Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Australian Journal of Basic and Applied Sciences, 5(12): 3171-3178, 2011 ISSN 1991-8178 Estimated Intakes of Fats, Cholesterol, Fiber, Sodium, Calcium, Potassium, and Magnesium in Jordan Ref’at A. Alkurd Department of Nutrition, Faculty of Pharmacy and Medical Sciences, Petra University, Amman, Jordan. Abstract: This paper evaluates the estimated intakes of total fats and n-3, n-6, saturated and trans fatty acids, in addition to cholesterol, dietary fiber, sodium, calcium, potassium and magnesium as calculated from the most recent data of Jordanian Household Expenditures and Income Survey (JHEIS) for the year 2006/2007. The estimated intakes of these food constituents were analyzed for different governorates using a nutrition analysis software program. The results showed that the whole country (Kingdom) mean of daily per capita intake of total fat was within the recommendations of the AMDR, whereas, n-3 and n-6 fatty acids were 35% and 47% of the lower range of AMDR, respectively. The Jordanian estimated consumption of saturated and polyunsaturated fatty acids were in agreement with the recommendations of the American Heart Association (AHA), whereas, the consumption of monounsaturated fatty acids was lower than these recommendations. There was a variation in the estimated intake of these constituents among different governorates. The consumption of cholesterol for the whole country and all governorates was within the recommendations of the AHA. The ratio of polyunsaturated/saturated fatty acids for the whole country was 1.3/1 which is within the recommended ratio (1-1.5/1). The dietary fiber consumption of the whole country was 24.4 g, whereas, the consumption of the governorates ranged from 20.1 to 28.0 g. Expressed as g/1000 kcal, the dietary fiber consumption for the whole country was 8 g/1000 kcal which is approximately 2/3 of the DRIs (14 g/1000 kcal). The sodium consumption was more than 5 times its AI, whereas the consumptions of calcium, potassium and magnesium were lower than their DRIs. It is possible that high prevalence of CVD among Jordanians is correlated partially with the high intakes of energy and sodium and the low intake of dietary fiber, n-3 and n-6 fatty acids, calcium, potassium and magnesium. To aid reducing the risk factors of CVD, the researcher recommends the increase the intake of dietary fibers, particularly from fruits and vegetables, calcium, potassium and magnesium and the decrease in energy and sodium intakes. Increased physical activity and weight reduction of the obese and overweight persons are also recommended. Key words: Fat, cholesterol, CVD, sodium, Jordan, JHEIS INTRODUCTION Cardiovascular disease (CVD) is a general term of all diseases of the heart and blood vessels. Atherosclerosis is the main cause of CVD. Common examples of CVD include coronary heart disease (CHD), stroke, hypertension, and myocardial infarction (Rolfes et al., 2009). Jordan, like other middle-income countries, is attending an epidemiologic transition, which is characterized by an increase of non-communicable diseases, particularly CVDs, cancer, diabetes, and chronic respiratory cases (Ajlouni, 2010). The first leading cause of death in Jordan is related to CVD; around 38.2% of the deaths are caused by this disease (Shishani, 2010). Percentage of deaths according to causes is 16% of ischemic heart disease (the first cause of death in Jordan) and 6% of cerebrovascular disease (4th cause of death) according to 2002 census data (WHO, 2006). Hypertension, coronary heart disease, and stroke together with cancer are responsible for more than half of all deaths (WHO, 2003). The Jordanian Ministry of Health reported a national ratio of hypertension of 25.6% among those aged 18 years and above (MOH, 2007). The Utilization of Health Services and Delivery Study showed that over 85% of hypertensives were either overweight or obese (Arbaji, 2002). The