RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.Name of the candidate and address / MS. CHERYL LOBOM.Sc NURSING 1 YEAR
Dr. SYAMALA REDDY COLLEGE OF NURSING
#111/1 SGR MAIN ROAD,
MUNNEKOLALA,
MARTHAHALLI,
BANGALORE-560037.
2.Name of the Institution / Dr. Syamala Reddy college of nursing
3.Course of study and subject / M.Sc nursing 1 year.
Community Health nursing.
4. Date of admission to course / June 2010.
5. Title of the study / A descriptive study on assessment of knowledge and practice regarding Calcium intake among young adults in a selected college at Bangalore, Karnataka.
6.0. BRIEF RESUME OF INTENDED WORK
Introduction:
Nutrition is the science that deals with all the various factors of which food is composed and the way in which proper nourishment is brought about. The average nutritional requirements of groups of people are fixed and depend on such measurable characteristics such as age, sex, height, weight, degree of activity and rate of growth. Today we spend millions of money in India each year to investigate the many aspects of nutrition.1
Nutrition is the provision, to cells and organisms, of the materials necessary in the form of food to support life. Many common health problems can be prevented or alleviated with a healthy diet. 2
The importance of nutrition requires implementing a well-balanced diet plan and avoiding the tendencies of overeating. If you want to have a healthy body, you must know the right food nutrients that your body needs to have. These food nutrients specifically refer to protein, carbohydrates, fats along with essential vitamins and minerals .3
Calcium is the most abundant mineral in the human body. It is essential for the development and maintenance of strong bones and teeth. About 99% of the body's calcium is stored in the bones and teeth (National Research Council, 1989; Whitney et al, 1996) with the remaining 1 % in the soft tissues and watery parts of the body where calcium helps to regulate normal processes of the body.4
More than 90% of a person’s bone mass develops before age 20 years, and half of that bone mass develops from age 11-15 years. To have strong bones, children and adolescents need to consume enough calcium to build up the bone mass that they will need throughout their lives. Even after age 20, a person can help protect his or her bones. Bone mass can still be built up until the early 30s. After that, protecting the amount of bone that already exists comes from consuming enough calcium because calcium is essential in maintaining bone mass.4
Calcium works like this: After calcium is consumed, several nutrients, especially vitamin D, help the body absorb the calcium. The blood transports the calcium that is needed for other body processes to the bones where it adds to the bone mass and is stored for when it is needed in the rest of the body. Sometimes a lack of calcium comes from not consuming enough in the diet or because the body is not absorbing enough into the blood. When this happens, calcium is removed from the bones into the blood to keep a constant level of calcium in the blood .5
Adequate calcium intake is important to keep a normal amount of calcium in the blood and to protect the bones from calcium loss. If enough calcium is not regularly consumed and the calcium continues to be taken from the bones , a person's bone mass decreases. Every day, the body loses calcium through shedding hair, skin, and nails and through sweat, urine, and feces. Every day, this lost calcium must be replaced by what a person eats .6
Dairy products like milk, curd, yoghurt and cheese are the best sources of calcium. Other important sources are spinach, fenugreek leaves, mustard leaves, dry figs, almonds, whole meal bread/flour, potatoes, dried apricot, citrus, celery, parsley, certain fish like pamphlet, and fruits. Other calcium rich items are cereals, breads , and ragi, sea same seeds, pulses, rajmah, soybean, poppy seed, dry, coconut, vegetables and fruits, and drink enough water at least eight glasses a day.4
In 1998, the Institute of Medicine at the National Academy of Sciences issued new Adequate Intake (AI) levels for calcium. The recommendations of calcium for adult is 1000mg .4
Calcium also plays a role in many physiological activities not related to bones including blood clotting, nerve conduction, muscle contraction, regulation of enzyme activity, and cell membrane function. Because these physiological activities are essential to life, the body utilizes complex regulatory systems to tightly control the amount of calcium in the blood so that calcium is available for these activities. As a result, when dietary intake of calcium is too low to maintain normal blood levels of calcium, the body will draw on calcium stores in the bones to maintain normal blood concentrations, which, after many years, can lead to osteoporosis.6
Insufficient calcium intake , poor calcium absorption, and/or excessive calcium losses through the urine and feces can cause calcium deficiency. In children, calcium deficiency can cause improper bone mineralization, which leads to rickets, a condition characterized by bone deformities and growth retardation. In adults, calcium deficiency may result in osteomalacia, or "softening of the bone". Calcium deficiency, along with other contributing factors, can also result in osteoporosis.6
6.1) NEED FOR THE STUDY:
Calcium intake refers to the levels of the consumption that are necessary for an individual to maximize peak adult bone mass, to maintain adult bone mass, and to maximize bone loss in later years .7
Everyone knows that children need calcium daily to support the growth of their bones and teeth, but not everyone is aware of adults’ needs for daily intakes of calcium. Abundant evidence now supports the importance of calcium for adults, especially women, who need about as much calcium in their later years as they did when they were adolescents. A deficit of calcium during the growing years and in adulthood contributes to gradual bone loss, osteoporosis, which can totally cripple a person in later life 1.
Adequate dietary calcium intakes do not end with teenage years, taking in sufficient amount of calcium continues to be important in the adult’s years as well. Healthy adults between ages of 19 – 50 should aim for 1000mg of calcium in order to preserve bone mass. As we age, our bone loses some calcium. If we don’t take in enough calcium through diet, calcium fortified foods and calcium supplements, our bone store will eventually become depleted, leaving our bones weak and prone to fractures a condition known as “osteoporosis” 8.
