Name: Lim Yun Hui
Admin Number: 141277G
Summary Review and Introduction of Centre of Functional Food and Human Nutrition (CFFHN)
1) Background of Adolescents’ nutrition status
2) Background of Adolescents’ physical activity level
3) Available nutrition programs in Singapore and overseas that help to prevent chronic diseases and are meant for adolescents as well as adults
4) Complications of chronic diseases such as diabetes, high cholesterol, high blood pressure, obesity, cardiovascular diseases
5) Lifestyle prevention of chronic diseases with modifiable and non-modifiable factors
1. Background of Adolescents’ nutrition status
Adolescents are young teenagers with age between 13-18 years old (Sallis, Prochaska, ; Taylor, 2000). It is an age state when there is a lot of changes taking place during puberty period and will affect one’s future health development, in which having adequate amount of nutrition intake is very important. The figuring out of correlates of youth physical activity will have impacts on public health, in which this kind of details could showcase efforts that are trying to raise the number of adolescents who reach health-related physical activity guidelines (Sallis, Prochaska, & Taylor, 2000).
1.1 Despite with young age, study is being done and it was found out that many adolescents have poor nutrition status, which is closely linked to physical image and psychological state (Pelegrini & Petroski, 2010). This is due to adolescents being more self-conscious and they are very sensitive to how people around them perceive their physical look. It will cause them having the mindset to want to look good with nice figures. As such, adolescents will eat very little or have extreme diets to make themselves look slim, which result in them having insufficient nutrition that their bodies required and being under-nutrition (Pelegrini & Petroski, 2010). Body image is a complicated issue that involves a lot of discussions and will include distorted perceptual, affective, cognitive or behavioral actions or thoughts. Body dissatisfaction is extremely common during adolescence. A study was done and it showed that more than fifty percent of adolescents were dissatisfied with their individual body image. Research also states that females in general have greater body dissatisfaction than males. While body dissatisfaction is closely connected with the hope of being slimmer among ladies, for the male adolescents their body dissatisfaction is more related with the wish to gain weight instead, in order to obtain an athletic figure (Pelegrini & Petroski, 2010). Body dissatisfaction has frequently been linked to differentiation between actual and virtual expectations. Even though it is a complicated matter to look deeper into, there is proof that social and sociocultural elements have an impact on implanting improper body image. A number of nutritional status disorders can be seen in adolescents of current generation, classified both by nutritional excesses and deficits (Pelegrini & Petroski, 2010). Over these few years, overweight and obesity have been discovered to rise in all age groups, and as a result, obese adolescents are having a hard time from issues that are linked to acceptance of their self-image and cherishing of their own bodies. Body dissatisfaction is widely known to be a greatly common problem in adolescents of both gender (Pelegrini & Petroski, 2010). Therefore, parents, educators and health professionals have to be notified about the increasing negative impacts of body dissatisfaction in adolescents. Since obesity is confirmed by many as a global public health issue, discovering that overweight adolescents are unhappy with their body figure should imply that they are prepared and encouraged to take actions and try to reduce body weight. This can result, in greater depth, to unhealthy actions such as anorexia, bulimia, muscle dysmorphia and improper dieting (Pelegrini & Petroski, 2010).
1.2 With reference to the analysis being done, the discoveries inform that nutritional status, primarily overweight, determines body dissatisfaction, typically for female adolescents (Horikawa et al., 2011) (Lytle, 2002). Despite of the body dissatisfaction to be more prominent in male adolescents, they are able to accept their body image greater, even those are having unhealthy nutritional status. Hence, it is advised that studies of nutritional interventions and physical exercise are need to be carried out in place in order to aid in decreasing the occurrence of overweight and obesity, and in frequent state of intervals to enhance the self-esteem of the adolescents. More in depth cross-sectional researches and studies with regards to unique social classes and various age groups are also required to enhance the understanding of the relationship between body image and nutritional status (Lytle, 2002). The economical state of the nation also plays a part in adolescents’ poor nutrition status. Countries with good economy and wealth are able to import and have large amount of fast foods and snacks. Adolescents from the rich families will then consume these imported fast foods and snacks in long period of time and develop obesity, causing them to be overweight (Horikawa et al., 2011). Furthermore, unhealthy lifestyle habits such as smoking and drinking of alcohol will also add on to the poor nutrition status of adolescents (Lytle, 2002). This can be influenced by family and friends who are also smoking and drinking alcohol, which affect the adolescents in following their footsteps. During puberty period, adolescents may also have mood swings that affect their psychological mind and have negative feelings such as pressure. This will also affect the nutrition status of adolescents (Horikawa et al., 2011). A balanced diet during adolescence helps to encourage appropriate health state, growth and development of adolescents, in which it will enable precaution against the chronic disease when adolescents get older. There are solid proofs which shows that eating habits being developed early in childhood are linked in one way or another with adulthood, while the growth change from childhood into adolescence is always connected to improper dietary changes (Lytle, 2002). Hence it is crucial to develop appropriate eating habits from young, as well as typically concentrate on the growth change from childhood to adolescence. Studies show that the dietary recommendations for a balanced diet in western countries suggest to obtain minimum ?ve portions of fruit and vegetables for one day, decrease the consumption of saturated fat and salt, as well as to eat greater amount of complicated carbohydrates and ?bres (Horikawa et al., 2011). Nevertheless, questionnaires done for dietary eating habits have revealed that most adolescents do not meet the dietary guidelines. Current numbers also portray shocking and rising amounts of obese and overweight children and adolescents in the western countries, implying that energy intakes are larger than energy requirements. Resolutions on ways to handle the problem of obesity is extremely huge on the health policy agenda and effective health promotion is still being the major method (Lytle, 2002). Hence, there is the requirement to create and initiate successful programmes and events which will enable adolescents to obtain healthier diets. Schools are an important social environment for adolescents and several solutions have been done to make use of this environment to enhance appropriate eating habits in adolescents, including positive eating thoughts. School-based interventions have the ability to achieve almost full percentage of teenagers from various ethnic and socio-economic groups in the western regions (Horikawa et al., 2011). Other impactful aspects at school for affecting eating habits are food and beverages that can be obtained at school outside meals, such as vending machines and school stores, as well as nutrition education classes. Thus, it can be seen that schools depicts a crucial surrounding to advertise and give out healthy nutrition and nutrition education (Lytle, 2002) (Van Cauwenberghe et al., 2010).