pathogenesis of atherosclerosis is multifactorial (Singh et al., 2002). Various studies demonstrated a definite association between types of dietary fats (triglycerides) and lipoproteins and elevated blood lipid levels, especially cholesterol (Mensink and Katan, 1992). Diet is the first line of therapy for the management of plasma lipids in the prevention and treatment of CVD. The goal of dietary therapy is to reduce elevated total cholesterol and LDL-cholesterol concentrations and thereby reduce CVD morbidity and mortality (Yu-Poth et al., 1999). Substitution of foods high in polyunsaturated fatty acids (PUFAs) for foods high in saturated fatty acids (SFAs) and total dietary fat reduction has produced a lowering of blood cholesterol (Schlenker and Long, 2007). Corresponding Author: Dr. Ref’at Ahmad Alkurd, Assistant Professor of Human Nutrition, Department of Nutrition, Faculty of Pharmacy and Medical Sciences, Petra University, Amman, Jordan. P.O.Box: 961343. Fax: +96265715570, E-mail: [email protected] 3171 Aust. J. Basic & Appl. Sci., 5(12): 3171-3178, 2011 The Adult Treatment Panel III (ATP III) suggests a comprehensive lifestyle approach to reduce the risk for CHD called therapeutic lifestyle changes (TLC) and incorporates the following components: reduced intake of SFAs and cholesterol, therapeutic dietary options for enhancing LDL lowering (plant stanols/sterols and increased soluble fiber), weight reduction and increased regular physical activity (NIH, 2002). The major LDL-raising nutrient component is SFAs in addition to cholesterol (AHA, 2002). The foundation of the TLC Diet focuses on reducing SFAs (<7% of total energy intake) and cholesterol (<200 mg/day) (NIH, 2002). There is a "dose-response relationship" between SFAs and LDL cholesterol levels; for every 1% increase in kcalories from SFAs as a percentage of total energy, serum LDL cholesterol increases by around 2%, and a 1% decrease in SFAs will lower serum cholesterol by around 2%. Although weight reduction by itself, even of a few pounds, will reduce LDL cholesterol levels, weight reduction attained using a kcal-controlled diet low in SFAs and cholesterol will improve and maintain LDL cholesterol lowering. Although dietary cholesterol does not have the same influence as SFAs on serum LDL cholesterol levels, high cholesterol intakes raise LDL cholesterol levels. Therefore reducing dietary cholesterol to <200 mg/day decreases serum LDL cholesterol in most persons (Schlenker and Long, 2007). The TLC Diet recommends substitution of MUFA for SFA at an intake level of up to 20% of total energy intake (NIH, 2002) because MUFAs lower LDL cholesterol levels relative to SFAs without decreasing HDL cholesterol or TG levels. Therefore, it has been recommended to use plant oils, particularly olive oil, and nuts because they are the best sources of MUFAs (Schlenker and Long, 2007). PUFAs, particularly linoleic acid, reduce LDL cholesterol levels when used instead of SFAs and can also cause small reductions in HDL cholesterol as compared with MUFAs. The TLC Diet recommends the use of liquid vegetable oils, semiliquid margarines and other margarines low in trans FAs because they are the best sources of PUFAs. For this reason, the intakes of PUFAs can range up to 10% of total energy intake (NIH, 2002). In view of the fact that only SFAs and trans FAs increase LDL cholesterol levels (NRC, 1989), serum levels of LDL cholesterol are unrelated to total fat inake per se. For that reason, it is not crucial to limit total fat intake for the specific goal of reducing LDL cholesterol levels, provided SFAs are decreased to goal levels (AHA, 2002). Controlling hypertension improves CVD risk considerably. Both lifestyle modifications and drug therapies are used to treat hypertension. For people with prehypertension, changes in diet and lifestyle alone may lower blood pressure to a normal level. The lifestyle modifications include weight reduction if overweight