat and cholesterol. Moreover, diets very low in total fat are high in carbohydrates, which may increase triglyceride levels and lower HDL cholesterol levels.

 

Cocoa powder is an unsweetened powder produced by grinding cocoa beans and pressing out the cocoa butter(fat). Natural Unsweetened Cocoa Powder tastes very bitter and gives a deep chocolate flavor that makes it very palatable. The odor smells as the chocolate and appears in dusky brown in appearance. It has no side effects. In May 2010, a literature review of short-term research from eight previous trials demonstrating the impact of cocoa on cholesterol was published in the American Journal of Clinical Nutrition. In fact, the researchers found that chocolate is effective only for reducing cholesterol at low doses and only for people who are already at risk for cardiovascular disease. Jai et al., (2010) performed a study about the Short-term effect of cocoa product consumption on lipid profile which showed that cocoa considerably reduced cholesterol level in hypertensive patients. Albert et al., (2007) in their study found out that Continuous intake of poly phenolic compounds containing cocoa powder reduces LDL oxidative susceptibility and has beneficial effects on plasma HDL-cholesterol concentrations in humans.

 

During the interview with those clients, the investigator found out that they feared about their increased cholesterol and expressed their willingness to take further treatment to reduce their cholesterol level at the earliest. As they revealed that they could be treated without the medications for reducing the same as they are under the anti – hypertensive drugs too. So, the investigator thought of carrying out an intervention which can be easily affordable and available to the community people in the rural area so that they could be encouraged in their home management. The investigator after the reviews found out that cocoa powder would be very effective in reducing cholesterol levels at the reliable manner. The cocoa powder would be easily available, cost effective, affordable, and palatable and without any side effects may considerably decrease the cholesterol levels which in turn improves the cardiovascular health.

 

STATEMENT OF THE PROBLEM:

Assess the effectiveness of cocoa powder in reducing cholesterol level among the Hypertensive clients at the rural area, Medavakkam, Chennai.

 

OBJECTIVES OF THE STUDY:

·       To assess the pre test cholesterol level of Hypertensive clients in experimental and control group.

·       To assess the post test cholesterol level of hypertensive clients in experimental and control group.

·       To compare the pre test and post test cholesterol level of Hypertensive clients in experimental and control group.

·       To identify the effectiveness of cocoa powder on Cholesterol levels in experimental group.

·       To associate the findings with the selected demographic variables.

 

HYPOTHESIS:

There is a significant association between cocoa powder and the cholesterol levels.

 

RESEARCH DESIGN:

The research design used in this study was quasi experimental design that helps to provide factual information about the existing phenomena.

 

SETTING OF THE STUDY:

The selection of setting was done on the basis of the feasibility for conducting the study, availability of the sample, convenience to the investigator, geographical proximity and co operation from the authority. The study was conducted in the rural area Medavakkam. Medavakkam is a rural area, which belongs to St. Thomas Mount Block , kancheepuram District and is located around the Upgraded Primary Health Centre, Medavakkam. It has 9 village panchayats covering a population of 1,01,527. Among the 9 village panchayat which has 24 streets. The department of Community Health Nursing, College of Nursing, Madras Medical College adopted Kalaingar Nagar and Vanathurai to provide the curative and preventive care. These areas were selected for the study.

 

VARIABLES:

·       Variables included in the study were:

·       Dependant variables: Cholesterol levels.

·       Independent variables: Cocoa powder administration

 

POPULATION:

The study population includes all the Hypertensive clients who were residing at the rural area, Medavakkam. The areas of Kalaingar Nagar and Vanathurai were selected for the study. The total population was 6710 in Kalaingar Nagar and 6222 in Vanathurai. The Hypertensive clients with cholesterol above 200 mg/dl in each area were 44 in Kalaingar Nagar and 72 in Vanathurai

 

SAMPLE AND SAMPLE SIZE:

The study sample comprises of Hypertensive clients with the Blood pressure above 140/90mmHg and high cholesterol of above 200mg/dl at the rural area, Medavakkam. The experimental group 30 and control group 30 were selected from Kalaingar Nagar and Vanathurai.

 

SAMPLING TECHNIQUE:

The sampling technique employed to recruit the samples for the study was simple random sampling.

 

CRITERIA FOR SAMPLE SELECTION:

Inclusion criteria:

·       Clients who are willing to participate in the study.

·       Clients who are having Hypertension above 140/90 mm Hg residing at the rural area , Medavakkam.

·       Hypertensive clients having high cholesterol levels of above 200 mg / dl who are not taking anti lipedimic drugs.

·       Clients who are able to understand English and Tamil.

 

Exclusion criteria:

·       Hypertensive clients with the history of Diabetes Mellitus.

·       Clients with complication related to Hypertension like Myocardial infarction.

 

DEVELOPMENT AND DESCRIPTION OF THE TOOL:

The development of the tool was developed based on the objectives of the study, review of literature and the opinion from the experts and it helped the investigator in the development of the tool.