1.3 The main idea of the nutrition research done is to obtain the verified proofs of the impactful outcomes of school-based programmes that advertise a balanced diet on dietary intake and assessments of children and adolescents in western countries (Rolland-Cachera, Bellisle, ; Deheeger, 2000). As the number of researches being done among children was greater than twice and further discovery work in children were of greater standards, this have led to more assurance of impact for interventions towards children than towards the adolescents. There are stable proofs for children that multicomponent interventions with merging of upgraded convenience of obtaining the fruit and vegetables with a nutrition education curriculum conducted by the teacher, and furthermore with the addition help from various parents which will also influence the consumption of fruit and vegetables (Rolland-Cachera et al., 2000). On the other hand, there is little amount of proof of effect that could be obtained for nutrition education programmes dedicated by teachers with the use of practical lessons which are taste testing, cooking classes and so on. Very little amount of available proofs of effect was also discovered for the effectiveness of events that only concentrated on environmental change. These were only available for fruit and vegetables disseminate events, either for free or as a kind of subscription activities. For both activities, proof for effectiveness was discovered (Rolland-Cachera et al., 2000). Moreover, proof with no ending determinant of effect on dietary habits was identified for environmental initiatives that are aiming towards breakfast eating behaviours, for studies mainly focused towards children from socio-economic backgrounds or ethnic minority groups that are not high. The study also portrays not completed proof of impact of educational interventions on body composition, while this impact had never been calculated in the environmental and multicomponent interventions in children. It is able to be summarised for children that various types of fruit and vegetable promotion programmes are suitable to be suggested for carrying out to be done, which will ensure a huge chance of success, in which all the environmental and multicomponent interventions that also have a fruit and vegetable provision event have ended up in better progress in this habit (Rolland-Cachera et al., 2000). Regardless of fruit or vegetable advertising event will significantly play an impactful role to obesity precaution is quite doubtful, and further researches will be required that are aiming at a certain amount of nutrition eating habits, which play a significant role that is also crucial for energy balance (Van Cauwenberghe et al., 2010) .
1.4 With regards to adolescents, quite a number of available proofs were discovered for the impact of education-only interventions towards dietary consumption (Rolland-Cachera et al., 2000). Educational experiments done on adolescents will mostly portray a nutrition education curriculum that was conducted by the teachers. Moreover, very little amount of solid proofs of impact is given for the various component programmes on dietary eating habits. The environmental part of these various component experiments has displayed possibility of modifying or raising the ease of obtaining healthy food. This was merged with passing on of knowledge to the adolescents about healthy nutrition through the teacher (“/Reviews A nalyses Use and interpretation of anthropometric indicators of nutritional status* WHO WORKING GROUP’,” 1986). In an overall view, there is uncertainty about the presence of solid proof of impact from all these interventions that had been found on anthropometrics. With regards to children, it is also quite obvious in the various experiments for adolescents that there is an emergency requirement for dietary interventions in adolescents which will evaluate the impact towards overweight or obesity (Van Cauwenberghe et al., 2010). The most current international review that analyses the positive or negative impact of interventions in upgrading the school food environment, is discovered to have positive impact for school food policies on appropriate food consumption, but very minimum amount of analysis on the outcome on BMI was discovered. It is widely known that parents have a greatly significant role in children’s and adolescent’s eating habits and as a result, it is being recognized that interventions which are targeted towards enhancing children’s and adolescent’s nutrition are required to notify the family and enable them know about it (Van Cauwenberghe et al., 2010). Moreover, many of the past reviews also summarized that the engagement of parents is an extremely crucial factor for good eating behaviours. Several school-based interventions that are carried out in the current review also depict the engagement and contributions from parents (Van Cauwenberghe et al., 2010).
1.5 Despite that it was always allocated only for newsletters, folders, homework assignments, or at most the organisation of certain family nights at school, it was simply being shown that more than half of the interventions were able to work out well in enhancing dietary behavior, which cause it to have problems in having an identical, stable and recognized ending statement that is found in other international reviews (Butte, Garza, ; de Onis, 2007). The solid proof of impact that are all gathered together within the respective Western countries studies have implied plenty of suggestions and ideas for further discoveries in the western countries (Butte, Garza, ; de Onis, 2007). The current review has portrayed in a number of researches that have involved anthropometric evaluation, the solid proof on body composition was not sufficient or inappropriate. There is very little and restricted number of researches that calculate anthropometrics, in which the researches that have done were studies with little significance and quality within a short amount of time in general (Butte, Garza, ; de Onis, 2007). Moreover, a lot of the involved studies were not specifically targeting to reduce obesity, in which obesity precaution is merely a portion of a nutritional problem. Nevertheless, there is an emergency requirement for researches that involve calculation of body composition to. Next, more agreements are required about the ideal amount for diet, which would aid in raising the differences among various studies and help to organize progress of impact (Butte, Garza, ; de Onis, 2007). As such, this demonstrates the requirement for objective and agreed result calculations for health behaviours. On the other hand, certain studies merely analysed the impact on food consumption at school. This leads to the appearance of queries about the ability of children to make up for during the entire moment of the day. Thus it is crucial to evaluate the impact of the intervention with regards to total dietary habits. Hence, greater in-depth research is required in certain particular groups (Butte, Garza, ; de Onis, 2007).
1.6 As a whole, a lot of studies are required for adolescents, particularly the older adolescents who were not mentioned in the respective studies (Butte et al., 2007). Moreover, socio-economic status and ethnicity are recognised as factors of healthy eating, but lesser interventions aimed at children and adolescents from socio-economic backgrounds that are not high and from ethnic minority populations. As such, many more research are needed to notify these groups of people. It also shows that the follow-up periods were not long in general, with less than fifty percentage of the studies in children and in adolescents have proven large period of effects (Butte et al., 2007). Furthermore, the interventions were mainly having attention on short period changes immediately after the intervention, while it is necessary to have calculations of minimum half a year after the intervention to enable the research on the progress of behaviour evaluations and to identify whether weight condition has changed (Butte et al., 2007). Studies with larger portions are required to enable it happen so that conclusions can be made about the positive impacts on behaviour and obesity, as well as the continuity of the intervention. Furthermore, data with efficient cost were merely given within in a single study, while it is suggested that the impact of the intervention is also evaluated together with its availability (Butte et al., 2007).
1.7 Economic evaluation and economic proofs are required for a major part of prevention studies. They are required for suitable policy decision making as well as to analyse long period of advantages (Gibson, Sazawal, ; Peerson, 2003). Many of the methodological weakness that were showcased in the quality evaluation were resulted from too little amount of required details. Hence it is shown that researchers will go along with the current available guidelines for showcasing outcomes of experiments in the future. Moreover, the major causes that researches obtained quality of rating that are not high in general were resulted from a poor evaluation on the requirement selection bias as well as ways of obtaining data (Gibson, Sazawal, ; Peerson, 2003). There is continuous proof within the same area from the literature which implies that the efficient usage of information will effectively upgrade in a large extent, however not the entire of the studies will showcase the function of a theoretical background. The educational and multicomponent studies will specifically require a lot about a theoretical background, while environmental interventions will not showcase a theoretical background even once (Gibson, Sazawal, ; Peerson, 2003). From the current review, it is unable to state that a theoretical background is a crucial role to achievement due to both studies showcasing the function of a theory and studies that never showcased positive outcome (Gibson, Sazawal, ; Peerson, 2003). One of the main benefits of the current review is that grey literature and poorer quality studies can be obtained. Through this method, proof from the western countries was widen and expanded, but grey literature and poorer quality studies are beneficial in-depth details that is not included in several systematic reviews that will go on to initially concentrate on researches with hardcore designs. Second benefit is that the current review seems to be typically at the evidence that are situated in western countries (Gibson, Sazawal, ; Peerson, 2003). Western studies were the least amount of involved studies in other systematic reviews. However, a lot of the studies that are mentioned in the current review were done respectively in countries from Western and Northern parts of Europe. This generates doubts with regards to the ability of summarising these results to other countries in Europe, typically because contextual variables were always not in sufficient amount in the involved researches (Gibson et al., 2003). For the purpose of evaluating the benefits of the methods in the other parts of Europe, it is suggested that double copying of the analysis of the successful interventions that are pointed out in the current review suited to a particular nation and its culture should be done (Gibson et al., 2003). A wide range of policy documents are being summoned for the enhancement of efficient methods to enable better dietary behaviours in children and adolescents, which will aid in stopping or reverse the rise in obesity as well as to enhance other areas related to health. For adolescents, an educational event will exhibit high chance of having great impact in advertising healthy nutrition (Gibson, Sazawal, ; Peerson, 2003). Additionally, proof was also discovered for events that have enhanced school lunches or raised the ease of obtaining of healthy food and merged this together with a nutritional curriculum on food eating habits. In summary, proof of positive impact was discovered for the western countries school-based first-done activities that advertise a healthy diet in school-aged students about good eating habits (Gibson et al., 2003). Western countries’ proof of the positive impact was not being set up for school-based dietary interventions on precaution against obesity. Moreover, suggestions should not merely be focusing on effectiveness, quite a number of other aspects such as sustainability, integrity, context and impact of pricing should also be taken into notice so as to enable successful dissemination of suitable evidence-based suggestions and solutions to the policy makers. Further in-depth studies should concentrate about ?lling the lacking areas mentioned in the current review (Gibson et al., 2003). To better enhance the quality of the solid proof of positive impact towards these types of interventions, it is extremely crucial that good quality researches are conducted, which should focus on studies with the largest amount of eye-catching design as possible, together with a suitable sample size, a more detailed description about further post intervention, the function of greater unbiased evaluation about dietary habits, calculations about body composition as well as the analysis of implementation problems and impact of pricing. Together with good quality researches, excellent quality interventions are needed (Gibson et al., 2003). They are interventions with higher level and greater in-depth, in which interventions with small amount of dose over short amounts of time are highly unable to implement better changes in eating habits and anthropometrics, appropriate amount of integrity as well as sufficient engagement of the parents and schools (Gibson et al., 2003). Additionally, researches should be done according to some particular standards such as the consort and the trend statement, in which the present researches are able to be better identified for their weakness and strengths and also all the required details are disseminated to viewers (Gibson et al., 2003).