or obese; a diet low in sodium and rich in calcium, potassium and magnesium; regular physical activity; and a moderate alcohol intake (AHA, 2002; NRC, 1989). Combining two or more of these modifications can enhance results. Weight reduction and dietary changes generally have the most dramatic effects on blood pressure (Rolfes et al., 2009). Several studies have confirmed positive effects of sodium reduction on blood pressure in both normotensive and hypertensive individuals (He and MacGregor, 2002, 2004). Such data provide the basis for current dietary guidelines for all Americans to limit salt intake to 6 g/day or sodium intake to 2.4 g/day, and for those with hypertension to limit sodium intake to 1.5 g/day (Pimenta et al., 2009; USDHHS, 2005; Midgley et al., 1996). Nutritional treatment of congestive heart failure implies a sodium restriction (Verbalis et al., 2007) to 2 g/day and may be adjusted upwards to 3 g/day if necessary to promote dietary intake (Schlenker and Long, 2007). The effect of potassium on blood pressure is still being actively investigated. Dietary potassium and blood pressure are inversely related. High dietary potassium may help prevent and control hypertension (Whelton et al., 1997). Investigators postulate that this effect occurs because potassium antagonizes the biological effect of sodium (Dahl et al., 1972); potassium acts directly on the renal tubule to increase the urinary excretion of sodium chloride. Blood pressure may be more related to sodium/potassium ratio than to the actual amount of dietary sodium (IOM, 2005; Sacks, 1998). Higher dairy calcium versus nondairy calcium has been associated with a lower incidence of stroke (Ascherio et al., 1998). These findings suggest that the effects of calcium may differ, depending on the food source, or alternatively that other constituents of dairy may be responsible for the observed associations. Peptides derived from milk proteins, especially fermented milk products, have been shown to function as angiotensin-converting enzymes, thereby lowering blood pressure (Seppo et al., 2003). A report recommends a diet rich in fruits, vegetables, and low-fat dairy products over calcium supplementation for the prevention and management of elvated blood pressure (Chobanian et al., 2003). An intake of dietary calcium to meet the goal of 1000-2000 mg/day is recommended (Sacks, 1998). Magnisium is a potent inhibitor of vascular smooth-muscle contraction and may play a role in blood pressure regulation as a vasodilator. Dietary magnesium was inversely related to blood pressure (Ascherio et al., 1998). The Dietary Approach to Stop Hypertension (DASH) dietary pattern emphasizes foods rich in magnesium including green leafy vegetables, nuts, and whole grain breads and cereals. Foods high in magnesium are frequently high in potassium and dietary fiber (NIH, 2009). Overall food sources of magnesium 3172 Aust. J. Basic & Appl. Sci., 5(12): 3171-3178, 2011 rather than supplemental doses of the nutrient are encouraged to prevent or control hypertension (Chobanian et al., 2003; Sacks, 1998; Matuura et al., 1987). In this study, it was thought beneficial to estimate the intake of food components that are related to CVDs. These components include fats and fatty acids, cholesterol, dietary fibers, sodium, calcium, potassium and magnesium from the latest JHEIS data 2006/2007. MATERIALS AND METHODS Data in this paper were based on the Jordanian Household Expenditures and Income Survey (JHEIS) 2006/2007, which aimed at collecting detailed data on the household expenditures and income. The raw data collection of this survey extended from July, 2006 to January, 2007 (DOS, 2008). In the JHEIS survey, the annual per capita food consumption data of a representative sample of all Jordanian households was calculated. The included 12768 households were proportionally distributed among the different governorates of the whole country (Kingdom) using two-stage