 

Section A: Demographic data of the Hypertensive clients which included the age, sex, educational status, marital status, occupation, family history of Hypertension, dietary habits, duration of illness, drugs taken by the clients, frequency of taking the drugs, reason for missing the dose if any, average hours of sleep, nap in the afternoon and the history of practicing exercises

 

Section B: Observation schedule of Cholesterol levels before and after the administration of Cocoa powder of the Hypertensive clients with High cholesterol.

 

ETHICAL CONSIDERATION:

The proposal of the study was approved by the experts prior to the pilot study by the Ethical Committee of Madras Medical College, Chennai. Each individual client was informed about the purpose of the study. Informed consent was obtained. Assurance was given to them that confidentiality and privacy would be maintained.

 

 

DATA ANALYSIS AND INTERPRETATION:

Table 1: Percentage Distribution of demographic variables of the hypertensive clients.

Demographic variables		Group
		Experiment		Control
		n	%	N	%
Age	36 -50 yrs	7	23.3%	6	20.0%
	51 -65 yrs	13	43.3%	10	33.3%
	> 65 yrs	10	33.3%	14	46.7%
Sex	Male	16	53.3%	10	33.3%
	Female	14	46.7%	20	66.7%
Education status	Non formal Education	9	30.0%	10	33.3%
	High school	18	60.0%	15	50.0%
	Higher secondary	3	10.0%	5	16.7%
Marital status	Married	30	100.0%	30	100.0%
Occupation status	Professional	2	6.7%	2	6.7%
	Business	9	30.0%	3	10.0%
	Daily wages	10	33.3%	10	33.3%
	Unemployed	9	30.0%	15	50.0%
Family history	Yes	12	40.0%	15	50.0%
	No	18	60.0%	15	50.0%
Dietary habits	Vegetarian	3	10.0%	2	6.7%
	Non vegetarian	27	90.0%	28	93.3%
Duration of illness	< 2 yrs	7	23.3%	7	23.3%
	2 -5 yrs	11	36.7%	17	56.7%
	> 5 yrs	12	40.0%	6	20.0%
Frequency of drug	Daily morning after food	22	73.3%	26	86.7%
	Daily in the morning and night after food	8	26.7%	4	13.3%
Chance to miss the dose of the drug	No	30	100.0%	30	100.0%
Average hours of sleep per day	<8 hours	14	46.7%	17	56.7%
	8 hours	16	53.3%	13	43.3%
Nap in the afternoon	Yes	11	36.7%	16	53.3%
	No	19	63.3%	14	46.7%
Practicing any exercise regularly	Yes	4	13.3%	5	16.7%
	No	26	86.7%	25	83.3%

 

Table 2: Percentage Distribution of pre test cholesterol level among Hypertensive clients in experimental and control group.

S. No	Samples	N	Mean	SD
1.	Experimental group.	30	220.97	10.79
2.	Control group	30	219.37	10.47

 

Table 3: Percentage Distribution of post test cholesterol level among Hypertensive clients in experimental and control group.

S. No	Samples	N	Mean	SD
1.	Experimental group.	30	210.80	15.93
2.	Control group	30	218.37	11.22

 

Table 4: comparison of pretest and posttest cholesterol level  among experimental and control group .

	No. of clients	Pretest Mean±SD	Posttest Mean±SD	Student’s paired t-test
Experimental group.	30	220.97±10.79	210.80±15.93	t=6.34 P=0.001*** DF =29
Control group.	30	219.37±10.47	218.13±11.22	t= 0.28 P=0.77 DF =29

 

Table 5: Comparison of the cholesterol level among hypertensive clients of experimental and control group.

	Experimental group	Control group	Student’s independent t-test
Pretest	220.97±10.79	219.37±10.47	t=0.52 P=0.60 DF= 58 not significant
Posttest	210.80±15.93	218.13±11.22	t=2.06 P=0.04* DF= 58 significant
Student’s paired t-test	t=6.34 P=0.001*** DF =29	t=0.28P=0.77 DF =29

 

Table 6: Mean difference of cocoa powder in pretest and posttest among experimental and control group.

		Mean score	Mean Difference in cholesterol value with 95% Confidence interval
Experiment group	Pretest	220.97±10.79	10.17(3.13 – 17.20)
	Posttest	210.80±15.93
Control group	Pretest	219.37±10.47	1.24(-4.36 – 6.84)

 

Table 7: Association between posttest level of cholesterol value and their demographic variables in experimental group.