2. Background of Adolescents’ physical activity level
Physical activities are very important in keeping adolescents in good state of health with sufficient nutrition. The physical activity level of adolescents is expected to be high as adolescents are young people with youth age that is supposed to have great amount of energy and being active (Mota, Almeida, Santos, ; Ribeiro, 2005). Research was done and it was found out that adolescents’ physical activity level is largely affected by factors such as the accessibility of shops, social environment, neighbors with recreational facilities, as well as aesthetics (Mota, Almeida, Santos, & Ribeiro, 2005). When people are able to access to aesthetic and recreational facilities that are convenient to go to with ease, they are more willing to do physical activities as compared to people who have inconvenience in accessing the recreational facilities. When adolescents are in a social environment where people around them are doing physical activities frequently, they will be influenced by the people and also do more physical activities (Mota, Almeida, Santos, & Ribeiro, 2005). On the other hand, if the surrounding people seldom do physical activities, there is high possibility that adolescents will also not do physical activities as well. For aesthetics, adolescents are more willing to do physical activities with facilities that are able to get their attention and being appealing visually. If the aesthetics of the facilities are boring and unattractive, then most likely adolescents will not tend to try out on the particular facilities to do the physical activities (Mota et al., 2005).
3. Available nutrition programs in Singapore and overseas that help to prevent chronic diseases and are meant for adolescents as well as adults
As such, there are a number of available nutrition programs in Singapore and overseas that helps to prevent chronic diseases. In Europe, school-based interventions are carried out. It implements healthy eating habits of consuming fruits and vegetables as well as having breakfast habits that promotes healthy diet (Van Cauwenberghe et al., 2010). In United Nation, the UNU Food and Nutrition Program works with WHO Department of Nutrition for Health and Development and the Food and Agriculture Organization (FAO) Food and Nutrition Division (Butte et al., 2007). World Food Dietary Assessment System is also carried out in developing countries (Gibson et al., 2003). In Singapore, several health promotion activities were carried out by the Ministry of Health, such as Trim and Fit program, National Healthy Lifestyle Campaign and public education nutrition programs which educate the public on healthier food choices as well as creating positive environment of healthier eating with sufficient amount of healthier food products (Gibson et al., 2003) (Toh, Chew, & Tan, 2002). Cancers and cardiovascular diseases are the main causes of health concerns that are influencing Singaporeans negatively today, being responsible for more than fifty percentage of all deaths. This is a huge difference from the 20th century when spreadable diseases such as tuberculosis and gastroenteritis were within the top five major factors of death in Singapore (Toh, Chew, & Tan, 2002). The main causing aspects of the epidemiological in improvement are upgraded housing and sanitary conditions, ease of obtaining clean usable water, successful vaccine and disease surveillance events and better cleanliness lifestyles, which occurs due to fast growth of socio-economic progress. With the change in disease formats upon chronic lifestyle diseases, the Review Committee on National Health Policies had implemented a policy review of the healthcare services in 1991 (Toh, Chew, & Tan, 2002). The Committee emphasized the attention that was put on health advertisement and disease precaution to minimize movement and mortality of Singaporeans and strongly encouraged the importance of each and every Singaporean in being accountable for taking care of their personal health (Toh, Chew, & Tan, 2002). Therefore, a combination series of health broadcast activities was simultaneously organised under the National Healthy Lifestyle Programme which took place in 1992. Information about citizens is required for looking into the changes about the health situation of the country (Toh et al., 2002). With respect to this, the first National Health Survey (NHS) was taken place in 1992 to evaluate the national baseline prevalence of the cardiovascular danger aspect status of diabetes, hypertension, high blood cholesterol, obesity, physical activity as well as smoking before the launching of healthy lifestyle intervention activities (Toh et al., 2002). NHS 1998 was also performed to evaluate the development in the standards of the danger aspects that lasts for six years. By looking through the multifactorial reasons of cardiovascular disease and its danger aspects, as well as the obstacle of designing and organising positive analysis researches about health advertising activities, the NHS information will be taken into consideration in this study, as a determining factor for the general effect of the entire activities done under the National Healthy Lifestyle Programme on the precaution of cardiovascular danger aspects in Singapore (Toh et al., 2002). The identical activity for the wide range of disease status are being done for the information from both NHS. Non-specific population of approximately 4,000 Singaporean residents of 18 to 69 years old have taken part in each of the two surveys (Toh et al., 2002). This nationally motivated Healthy Lifestyle Programme concentrated upon four major lifestyle precautions, which are staying smoke free, physical activity, consume moderately and appropriate handling of pressure from daily lives, in order to fight against the widely known chronic diseases and their danger aspects (Toh et al., 2002).