cluster stratified sampling method in light of the housing census frame, 2004. A questionnaire was distributed to households included in the study. The questionnaire contained data of the expenditure on different food and nonfood categories. Each category included a number of food items. The data on food items was analyzed using a nutrition analysis software program (Food Processor SQL nutrition and fitness software, 2008) which included details on the contents of energy and nutrients for each food item. In case a food item that was not included in the database of the mentioned program, the nutrient makeup of this food was obtained from other food analysis sources such as Food Composition Tables for Use in the Middle East (Pellet and Shadarevian, 1970) and Food Composition Tables of the Gulf Region (Musaiger, 2006). Such foods and their analyses were introduced to the Food Processor database. Then the daily intakes of total fats, n-3 and n-6 fatty acids, saturated, monounsaturated, polyunsaturated and trans fatty acids, cholesterol, dietary fibers, sodium, calcium, phosphorus and magnesium were calculated, and the daily per capita intakes of these food components were obtained using the provided household expenditure data for 6 months. Consumption values of these food components obtained for the different governorates were compared with the highest DRI and other professional health recommendations to assure that needs were met for all age groups (IOM, 2002/2005/2010). RESULTS AND DISCUSSION Table (1) shows the daily per capita estimated consumption of energy, fat, dietary fiber, and cholesterol in the whole country and governorates as indicated in the JHEIS, 2006/2007. The whole country daily energy consumption (kcal), total fat (g), dietary fiber (g) and cholesterol (mg) were 3031, 87.0, 24.0 and 203.8. In the governorates they respectively ranged from 2710 in Tafila to 3328 in Madaba, 64.9 in Tafila to 112.9 in Ajloun, 20.1 in Tafila to 28.0 in Jarash and 154.1 in Balqa to 241.3 in Amman. The DRI values for energy of low active individuals (Tables 2 and 3) are respectively 2680 and 2105 kcal for the reference man and woman of the age 25 years. The whole country estimated energy consumption (3031 kcal) is 13% and 44% higher than the Estimated Energy Requirements (EER) of the reference man and woman, respectively. It is important to notify that the highest recommendations were used for the comparison of nutrients. On the other hand, the “low active level”, not the “very active level” was chosen for comparison of energy for the purpose of having foods of high nutrient density rather than high energy foods, because enough energy is needed to sustain a healthy and active life, but too much energy leads to overweight and obesity (IOM, 2005). As indicated by Takruri and his colleges in their study on the energy and macronutrient consumption of Jordanians as obtained from the JHEIS 2008, the high energy consumption of Jordanians was due to the trend for increased consumption of meat group, mainly chicken, and sugars (Takruri et al., 2011). The high consumption of these foods is related to the increased risk of CVD. Except for infants, there are no DRIs (AIs) for the total fat intake. The highest DRIs (AI, g/day) of dietary fiber are 38 and 26 for males and females of the age 14-18 year, respectively. The whole country estimated consumption of dietary fiber (24 g/day) is lower than these recommended AIs. It is well documented that the adequate intake of dietary fibers has many beneficial physiological effects and protects against constipation, diverticular disease, CVD, colon cancer and diabetes mellitus. It is also documented that increasing fiber intake lowers blood pressure and serum cholesterol levels (Anderson et al., 2009). Table (4) shows the daily per capita estimated intake of SFAs, MUFAs, PUFAs, trans, n-3, and n-6 fatty acids in the whole country and governorates in Jordan. The consumptions (g/day) of SFAs, MUFAs, PUFAs, and trans, n-3, and n-6, fatty acids were 21.0, 27.1, 27.0, 1.25, 0.68, and 7.6. In the governorates they respectively ranged from 15.0 in Tafila to 26.3 in Irbid, 19.6 in Tafila to 38.2 in Ajloun, 18.5 in Aqaba to 37.6 in Ajloun, 0.80 in Balqa to 1.97 in Ma’an, 0.57 in Ma'an to 0.86 in Ajloun, and 6.7 in Tafila to 9.2 in Irbid. 