A recent study reveals that the dietary calcium intake in south India is around 350mg in urban and 275mg among rural population where as minimum requirement is 1,000mg per woman. By some estimates 20 percentages of young women would be osteoporotic, which would increase the total affected population to 25 millions individuals in India9 .
Dr Hemant kalyan, consultant orthopedic surgeon of manipal hospital, “we see a 4% to 5% rise every year. The largest group that is affected is the post menopausal women segment and the elderly . However; there is an increasing trend of osteoporosis among younger women due to smoking and sedentary life style . . Many who are on steroids due to other health conditions also suffer from similar issues. However, precautions need to be taken very early in life even for teens, like regular exercise and eating food properly supplemented with calcium and vitamin D9 .
In 2010 , the goal of World Osteoporosis Day is to educate the public about bone health with special focus on spinal bone health, with the theme ‘Don’t bend to osteoporoses. And it’s not just the elderly who are at risk of developing osteoporosis – a disease of the bones that increases chances of fracture. Less exercise and high junk food intake are making even the young vulnerable to it. Adults have about 206 rigid bones in their bodies. The bones are made up of calcium, phosphorous, sodium and other minerals, vitamins and the protein, collagen. Calcium is stored in the bones and is released to the other body parts according to the need. As children grow, bones become strong due to accumulation of bone mass. This process takes place till about 30 years of age 10.
Nearly 71% of the osteoporosis fractures occur in women. Genetically, women are born with a bone mass less than that of men that is why osteoporosis is more common in women than men. Notwithstanding, nearly one in 3 women and one in 5 men over the age of 50 are grappling with the effects of bone loss. More than 25 million people in India alone are battling osteoporosis; these numbers are expected to go up to 36 million by 2013. Further, as per forecasts, Asia will account for more than 50% of hip fractures in the world by 2050 10.
Unfortunately, national survey showed that one-fifth of females between the ages of 19-30 get the recommended amount of calcium. In fact, between ages 20-29, 43% of women one serving or less of dairy products daily. During middle adolescence, more than 72% females had calcium intakes that were lower than the recommended 1300 mg daily amount. During young adulthood 68% females had calcium intakes lower than recommended allowance for their age, 1000 mg daily. The study shows that females reduced their milk intake. Only 38% of females increased their calcium intake over the five years. Most females reduced their calcium The study also uncovered a number of perceived barriers to healthful eating (such as, its too expensive, I don’t know what to buy, my parents do the shopping and I don’t have any choice, I don’t have time to sit down and eat healthy food). These were, of course, associated with lower calcium intake; as were the degree to which a person snacked, drank soft drink 11.
From the above fact ,it is understood that calcium insufficiency leads to conditions like osteomalacia, osteoporosis etc. Therefore the researcher has chosen this topic to assess the existing knowledge and practice of young female adults regarding calcium intake, in-order to promote awareness among young adults regarding importance of calcium and thereby this can help young adults to protect from osteoporosis.
6.2) Review of literature:
The review of literature is an important step in the development of research project. The investigator carried out an extensive review of literature on the research topic to gain deeper insight in to the problem and to collect maximum relevant information for building up the study in a scientific manner, so as to achieve the desired results.
1. Studies related to calcium intake
2. Studies related to knowledge on calcium intake and osteoporosis.
Studies related to calcium intake:
An investigation was done to determine the association between calcium intake and tooth loss in 1602 adults (30-50years) with information on dietary calcium intake and a subset of 511 participants with information on tooth loss. Less calcium intake was more frequent among females (55%). Thus a calcium intake below recommendations was significantly associated with increase risk of subsequent tooth loss in females 12.
A study conducted to examine health implications on the declining calcium intake in female adults a structured questionnaire disturbed to 500 female students to access their calcium intake from the food they eat. The result showed that many adults avoid dairy products because of the perception that all dairy products are fat laden foods. Some are not aware of the serious long lasting health implication of inadequate calcium consumption 13.
A cross sectional survey to examine calcium intake and food sources among Asian youth with two 24 hour dietary recall one week apart. Calcium intake was evaluated in 167 female Asian youth, age’s 18-25years. The result revealed that calcium intake was 868 mg/day for Asians instead of 938mg/day 14.
Studies related to knowledge on calcium intake and osteoporosis:
A study conducted to determinate the knowledge on osteoporosis-risk factors and disease in three age groups of adults.
In this exploratory cross-sectional study, an osteoporosis knowledge assessment questionnaire (OKAT) was used to collect data and it was delivered through a face-to-face interview. Questions were asked about symptoms of osteoporosis, knowledge of risk factors, preventive factors and treatment. A convenience sample (n =320) comprising of three groups of healthy women aged 25-35 years, 36-45 years, and over 45 years was taken. The scoring range was 0 to 20. To determine the overall influence of osteoporosis-risk factors, the multivariate analysis was used. The knowledge on osteoporosis in younger women was very poor compared to relatively older females. However, women belonging to higher socioeconomic status and better education had slightly more knowledge about osteoporosis compared to those with a low education level, regardless of age. The majority of women had modest knowledge on osteoporosis. Younger women were at increased risk for low bone mass and premature osteoporosis 15.
A cross-sectional survey was conducted in relation to knowledge of osteoporosis and beliefs in young adult women. The study revealed that young adult women (n=265) were very lightly (80.6%) to have accurate knowledge about osteoporosis but also typically had a low calcium intake (454mg/day). The women in this study believed that they were at risk of osteoporosis but felt prevention was difficult 16.