3.1 For smoking problem, Singapore has stably and frequently implementing challenging no-smoking policies since the 1970’s (Toh et al., 2002). A wide range of combination of solutions was being carried out which consist of public education, legislation, cigarette taxation and limitation of smoking cessation management. The goal of the solutions was to give warning to the public about the negative impacts of smoking, to enable it being obstructing and costly to smoke, as well as to protect them from the forced decision to smoke (Toh et al., 2002). Legislative solutions with examples of the banning of smoking in public by age eighteen years old or below, compulsory implementations of health effects on cigarette packaging covers, limited allowance of smoking in public areas as well as the limited allowance on the selling of cigarette materials are showing positive effects merely with the aid of largely known and impactful emphasizing by the legislation with the conduction of penalties on people who go against the implemented laws. Together with largely promoted public education programmes in every year, these solutions could have played a role to the minimizing of the general smoking rates, such as from 18% in 1992 to 15% in 1998 (Toh et al., 2002). For the present rates of smoking that are not high, it will be full of obstacles for Singapore to minimize the number of people smoking to an even larger extent. The number of male smokers is made up of 90% of all smokers in Singapore, in which 46% of all the adult female smokers are between eighteen to twenty-nine years old. The national program will concentrate on these two populations of smokers, which comprise of the males who take up smoking cessation as well as young children who personally went through and being glued to smoking of cigarettes. The Singapore Youth Tobacco Survey in year 2000 portrayed that one out of four secondary school children was discovered to being attempted to try on smoking, while approximately one out of ten had smoked minimum for a single day in the last one month (Toh et al., 2002). To improve any amendment in their smoking behaviours, the requirements and insecurities of the young children such as perception by others as well as peer pressure are necessary to be completely analyzed with more in-depth. A lot of innovative interventions are required to be upgraded in order to overcome the cunning strategies done by cigarette companies to advertise their product, with examples like placing cigarettes into tiny packets with lesser amount that enable it more cost-efficient for people to smoke, particularly young adults (Toh et al., 2002).
3.2 The double issues of physical inactivity and aggressive diet are largely related to obesity (Butte et al., 2007). The solution was to advertise physical activity and eating appropriately with two portions of a healthier lifestyle, which is from the working locations as well as schools where people spend a great period of their time daily (Butte et al., 2007). Obesity in students from primary, secondary and pre-university schools portrayed an almost three-fold rise from 5.4% in 1980 to 15.1% in 1991. With regards to this norm, the Ministry of Education, hugely backed up by the Ministry of Health, implemented the Trim and Fit (T.A.F.) program to students in 1992 to minimize obesity and enhance physical fitness among school children in primary schools up to pre-university level (Butte et al., 2007). Most of the solutions implemented in the T.A.F. program involve the management of food and drinks sold in school canteens, exercise activities for overweight and obese students, parental engagement and support, as well as working together with other relevant labels. Over the long duration of ten decades starting from 1992 when the event was implemented, obesity in school children have positively decreased from 14% to 10%. As the T.A.F. activity contributes significantly, other ongoing events for exercise and sports done by the Ministry of Education could have also play an important role to the reduction of obesity occurrence in young children and adolescents. There are other solutions that can be carried out to cut down the obesity occurrence to a larger extent (Butte et al., 2007). Large amount of hard work during the start of intervention stage that can enable students to reduce weight is crucial. Larger engagement of parents in the TAF program is required, in which the home conditions plays a significant role to the shaping of the child’s habits in positive or negative way. Intervention for people at young age has also been proven to have positive impact locally. A current recognition of the C.H.E.R.I.S.H. (Championing Efforts Resulting in Improved Health) Award, acknowledge schools that have implemented more innovative and interesting methods in grooming the physical and mental health of students and staff to enable them live healthy lifestyles. When there is increasing number of schools which manage to get this award, many more schools will be motivated to achieve identical levels as them (Butte et al., 2007).
3.3 The alternative way of achieving the people for healthy lifestyle advertisement is through the working areas where adult Singaporeans spend approximately two-thirds or more of their daily waking time (Toh et al., 2002). Until now, several companies still unwilling to carry out the strategy of organising health advertisement events for their employees as they felt that it was an unneeded spending of company’s money. Nonetheless, studies have proven that implementing of health advertisement activities in working areas are efficient in enhancing the health condition and working ability of employees. The National Workplace Health Promotion Programme implements a plan to motivate more relevant parties to organize and maintain health advertisement activities in working areas which will obtain expected health results. This plan makes use of health-related staffs who are employees of an organization to be the first and foremost starters in the companies to motivate and manage the implementation of healthy lifestyles among the working staffs (Toh et al., 2002). Training sessions and education programmes are held to impart supervisors and management personnels with information and skills to carry out and advertise a healthy lifestyle at their working areas. The Singapore H.E.A.L.T.H. Award was introduced in 1998 to showcase national acknowledgement to working areas with positive health advertisement activities in working areas, which could involve health detail distribution, appropriate events for behavioral changes and environmental back up with the establishment of water coolers and healthier choices at the working areas’ canteen. In 2000, 135 companies had received the H.E.A.L.T.H. Award. Several initiatives are underway to further encourage the adoption of workplace health promotion (Toh et al., 2002).
3.4 The Workplace Health Promotion Grant, which focus on the rational of co-funding, was established to aid organisations in broadening and enhancing their health advertisement activities (Toh et al., 2002). There are intentions to implement health advertisement at the working areas as one of the achieving point for national productivity awards to showcase the importance of employee health to business management. A National Healthy Lifestyle Campaign is held for thirty days annually, which aims to educate Singaporeans of the crucial significance of a healthy lifestyle (Toh et al., 2002). From day one when the Campaign began in year 1992, it has obtained the back up and engagement of several politicians. The Great Singapore Workout, a combination of simple and little effect aerobic procedures for both young and old people, is being taken as the exercise activity for the yearly National Healthy Lifestyle Campaign since year 1993. Unfortunately, its function outside the campaign time was not broad enough, in which a new exercise activity was implemented in year 2001. The new workout, the “Work Fit” was intentionally created with the thought of working adult, imitating steps of widely known sports for convenient memory. The public education nutrition activity implements several methods to impart knowledge to the public regarding healthier food preferences, enabling a positive surrounding for healthier eating, as well as giving sufficient amount of healthier foods (Toh et al., 2002). In year 1998, Nutrition Labelling was implemented to motivate the food industry to showcase nutritional detail panels on amount of energy and composition of seven selected nutrients in one serving size and 100 grams of the packaged food. The Healthier Choice Symbol on packaged food was implemented for the convenience of consumer acknowledgement. Restaurants, food courts and hawker centres are being motivated to provide customers with greater amount of vegetables, lower amount of fat and oil though the “Ask for Healthier Food” activity (Toh et al., 2002).
3.5 The health advertisement hard works of the National Healthy Lifestyle Campaign will most probably play a role in the rising standard of announced exercise event in the population and decrease of in smoking occurrence (Toh et al., 2002). Unfortunately, detectable causes of cardiovascular occurrence seem to have destructed. There is a need to analyze and improve the existing methods for fighting cardiovascular illnesses. Present improvements in services should be identified and mentioned. More in-depth focus could be given to high risk population. A large-scale implement was required to modify health services with the changing national requirements and concerns. Since year 2000, the Ministry of Health launched a national illness improvement project for common chronic disease status in Singapore (Toh et al., 2002). The purpose was to minimize the pressure of severe disease status that resulted in mortality and morbidity, with examples like cardiovascular diseases. The National Disease Plans implement an efficient method that enhances patient responsibility, integration of care by many providers as well as acknowledgement of responsible people to enable successful outcome. In the implementation project, initial precaution events are aimed at both the major public and high-risk populations. In cases when initial precaution is unsuccessful, danger causes are needed to be discovered early and healed with secondary and tertiary precaution methods, with regards to the general necessary implementation ways to disease precaution and management (Toh et al., 2002).