3173 Aust. J. Basic & Appl. Sci., 5(12): 3171-3178, 2011 Table 1: Daily per capita consumption of energy, fat, dietary fiber and cholesterol in the whole country and governorates in Jordan. Governorate Energy (kcal) Total fat (g) Dietary fiber (g) Cholesterol (mg) Amman Balqa Zarqa Madaba Irbid Mafraq Jarash Ajloun Karak Tafilah Ma’an Aqaba Whole country 2940 3079 2893 3328 3320 2876 3054 3245 3107 2710 3075 2750 3031 92.5 89.4 85.3 97.3 111.4 79.2 82.1 112.9 74.1 64.9 79.4 75.3 87.0 24.0 26.1 22.6 25.2 26.9 21.6 28.0 25.1 21.6 20.1 25.4 21.0 24.0 241.3 154.1 218.2 231.8 234.3 180.7 207.2 227.9 194.4 200.2 175.3 180.7 203.8 Table 2: New reference heights and weights for children and adults as indicated in the DRIs*. Sex Age, y Median BMI (kg/m2) Median reference height, cm Male, Female 1–3 — 86 Male Female 4–8 9–13 14–18 19–30 9–13 14–18 19–30 15.3 17.2 20.5 22.5 17.4 20.4 21.5 115 144 174 177 144 163 163 Reference weight, kg 12 20 36 61 70 37 54 57 * IOM, 2002 Table 3: The estimated energy requirements (EER) for different physical activity (PA) levels of 25-year reference male and female according to the equations of the DRIs*. PA level EER (kcal/day) Male Female Sedentary 2452 1899 Low active 2680 2105 Active 2970 2362 Very active 3445 2671 * Calculations of these figures are based on IOM, 2001. Table 4: Daily per capita consumption of different fats in the whole country and governorates in Jordan. Governorate Daily intake of fat types (g) SFA MUFA PUFA Trans Amman 22.7 28.1 28.5 0.91 Balqa 22.2 23.8 28.9 0.80 Zarqa 20.8 25.4 26.7 1.08 Madaba 21.3 28.2 33.7 1.13 Irbid 26.3 37.3 32.2 1.32 Mafraq 20.2 25.6 22.9 1.81 Jarash 21.9 23.4 23.2 1.03 Ajloun 25.0 38.2 37.6 1.89 Karak 16.8 22.7 25.0 1.16 Tafilah 15.0 19.6 20.3 0.95 Ma’an 18.0 27.1 23. 5 1.97 Aqaba 21.7 26.1 18.5 0.89 Whole country 21.0 27.1 27.0 1.25 n-3 0.77 0.59 0.65 0.75 0.84 0.59 0.67 0.86 0.66 0.60 0.57 0.61 0.68 n-6 7.8 6.8 6.9 8.2 9.2 7.4 7.7 8.9 7.7 6.7 7.3 7.0 7.6 Table (5) shows the % share from total estimated energy intake of total fats, SFAs, MUFAs, PUFAs, trans fats, n-3 FAs and n-6 FAs in addition to dietary fiber intake (g/1000 kcal) and ratio of PUFA to SFA in the whole country and governorates. The % of total fats from total energy in the whole country and governorates was within the recommendations of the Acceptable Macronutrient Distribution Range (AMDR) (Table 6). The SFAs as a % for total energy of the whole country was 6.2 which lies within the recommendations of healthy individuals and the TLC Diet. The whole country % of MUFAs from total calories was 8.0 which is less than the recommendations (10-15%) in the whole country and most of the governorates. The main sources of MUFA in Jordan are olives and olive oil, which are produced locally in good quantities. The annual production of olives was 140,719.1 tons in the year 2009 (DOS, 2009). Concerning the % of PUFAs from the total energy, the consumption of the whole country and most of the governorates was within the recommendations (≤10%). Therefore, to have a healthier diet, it is advisable to substitute some of the consumed vegetable oils by olive oil; this practice will increase the % and amount of MUFA consumed in the Jordanian diet. The per capita consumption (g/day) of olive oil (7.5) comes in the third degree after soybean (14.1) and corn (8.4) oils. It was estimated in the years 2007-2009 that 3174 Aust. J. Basic & Appl. Sci., 5(12): 3171-3178, 2011 the total per capita vegetable oil consumption was 43.2 g/day (DOS, 2009). The % of the trans FAs in the whole country was relatively low (<1%) which is healthy and