Demographic variables		Posttest Level of cholesterol				Total	Pearson chi square test /Yates corrected chi square test
		≤ 200		>200
		n	%	N	%
Age	36 -65 yrs	8	40.0%	12	60.0%	20	c2=5.45P=0.02* DF=1
	> 65 yrs	0	0.0%	10	100.0%	10
Sex	Male	3	18.8%	13	81.3%	16	c2=1.10 P=0.29 DF=1
	Female	5	35.7%	9	64.3%	14
Education status	Non formal Education	1	11.1%	8	88.9%	9	c2=1.59 P=0.20 DF=1
	High school/HSc	7	33.3%	14	66.7%	21
Marital status	Married	8	26.7%	22	73.3%	30	c2=0.00 P=1.00 DF=1
Occupation status	Employed	6	28.5%	15	71.5%	21	c2=0.13 P=0.71 DF=1
	Unemployed	2	22.2%	7	77.8%	9
Family history	Yes	4	33.3%	8	66.7%	12	c2=0.45 P=0.50 DF=1
	No	4	22.2%	14	77.8%	18
Dietary habits	Vegetarian	0	0.0%	3	100.0%	3	c2=1.21 P=0.27 DF=1
	Non vegetarian	8	29.6%	19	70.4%	27
Duration of illness	< 5 yrs	5	27.7%	13	72.3%	18	c2=0.03 P=0.86 DF=1
	> 5 yrs	3	25.0%	9	75.0%	12
Average hours of sleep per day	<8 hours	1	7.1%	13	92.9%	14	c2=5.12 P=0.02* DF=1
	8 hours	7	43.8%	9	56.2%	16
Nap in the afternoon	Yes	5	45.5%	6	54.5%	11	c2=0.36 P=0.54 DF=1
	No	3	15.8%	16	84.2%	19
Practicing any  exercise regularly	Yes	3	75.0%	1	25.0%	4	c2=12.69 P=0.001*** DF=1
	No	5	19.2%	21	80.8%	26

The above table reveals that in the experimental group there is significant association between the selected demographic variables such as age , average hours of sleep per day and the practice of exercises regularly

 

 

DISCUSSION:

The study showed the findings that cocoa powder was found effective in reducing cholesterol level among hypertensive clients as the cholesterol level was reduced from the mean of 220.97 to 210.80. Due to the cocoa powder they are able to reduce 10.17 from base line score. This difference is statistically significant. Statistical significance was calculated by using student’s paired t – test.  t= 6.34 p=0.001.               

 

In post test, the experiment and control group are having statistically significant difference with P value-0.001 and DF=1. The study result showed that the cocoa powder was found to be effective in experimental group in reducing cholesterol level and the student’s independent t –test was used to find the significant difference. t-2.06, p=0.04 and DF =58.

 

In the finding of the experimental group, clients had  reduced 10.17 cholesterol value whereas in control group clients had reduced 1.24% cholesterol value. Difference was 8.93 cholesterol value. Experimental group clients  were  benefitted 8.93value  than  control group. This 8.93 cholesterol value difference is the effectiveness of cocoa powder.

 

This effectiveness of cocoa powder was supported by  Jia et al (2010)  in the study of Short-term effect of cocoa product consumption on lipid profile for a  period of 2 weeks . Short-term cocoa consumption significantly reduced blood cholesterol, but the changes were dependent on the dose of cocoa consumption and the healthy status of participants. Cocoa consumption significantly lowered LDL cholesterol by 5.87 -6.27 mg/dL and lowered total cholesterol by 5.82 -7.34mg/dl.

·       Cocoa powder reduced the cholesterol level from100% to 73.3% in experimental group and no significant reduction  in control group.

·       The association of the effectiveness of the cocoa powder with the selected demographic variables showed that cocoa powder was found effective among the age group of between 36-65 years(40.0%)  and statistically  proved significant c2=5.45p=0.02.It was effective 43.8% among those who sleeps 8 hours a day with the significant value c2=5.12 p=0.02. It was effective 75% among those who perform exercises daily which was significantly proved to be significant c2=12.69 p=0.001.]

 

CONCLUSION:

Though the hypertensive clients were taking anti-hypertensive drugs for their treatment, they were unaware of the presence of cholesterol in them and so not taking appropriate treatment to cure it, as the  studies over lined that Hypertensive clients were at the high risk of developing Hypercholestremia at the later stages of life as they both were co related. Thus the chosen home management of easily available and accessible cocoa powder in reducing cholesterol level among the hypertensive clients by the investigator made a drastic changes in the acceptance and comfort of the people in the rural area.

 

REFERENCES:

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5.     Brand-Miller (1999), Chocolate and Cocoa: Health and Nutrition, 195-207 Blackwell Science Oxford, UK. .

6.     Bravo et al, (1998), Polyphenols: chemistry, dietary sources, metabolism, and nutritional significance,  Nutrition research, volume  56, page no: 317–333.

7.     British Cardiac Society, British Hyperlipidaemia Association, British Hypertension Society, et al. JBS 2: Joint British societies’ Guidelines on prevention of cardiovascular disease in clinical practice. Heart. 2005; 91 (supplement 5): S1-S52.

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Received on 06.02.2020          Modified on 14.03.2020

Accepted on 20.04.2020      ©A&V Publications All right reserved