3.6 For initial precaution, all along for several years, health teaching and advertisement have given details to the public about the advantages of a healthier lifestyle. Certain methods were also being done to ensure an appropriate surrounding for the taking of healthy habits. When the population gains more knowledge about healthy lifestyles, the public will have greater attention and more understanding about health problems (Gibson et al., 2003). The following obstacle will require the government to explore further other than simply distributing of knowledge to the following status of emphasizing the advantages of the healthier decisions, as well as giving skills and surrounding priviledges for the public to enable the successful improvement of health behaviour. Problems such as socio-cultural causes are needed to be announced when activities are targeted at typical high-risk populations. To ensure higher concentration upon initial precaution, a new statutory board, the Health Promotion Board was being implemented in April of year 2001 with a rise in spending of approximately $100 million for the year 2001 (Toh et al., 2002).
3.7 With regards to secondary and tertiary precautions, diabetes and hypertension will cause a person to have a higher danger for cardiovascular diseases. Almost two-thirds and more than half of Singapore residents with diabetes mellitus and hypertension did not know about their illness condition (Murray et al., 2003). To enhance early discovery of the chronic situations of diabetes, hypertension and hypercholesterolaemia, the government in year 2000 implemented the “Check Your Health” community health screening event. This event is aimed at the elderly of 50 years old and older. With cost of a greatly subsidised fee of $5, the screening activity is extremely available to lower and middle-income populations and is carried out at neighbourhood areas on weekends, when the children of these elderly are available to attend together with their parents. Even though there is efficient pricing and ease of convenience to go the location, merely around one out of four of the acceptable people was being screened (Murray et al., 2003). Further details could be found on the causes of the little engagement of people, in which strategies are implemented to improve them. Greater amount of frequent reviews should also be carried out. Furthermore, necessary procedures were done to enhance the handling of diabetes, hypertension and hypercholesterolaemia with the help of a Comprehensive Chronic Care Program. With references to government subsidised foremost healthcare polyclinics, this activity enables an efficient management to the three illnesses’ status, such that each of them will get an organized system of concern from aid of evidence-based healing processes. With the reshaping of the public-sector institutions in year 2000 into two groups of straightly integrated delivery managements that provide a variety of primary, secondary and tertiary care, polyclinics are able to contact hospital specialists and obtain efficient suggestions for their healthcare groups, as well as looking through the handling system of complicated issues with frequent intervals (Murray et al., 2003). An efficient benefit for patients is that the individualised attention of relevant supervisors who trail and motivate each patient to keep up with the required treatments and follow-up (Cheung et al., 2000). National Disease Plans are being implemented for myopia, cancer, coronary heart disease, final-stage renal failure as well as stroke. Mental health education events are being enhanced to incorporate more concern of people towards mental disorders among the major public (Cheung et al., 2000). Educational personnel and health specialists are also being groomed to identify, diagnose as well as handle mental health disorders which are widely known. While it is being recognized that high quality and analysis researches are difficult and expensive to carry out, it will become more and more important to have evidence-based details about the impact of associated activities. As pricing of health care rises, efficient pricing researches will also become crucial as a baseline for identifying the similarities and differences between various activities (Cheung et al., 2000).
3.8 Several health advertisement methods are being carried out efficiently through the National Healthy Lifestyle Program. It was shown that the National Smoking Control Program has successfully manage a low rate of smoking occurrence in Singapore (Toh et al., 2002). More enhancements of the methods are required to acknowledge new problems and awareness with examples like the increasing rate of young female smokers, in order to enable Singapore to be a smoke-free nation (Toh et al., 2002). The implementation of the chronic disease handling activities for the illnesses of great significance in Singapore will target on greater minimizing of the pressure of these illnesses among the people. Obesity is slowly being recognised as an aspect of concern in all parts of the world. Influential aspects involve rising of convenience from technological improvements that results in a lower manually requesting world. There is also convenient way of obtaining the food and ease of getting fast-food chains. Furthermore, obesity precautions at the moment being done in Singapore are according to the Caucasian norms, in which it may not entirely portrays the health hazards of Singaporeans. Researches have proven that a lesser amount of maximum level of the Body Mass Index may have higher appropriate amount for Asians which also involves Singaporeans (Toh et al., 2002). In situation where by a lesser amount of maximum Body Mass Index level is accepted for the symbolism of obesity in Singaporeans, the number of obesity in adults will be exceptionally greater. Higher level of concern towards the health dangers being connected to, as well as the requirement for handling of obesity will hence be required for both the general public and health professionals. The current society is ageing in fast rate, in which chronic diseases will further go on to take over as the main disease status in Singaporeans in the long run. The precaution against chronic, non-communicable diseases is very complicated and needs actions for large amount of time to avoid or reduce the further worsening of the various chronic diseases (Toh et al., 2002). The main aim will continue to be focused first and foremost on health advertisement, as well as the area of its weakness, management of danger aspects and the conditions of disease. The obstacle in first and foremost health precaution for non-communicable diseases is that there is zero immediate healing to a disease status. Not similar to infectious diseases when an antibiotic condition gives a positive effect solution, non-communicable diseases interventions usually need to have larger period of time with non-stop lifestyle improvements (Toh et al., 2002). As lifestyle improvements influence on the social, emotional, physical and even psychological factors of people’s daily activities, a higher quantity of encouragement as well as perseverance are to be achieved to initiate the will for better improvement as well as to carry out the improved ways in the daily lives. Intense management about the results of the current implementations as well as studies in health advertising activities will help to produce importable information on the long-term efficacy and impact of pricing of these types of methods. This information will enable useful effects in the non-stop hard work to uphold the increasing public health effect of widely known non-communicable diseases in Singapore (Toh et al., 2002).
4. Complications of chronic diseases such as diabetes, high cholesterol, high blood pressure, obesity, cardiovascular diseases
Moreover, chronic diseases are one of the major health destructing diseases that result from poor nutrition status of adolescents. They include diabetes, high cholesterol, high blood pressure, obesity as well as cardiovascular diseases (Chang-Chen, Mullur, & Bernal-Mizrachi, 2008a). For diabetes, type 2 diabetes mellitus consists of ?-cell failure in the building of insulin resistance. During the initial state, pancreatic ?-cells will adjust to insulin resistance by having larger amount and uses. As it continues to have extra nutrient, hyperglycemia and elevated free fatty acids will impact ?-cell function in bad way. This occurs through several mechanisms such as creation of reactive oxygen species, alterations in metabolic pathways, greater amount of intracellular calcium as well as release of endoplasmic reticulum stress. These processes severely cause obstruction to ?-cells by hindering insulin secretion, reduce insulin gene expression and eventually result in apoptosis. (Chang-Chen, Mullur, & Bernal-Mizrachi, 2008b) For high cholesterol, experimental trials show that the amount of mean distinction in LDL cholesterol observed between all the testing simvastatin and placebo only portrays approximately two-thirds of the LDL-difference created by the real function of osimvastatin. Thus, using simvastatin daily is able to reduce LDL cholesterol gradually (“MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20?536 high-risk individuals: a randomised placebocontrolled trial,” 2002).