in agreement with the American Heart Association (AHA) recommendations (Lichtenstein, et al., 2006) (Table 7). The percentages of n-3 (0.2%) and n-6 (2.3%) FAs in the whole country were lower than their recommendations. To increase the consumption of n3 FAs it is advisable to substitute some of the consumed chicken by fatty fishes such as herring, mackerel, salmon and tuna; this practice will also decrease the consumed amounts of total fat, SFA and cholesterol. The intake of dietary fibers in the whole country (7.9 g/1000 kcal) was approximately half the recommendations of 14 g/1000 kcal. The ratios of PUFA/SFA (1.3/1) were within their recommendations (1-1.5/1) in the whole country and most of the governorates. Table 5: The percentage share of fats out of total energy intake (TEE), dietary fiber intake (g/1000 kcal) and PUFA/SFA ratio in whole country and governorates in Jordan. Governorate fats % share of TEE Dietary fiber PUFA/S g/1000 kcal FA Total SFA MUFA PUFA Trans n-3 n-6 Amman Balqa Zarqa Madaba Irbid Mafraq Jarash Ajloun Karak Tafilah Ma’an Aqaba Whole country 28.3 25.9 26.4 26.2 30.0 24.7 24.0 31.0 21.4 21.5 23.1 24.6 25.6 6.9 6.4 6.4 5.7 7.1 6.3 6.4 6.9 4.9 5.0 5.2 7.1 6.2 8.6 6.9 7.9 7.6 10.1 8.0 6.8 10.5 6.6 6.5 7.9 8.5 8.0 8.7 8.4 8.3 9.1 8.7 7.2 6.8 10.4 7.2 6.7 6.8 6.0 7.9 0.3 0.2 0.3 0.3 0.4 0.6 0.3 0.5 0.3 0.3 0.6 0.3 0.4 0.24 0.17 0.20 0.20 0.23 0.18 0.20 0.24 0.19 0.20 0.17 0.20 0.20 2.4 2.0 2.1 2.2 2.5 2.3 2.3 2.5 2.2 2.2 2.1 2.3 2.3 8.2 8.5 7.8 7.6 8.1 7.5 9.2 7.7 7.0 7.4 8.3 7.6 7.9 1.3/1 1.3/1 1.3/1 1.6/1 1.2/1 1.1/1 1.1/1 1.5/1 1.5/1 1.4/1 1.3/1 0.9/1 1.3/1 Table 6: Acceptable Macronutrient Distribution Range (AMDR) for >19 years old as a percent of total energy intake*. Energy-yielding nutrient AMDR Carbohydrate 45-65% Fat 20-35% n-3 fatty acids 0.6-1.2% n-6 fatty acids 5.0-10 % Protein 10-35% * Institute of Medicine (IOM), 2002/2005 Table 7: American Heart Association 2006 diet recommendations for CVD risk reduction*. 1. Balance calorie intake and physical activity to achieve or maintain a healthy body weight. 2. Consume a diet rich in vegetables and fruits. 3. Choose whole grain, high-fiber foods. 4. Consume fish, especially oily fish, at least twice a week. 5. Limit intake of saturated fat to <7% of energy, trans-fat to <I % of energy, and cholesterol to <300 mg/day by: Choosing lean meats and vegetable alternatives. Selecting fat-free (skim), 1% -fat, and low-fat dairy products. Minimizing intake of partially hydrogenated fats. 6. Minimize your intake of beverages and foods with added sugars. 7. Choose and prepare foods with little or no salt. 8. When consuming alcohol, do so in moderation. 9. When eating food that is prepared outside of the home, follow the American Heart Association Diet and Lifestyle Recommendations. *Modified from Lichtenstein AH et al: Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Committee, Circulation 114:83, 2006. The whole country estimated consumptions, as % of the total energy intake, were healthy for total fat, SFA, PUFA and trans FA and the ratio of PUFA/SFA; whereas the percentages of MUFA and n-3 and n-6 FAs were unhealthy as they are lower than their recommendations. The consumption of dietary fiber, g/1000 kcal, was also less than the recommendations. The estimated total energy consumption of the whole country was higher than the EER assigned in the DRIs recommendations. According to these results of energy, fat and fiber intake and for the purpose of decreasing the risks of CVD, it is advisable to increase the daily consumption of MUFA, especially from olive oil, to not less than 10% of the total energy intake and to decrease the total energy and the PUFA intakes. It is also advisable to increase the daily intake of fibers from its natural food sources such as fruits, vegetables and whole grains and legumes. Table (8) shows the per capita estimated consumption (mg/day) of sodium, calcium, potassium, and magnesium in the whole country and governorates. The whole country consumption (mg/day) was 7623, 829, 3130, and 302 for sodium, calcium, potassium, and magnesium, respectively. The estimated intakes of these nutrients ranged respectively from 4747 in Karak to 10877 in Balqa, 654 in Tafilah to 949 in Irbid, 2624 in Aqaba to 3672 in Irbid and 257 in Tafilah to 359 in Irbid. 