4.1 For high blood pressure, it is shown through improvised information on degree of contacting and analysis of the magnitude of hazards that strokes and ischaemic heart disease can be attributed to systolic blood pressure greater than 115 mm?Hg (“MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20?536 high-risk individuals: a randomised placebocontrolled trial,” 2002). The joint impacts of blood pressure with cholesterol concentration are not too additive due to the multicausality of cardiovascular disease and both of their joint activity. Researches have also shown that high blood pressure is a huge risk to health in all parts of the world and not only in developed countries (Murray et al., 2003). For obesity, it is shown that massive localized lymphedema (MLL) is an excess production of soft tissue resulted from chronic lymphedematous changes. It usually appears on the thigh and is huge and painless. It is not greatly developed and consists of chronic lymphedema changes such as epidermal thickening. There is always inflammation with erythema and severe drainage. Furthermore, there is also diffuse edema on the skin and subcutaneous tissue without extension to muscle, as well as a dermis marked by dilated lymphatic spaces, dense edema, and extensive dermal fibrosis. The intense tissue portrays lobules of mature fat intercepted by pale-staining interlobular septa without presence of atypical septal fibroblasts and lipoblasts (Asch, James, & Castelo-Soccio, 2008). For cardiovascular disease, studies show that diabetes are greatly linked to both coronary heart disease and peripheral vascular disease, but not linked to cerebrovascular disease in one way or another. Smoking is one of the factors to the cerebrovascular and peripheral vascular disease and not coronary heart disease. Furthermore, diabetes are shown to have greater impacts than age towards these diseases (Cheung et al., 2000).
5. Lifestyle prevention of chronic diseases with modifiable and non-modifiable factors
Nevertheless, there are a number of lifestyle prevention ways of chronic diseases which consist of modifiable and non-modifiable factors. For modifiable factors, people need to avoid smoking cigarettes and drinking alcohol (Willett et al., 2006). People who have been smoking cigarettes and drinking alcohol should reduce the intake of them in gradual state, in which slowly the smoking and drinking habits will be quitted eventually. There is also the need in increase of pricing and taxing of cigarettes, in which this will cause people to have difficulty in affording and buying cigarettes, and gradually less people are willing to fork out money and pay for them (Brownson, Haire-Joshu, & Luke, 2006) (Egger & Dixon, 2014) (Lv et al., 2011). One of the easiest and highly efficient methods to minimize smoking is to increase the cost of cigarette products. Economic behavioral theory recommends that when the price of cigarettes becomes greater, it will result in lesser number of people begin smoking, and also present smokers will smoke less frequently, as well as larger number of smokers will try their best to get rid of their smoking habit. The first and foremost method in affecting the cost is by implementing federal and state excise taxes. In 2005, the federal tax rate was 39 cents for every packet while the median state tax rate was simply less than 70 cents for one packet (Egger & Dixon, 2014). A great number of econometric researches have studied thoroughly about the various connection factors between cigarette pricings and function of cigarette for adults and young people in both developed and developing countries. For adults, a 10% increase in cigarette prices is roughly calculated to create a 3% to 5% reduction in request by people. There is an increasing in trend condition that adolescents and young adults are showing greater amount of concern to the cost than the middle-aged adults. The rough calculations are shown as about 7% to 8% to as high as 14% (Lv et al., 2011). Current researches have mentioned that greater costing will influence smoking through the reduction of occurrence level, minimizing number of cigarettes smoked as well as cutting down the period of time for smoking and getting rid of smoking desire. After all, world-wide researches have showcased that in developed countries, costing flexibility is identical to the one discovered for the western countries, while the developing and countries with little amount of earning portray higher costing sensitivity. In addition to their certified positive impact, cost rises through tax strategies are appealing due to their wide expansion (Brownson et al., 2006). The country and region implement taxes that will impact every cigarette buyer. There are people who are concerned that rise of cost would lead to tax evasion and backing off through rising sale of illegally-sold cigarettes, greater manipulation of the social media to buy cigarettes that are not expensive, or extended amount of cross border cigarette buying and smuggling. Nevertheless, even though researches have showcased that people will buy cigarettes of lesser cost when they can be obtained with convenience, most of the researches also mentioned that cigarette buyers will have problems in getting away from greater cigarette costs when they are implemented (Lv et al., 2011).
5.1 Another method to modify the ?nancial condition for cigarette management is to minimize the prices for cessation goods and services for long-term smokers. Respective pricings for cessation are decreased first and foremost through rising of public or private insurance coverage. A minority of researches have showcased that decreasing cessation pricings can raise the amount of people who use cessation services by around 7%, as well as raise the amount of people who are able to fully get rid of smoking habits by around 8% (Lv et al., 2011). Even though insurance coverage of cessation services has been proven to be efficient in pricing, these services are still not being implemented in western countries insurance and handling care managements to a large extent. In the western countries, the National Health System has begun taking over cessation pharmacotherapies, in which existing proofs imply that this management has raise the function of services, get rid of attempts as well as short period of people getting rid of smoking. Clean indoor air laws and regulations minimize interaction of people with smoking of cigarette that also limit chances of touching cigarette products by only allow certain specific areas that people are able to smoke freely. The first and foremost impact of clean indoor air regulations is to minimize people who smoke as well as people who don’t smoke to come into contact with hazardous second-hand smoke (SS). SS occurrence has been connected to a large range of hazardous health impacts that involve lung cancer, pneumonia, bronchitis, nasalsinus, cancer, as well as unexpected baby death occurrence. Smoking restrictions are mainly being efficient to a large extent in lowering SS interactions with people (Egger ; Dixon, 2014). Through the researches done by the Community Guide, it showcases that the average decrease in SS interaction with people is 60% for self-report methods and 72% for environmental methods. Many of the in-depth details of worksite studies show that restrictions of smoking in restaurants and drinking areas have also lead to decreased occurrence for community residents (Egger ; Dixon, 2014). Researches have also proven that fully constructed smoking restrictions have greater impacts on decreasing ETS interaction with people than smoking limitations. A crucial secondary impact of clean indoor air regulations is that when the amount of smoke-free surrounding areas gets larger, the ecological and social emphasizing efforts to minimize smoking also rises proportionally. Cross-sectional evaluations have showcased that the occurrence of adult smoking is lesser among working staffs in smoke-free working areas than working staffs at working areas with zero smoking limitations (Lv et al., 2011). More solid proofs for the impacts of clean indoor air strategies regarding smoking habits are noted in experimental or prospective researches analyzed in the Community Guide. These researches similarly portray that the carrying out of impactful clean indoor air laws leads to a decrease in number of people buying cigarettes, smoking occurrences as well as raised cessation.
5.2 Even though it is unlawful to make profits from cigarette goods that are bought by few number of people, 82% of adults in the western countries started their initial smoking experience before eighteen years old, while 53% of adults became every-day smokers before eighteen years old (Egger ; Dixon, 2014). The main aim of youth entrance strategies is to minimize the selling of cigarette goods to adolescents and hence decrease smoking occurrence by stopping or procrastinating smoking desire. Despite of regions that have greater expansion of youth entrance strategies which effectively reduce number of adolescents smoking, it has been challenging to showcase a connective relationship between enhancing and emphasizing of youth entrance strategies as well as respective decrease in adolescents smoking (Brownson et al., 2006). Activities that enforce community and retailed decrease, sales monitoring together with policy enforcement is able to obtain efficient changes in retail business development, but this does not always portray the improvements in smoking habits (Brownson et al., 2006). Current literature searches of youth entrance interventions, purchase, function as well as possession strategies have portrayed little amount of solid proofs, in which they have commented that the obstacles in program monitoring, the potential of adolescents to obtain cigarette goods from social providing areas, as well as the large pricing of strategy emphasis all request that the respective parties involve in cigarette management should look for other strategies that have greater efficient pricing. Next, people need to reduce their time in using of electronic devices such as handphones and watching of television (Willett et al., 2006). Hectic and fast-paced life in developed countries has greatly minimize the chances of people to increase their physical activity level, regardless of travelling from one destination to another, in the job surroundings or within housing area. Huge amount of decrease in physical activity are also taking place in developing countries due to urbanization, rise in convenience of motorized travelling devices that takes over walking and bicycle riding as well as mechanization of physical work (Willett et al., 2006). However, frequent physical activity is a major factor in weight management and precaution against obesity. There are proven evidences that among middle-aged West African females, higher walking frequency was resulted to a three-unit lower BMI, while in China, people who have cars are 80% higher chances of being overweight. Furthermore, other than its major function in managing a healthy weight, frequent physical activity minimizes the occurrence of CAD, stroke, type 2 diabetes, colon and breast cancer, osteoporotic fractures, osteoarthritis, depression as well as erectile dysfunction (Willett et al., 2006). Crucial health advantages have even been connected to walking for half an hour every day, but higher decrease in occurrence are shown effective with longer periods of physical activity and greater vigorous activity. The amount of duration of television watched every day is connected to rising of obesity occurrence among both children and adults together with a greater danger of getting type 2 diabetes and gallstones. This relationship is most likely resulted from decrease of physical activity as well as greater intake of foods and drinks that have large amounts of calories, which are particularly the ones that are advertised on television. Reduction in amount of time spend on watching television programs will enable loss of weight, in which the American Academy of Pediatrics gives advice on spending two hours of watching television programs every day at most (Lv et al., 2011). Moreover, people’s diets can also be improved by upgrading the food supply. The common system of the food industry is that it merely supplies all the requests made by consumers, but this is an inappropriate point of view as the food industry spends more than US$12 billion dollars every year to manipulate the preferences of consumers merely within the western countries and multiple amount of this sum of money globally. A lot of this amount of money is spent on advertising foods with drastic health impacts, in which young kids are the first and foremost aims (Brownson et al., 2006).
5.3 Changing the manufacturing procedures can quickly and efficiently enhance diets, in which this type of action does not need the slow procedure of behavioral development. An example is getting rid of the half-done hydrogenation of vegetable oils, which destructs important omega-3 fatty acids and develops trans fatty acids (Willett et al., 2006). Western manufacturers have greatly excluded trans fatty acids from their food supply by modifying production steps. Regulations can aid in taking note of changes in manufacturing through straightforward or non-straightforward way by showcasing an incentive for manufacturers to alter their procedures (Willett et al., 2006). It was shown that in 2003, the U.S. Food and Drug Administration broadcasted that food manufacturers were required to insert trans fatty acid details on the standard food label. Abiding by the implementation of this requirement, a lot of huge food companies mention that they would decrease or exclude trans fats, in which many more are willing to do the same as well. In Mauritius, the government needs a modification in the widely used cooking oil from mainly palm oil to soybean oil, which altered the consumption of fatty acid by people and decreased their serum cholesterol levels. Modification in types of fat can frequently be almost unseen and cheap. Consumption of omega-3 fatty acid can be raised by gathering oils from rapeseed, mustard or soybean into manufactured foods, as well as cooking oils sold for consumption at home (Willett et al., 2006). Typical breeding and genetic engineering enable other routes to enhance the healthfulness of oils through altering their fatty acid contents. When the intake of processed food is in large amount, a decrease in salt intake will usually need improvement at the stage of manufacturing as processed food is the main provider for salt. When the salt composition of food products is minimized slowly, the improvement is acceptable to consumers (Willett et al., 2006). Cooperation among manufacturers or government regulation is required, in which otherwise the producers of food products containing minimal salt content will be situated in a negative state. Sadly, appropriate examples are unable to be identified. Other way of enhanced manufacturing would be to minimize the improvement of grain products, which can be completed in tiny, almost unseen surroundings (Willett et al., 2006).
5.4 Food fortification has gotten rid of iodine deficiency, pellagra as well as beriberi in most parts of the world. In areas where iodine deficiency is still being a severe issue, fortification is supposed to be a high advantage. Folic acid consumption is unobtainable in several locations of both developing and developed countries. Fortifying food products with folic acid is very affordable and is able to gradually minimize the occurrences of many chronic illnesses (Willett et al., 2006). Grain products such as flour, pasta and rice are often the most suitable foods to fortify, such that they are already being fortified with other B vitamins in a lot of countries. Since 1998, grain products in the western countries have been fortified with folic acid, which has almost gotten rid of folate deficiency, with occurrence of neural tube defect pregnancies being decreased for approximately 19%. As for consumption of vitamins B12 and B6 are also minor and play a part in elevations of homocysteine, as among vegetarian populations in India, subsequent fortification of food products with these vitamins are to be thought about. The impacts of fortification on decreasing CVD are not known to be certified, but the possible advantages are large, hence intervention experiments to analysis the impacts of fortification are to be great opportunity (Lv et al., 2011). Moreover, strategies related to the manufacturing, importation, distribution as well as retail of particular food products can affect their pricing and ease of obtaining. Implemented activities may be targeted at the main point of agricultural studies and the various kinds of production advertised by extension services. Strategies always tend to advertise grains, dairy products, beef as well as sugar, while those that motivate the manufacturing and intake of fruits, vegetables, nuts, legumes, whole grains as well as healthy oils would often refine rather than decrease health (Lv et al., 2011). Nevertheless, almost each national hard work to enhance nutrition emphasizes together with the advertisement of healthy food preferences, such as fruits, vegetables and legumes. This kind of collaboration is being carried out smoothly among government related parties, sellers, professional people as well as non-profit parties in a successful way, such that investment in hard work like this should involve the cautious experimenting and improving of social-marketing methods. Another solution is to protect consumers against vigorous advertising of unhealthy food products (Lv et al., 2011). Manufacturers spend billions of dollars annually in motivating children to eat food products that are causing damage to their health. Producers and fast-food chains beautify their food products with cartoon characters, place food brands on toys, as well as giving out “educational” card games that further encourage children’s natural attention for having fun, storytelling and easily persuasive nature (Brownson et al., 2006). The urge and desire to restrict promotion relies on a nation’s political norm, but the public is able to differentiate between promotion targeted at adults and that aimed at children. It was shown that in the western countries, 46% of adults have feedbacked to show approval upon limitations of promotion to young kids. Limitations can include from restricting promotion to children to restricting the kinds of products that promoters may showcase to the targeted consumer (Brownson et al., 2006). Moreover, people can also take up hobbies that do not require use of electronic devices, such as learning of musical instruments, calligraphy, reading and drawing. Short frequent break intervals should also be taken during the period of time of using handphones and watching television.
5.5 Furthermore, people are required to eat plenty of fruits and vegetables which are anti-oxidants and rich in vitamins B and C (Boeing et al., 2012). Fruits and vegetables play an extremely crucial role in human nutrition as providers of nutrients and non-nutritive food compositions which also includes for the prevention of disease occurrence. Even though their significance as providers of nutrients and non-nutritive food compositions is widely recognised, there are still doubts about their significance for the precaution of illnesses. Due to this issue, it has to be verified ?rst, such that diseases researches have discovered connection between the intake of fruits and vegetables as well as the danger of disease, so as to the way that this relationship has to be evaluated (Boeing et al., 2012). The more in-depth details showcase a crucial reference to analysis the precaution possibility of a diet that consists plenty of fruits and vegetables. Moreover, this would enable a rough calculation of the various developments pertaining to the issue of particular illnesses. The necessary information that can be obtain with little difficulty were noted down by respective literature study, in which the required aspects of the proof was confirmed by requirements stated beforehand (Boeing et al., 2012). As further detailed researches about the relationship between the intake of fruits and vegetables together with the danger of illness have been recognised since 2007, it was required to keep up with the latest information. Hence, the readily obtained information about the illnesses being identified in 2007 were carefully looked through again by noting down with concentration on important epidemiologic observational and intervention researches, such that with reference to these research information, the proof that is related to a precaution impact was analyzed. Various developments in lifestyle have lead to a huge rise in the occurrence of obesity in Western countries (Boeing et al., 2012). Obesity is connected to processes that enhance cancer such as chronic in?ammation, insulin resistance, impaired glucose tolerance as well as altered hormone metabolism. Fruits and vegetables consumption have been certified to have impact upon these developments, such as greater intake of fruits and vegetables is able to overcome chronic subclinical in?ammatory reactions that take place in cancer and obesity (Boeing et al., 2012).
5.6 Larger botanical range in fruits and vegetables consumption is connected to lower infection. It was being proven that the intake of fruits and vegetables from some particular botanical species will showcase unique protective impacts from all kinds of cancers, which will not be visibly witnessed if the whole range of fruits and vegetables are evaluated together (Boeing et al., 2012). Identical analysis was done for particular subtypes of cancer. Fruits and vegetables intake portrayed a protective impact merely for particular kinds of lung cancer, but not against other histological kinds of lung cancer. Hence, the general evaluation of all fruits and vegetables species as well as all cancers can lead to a severe missing of data. As the phytochemicals within the fruits and vegetables will especially affect in?ammatory reactions, cellular redox processes together with endothelial and metabolic developments, which are included in the evolution of the wide range of diseases, these mechanisms are first and foremost responsible for lowering of danger effect of fruits and vegetables intake in relation to the typical diseases (Boeing et al., 2012). This also being implemented to diseases with little amount of information, such that the strong components of proofs were given passed scores. Hence, it will be logically allowable to implement intervention researches that typically play a role in the evolution of the mechanisms. As it is always unable to conduct positively managed and long effect dietary improvements in a randomised study concept, intervention researches should be done as short period researches with a deeper insight of suitable surrogate creators of tough limited areas (Boeing et al., 2012). These intervention researches should manage efficiently the entire amount of obtainable fruits and vegetables to a large extent. Moreover, it is required to specifically carry on the evaluation of information in the current cohort researches about the connections between fruits and vegetables intake, as well as the danger occurrence of different types of diseases (Boeing et al., 2012). There is also likely to have the requirement to carefully evaluate the information about the analysis of the intake of fruits and vegetables in order to enhance the solutions for better outcomes. The outcomes from the various cohort researches together with the ones from intervention researches about the progresses of development will showcase a path of possibility for more in-depth analysis about the precaution ability of fruits and vegetables intake that is related to different types of chronic diseases through proof-based method. Physical activity also plays an important role in preventing chronic diseases (Kruk, 2007). People need to increase their physical activity level by doing appropriate amount of physical activities daily. Adolescents should take up sports such as running, swimming, dancing, cycling etc. and do exercises that help enhance physical activity. The act of walking as well as cycling with regards to traveling and during free time are positively impactful and realistic ways of being involved in physical activity and are still the most widely used methods to move around in quite a number of developing countries (Kruk, 2007).
5.7 For non-modifiable factors, it is the family history of family members who previously have gotten the chronic disease, in which the chronic disease is being passed on from generation to generation of the same family lines. This is unable to be prevented as it is occurred throughout the entire family line who are blood related to one another (Walter & Emery, 2005). The family history is gradually being developed into a largely influential factor of health advertisement and non-late discovery of widely known chronic diseases in primary care. There are several past studies on patients from genetics clinics which implies a significant difference with regards to how people that have a family history of chronic diseases will evaluate in their point of view and understand the hazards, as well as the risk details that are given by health professionals. The study is targeted to find out the approach that patients in primary care take to analyze and have better understandings of their family history of the various common chronic diseases and the impact of family history that will influence consultations with regards to the disease risk and way of handling (Walter & Emery, 2005). When a person is able to recognise that an illness is taking place within the family, the family history will expand in different ways with the aid of many paths to the point where there is increase in sense of weakness to the disease, such that the person will try to take charge of the situation or risk. The various ideas of personal relationships that are occurring within a family will influence the possibility of hazard, the impacts of their own experience of similar illness on risk understandings, as well as solutions patients will do to adapt to or manage their similar risk that were topics which have a place of certain crucial parts. Having understanding that a family record of a disease does not link or connect with feeling personally at risk with regards to the illness (Walter & Emery, 2005). The path of feeling at risk depicts the process of the family history achieving personal meaning, examples are the emotional influence about personally see a particular relative’s illness or death as well as the progress of that illness. Hence, having the feel of the progress of a relative’s illness, recovery or death, especially a parent or sibling, will further add on towards the participants’ point of view in evaluating the illness together with analysis of individual hazard. Being able to personally see the illnesses of closed ones or friends who are more far apart will increase in their personal analysis of the illness but with lower effect towards their feeling at risk (Walter ; Emery, 2005).
5.8 Patients’ analysis with regards to the factors of an illness of the family will have a crucial impact towards creating sense of individual hazard (Walter & Emery, 2005). When evaluating about the significance of a family history, the majority of the participants develop a multifactorial type of familial hazard, balancing the hazards of nature and grooming. The study has showcased that the ability to analyse the processes of inheritance was impactful merely to few people who were being aware of the danger of familial hazard (Walter & Emery, 2005). A lot of participants were cautioned with regards to their familial hazard being continued for endless of generations within the family line. Lesser participants figured out issues that the danger of these diseases might be passed on to their children or future generations, hence view themselves as ones with no hope of recovery. Negative attitudes about disease dangers were widely known by many, especially for cancer, which was known to be under fewer individual management, with lesser modi?able lifestyle hazard factors. Results of fatalism were also being recognised to be responsible for non-stop risky lifestyles, examples like smoking regardless of a family history of coronary artery disease. Reports of fatalism are being spread among people with familial hypercholesterolaemia which is a greatly concerned issue linked with a large possibility of coronary artery disease. These types of fatalistic reactions connected with thoughts about familial danger may disrupt the behavioral or lifestyle intervention that occur in multifactorial disease (Walter & Emery, 2005).
In conclusion, it is essential and important to penetrate deeper in finding out and analyzing more about the various causes and factors that affect and impact greatly on adolescents’ nutrition status as well as physical level, so that most of the current implemented nutrition programmes can be further enhanced and improved to enable more adolescents have a healthier eating habits and lifestyle, which will also help to reduce further the number of people being at risk of having chronic diseases. Through our Final Year Project, the objective is that my groupmates and I aim to enhance and increase people’s awareness about nutrition through assessing their knowledge on nutrition and at the same time also educate them about essential nutrition information, so that we can aid in helping more people to have a healthier lifestyle with appropriate eating habits as they change and improve on their current eating behaviors. People will also take notice about the importance of nutrition which will have great impact on their health.
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