3175 Aust. J. Basic & Appl. Sci., 5(12): 3171-3178, 2011 Table 8: Daily per capita intake (mg) of some hypertension-related minerals in the whole country and governorates in Jordan. Governorate Sodium Calcium Potassium Magnesium Amman 7062 873 3188 307 Balqa 10877 909 3058 297 Zarqa 6767 824 3018 295 Madaba 8896 917 3522 341 Irbid 9155 949 3672 359 Mafraq 6556 753 2740 267 Jarash 8537 916 3522 327 Ajloun 9600 919 3574 332 Karak 4747 688 2776 282 Tafilah 6281 654 2812 257 Ma’an 7232 793 3049 286 Aqaba 5762 747 2624 274 Whole country 7623 829 3130 302 The whole country estimated intakes of sodium, calcium, potassium, and magnesium, as a % of the DRIs were 508%, 82.9%, 66.8%, and 94.4% (compared to males, 31-50 years) and 71.9% (compared to females, 3150 years), respectively. The DRIs of these minerals are presented in Table 9. These results indicate that there was very high intake of sodium, while the intakes of calcium, potassium and magnesium were mildly to moderately low. Takruri et al., (2011) found that the whole country consumption of fruits and vegetables was lower than the recommendations; if fruits and vegetables are consumed in sufficient amounts, this will increase the consumed amounts of dietary fiber (mg/1000 kcal) and potassium. The consumption of good quantities of green leafy vegetables, nuts, and whole grain breads and cereals ensures a sufficient intake of magnesium. They also found that Jordanians were consuming very limited servings of milk group (0.6 serving per capita/day) which is the main dietary source of calcium. Table 9: DRI’s of some minerals and n-3 and n-6 fatty acids. Nutrient Calcium (mg), RDA Phosphorus (mg), RDA Potassium (mg), AI Sodium (mg), AI Magnesium, RDA n-3 fatty acids (g), AI n-6 fatty acids (g), AI Institute of Medicine (IOM), 1997/2005/2010 DRI (19-30, 31-50 years) Males 1000 700 4700 1500 310-320 1.3 17 Females 1000 700 4700 1500 400-420 1.1 12 Conclusion: It might be concluded that dietary factors contribute to the causation of high prevalence of CVD, including hypertension. In Jordan, the low intakes of MUFAs, n-3 and n-6 FAs, dietary fibers, calcium, potassium, magnesium and high consumption of energy and sodium. Also, the good dietary factors are the healthy intakes of cholesterol, total fats, SFAs, PUFAs, trans FAs and PUFA/SFA ratio. REFERENCES Ajlouni, M., 2010. Human resources for health country profile-Jordan. WHO. American Heart Association (AHA), 2002. ATP III Final Report: V. Adopting Healthful Lifestyle Habits to Lower LDL Cholesterol and Reduce CHD Risk. Circulation 106:3253. From: http://circ.ahajournals.org/cgi/content/full/106/25/3253. Anderson, J.W., P. Baird, R.H. Davis, S. Ferreri, M. Knudtson, A. Koraym, V. Waters and C.L. Williams, 2009. Health benefits of dietary fibers. Nutrition Reviews, 67(4):188-205. Arbaji, A., 2002. Utilization of Health Services Delivery and Health Status Study, Primary Health Care Initiatives, USAID. Ascherio, A., E.B. Rimm, M.A. Hernán, E.L. Giovannucci, I. Kawachi, M.J. Stampfer and W.C. Willett, 1998. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among U.S. men. Circulation, 98(12): 1198-1204. From: http://circ.ahajournals.org/cgi/reprint/98/12/1198. Chobanian, A.V., G.L. Bakris, H.R. Black, W.C. Cushman, L.A. Green, J.L. Izzo, D.W Jones, B.J. Materson, S. Oparil, J.T. Wright, E.J. Roccella and the National High Blood Pressure Education Program Coordinating Committee, 2003. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 Report. JAMA, 289(19): 2560-2571. From: http://jama.ama-assn.org/content/289/19/2560.abstract 3176 Aust. J. Basic & Appl. Sci., 5(12): 3171-3178, 2011 Dahl, L.K., G. Leitl and M. Heine, 1972. Influence of dietary potassium and sodium/potassium molar ratios on the development of salt hypertension. The Journal of Experimental Medicine, (136): 318-330. DOS (Department of Statistics), 2009. Food Balance Sheet of Jordan 2009. From: www.dos.gov.jo/agr/agr_a/aver_2002_2007/aver%202007-2009.pdf DOS (Department of Statistics), 2008. Household Expenditures and Income Survey 2006. DOS, AmmanJordan. Food Processor SQL, 2008. Food Processor nutrition and fitness software. Food Processor SQL Inc., Salem, OR, USA. He, F.J. and G.A. MacGregor, 2004. Effect of long-term modest salt reduction on blood pressure. Cochrane Database Syst Rev, 3: CD004937. He, F.J. and G.A. MacGregor, 2002. Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials: implications for public health. J Hum Hypertens, 16: 761. IOM (Institute of Medicine), 2010. Dietary Reference Intakes for Calcium and Vitamin D. From: www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx. IOM, 2002/2005. Panel on Macronutrients and Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Macronutrients and healthful diets. Dietary reference intakes for energy, carbohydrates, fiber, fats, fatty acids, cholesterol, proteins, and amino acids. Washington, DC: National Academies Press, 769-879. IOM, 1997/2005. Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride (1997); and Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005). Washington, DC: National Academies Press. From: http://www.nap.edu IOM, 2001. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. From: www.nal.usda.gov/fnic/DRI/DRI_Energy/energy_full_report.pdf Lichtenstein, A.H., L.J. Appel, M. Brands, M. Carnethon, S. Daniels et al., 2006. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation, 114: 82-96. Matuura, T., M. Kohno, Y. Kanayama, K. Yasunari, K. Murakawa, T. Takeda, K. Ishimori, I. Morishima and T. Yonezawa, 1987. Decreased intracellular free magnesium in erythrocytes of spontaneously hypertensive rats. Biochemical and Biophysical Research Communications, 43 (3): 1012-1017. From: www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WBK-4F031HH Mensink R.P., and M.B. Katan, 1992. Effects of dietary fatty acids on serum lipids and lipoproteins: a metaanalysis of 27 trials. Arterioscler Thromb, 12: 911-919. Midgley, J.P., A.G. Matthew, C,M. Greenwood and A.G. Logan, 1996. Effect of reduced dietary sodium on blood pressure: a meta-analysis of randomized controlled trials. JAMA, 275: 1590-1597. MOH (Ministry of Health), 2007. Behavioral risk factors for NCD. Directorate of Disease Control and Prevention. Amman, Jordan. Musaiger, A.O., 2006. Food Composition Tables for Arab Gulf Countries. Arab Center for Nutrition, Bahrain. NIH (National Institute of Health), 2009. Dietary Supplement Fact Sheet: Magnesium. National Institute of Health: Office of Dietary Supplements. From: http://ods.od.nih.gov/factsheets/magnesium/ NIH, 2002. Third report of NCEP expert panel of detection, evaluation and treatment of high blood cholesterol in adults (ATP III), Final Report. From www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf NRC (National Research Council), 1989. Diet and health: implications for reducing chronic disease risk. Washington, D.C.: National Academy Press: 171-201. Pellet P.L., and S. Shadarevian, 1970. Food Composition Tables for Use in the Middle East. AUB, Beirut, Lebanon. Pimenta, E., K.K. Gaddam, S. Oparil, I. Aban., S. Husain, L.J. Dell’Italia and D.A. Calhoun. 2009. Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension results from a randomized trial. Hypertension, 54: 475-481. Rolfes, S.R., K. Pinna and E.N. Whitney, 2009. Understanding Normal and Therapeutic Nutrition. 8th edition. West Wadsworth Intern. Pupl. Co., NY. Sacks, F.M., W.C. Willett, A. Smith, L.E. Brown, B. Rosner and T.J. Moore, 1998. Effect on blood pressure of potassium, calcium, and magnesium in women with low habitual intake. Hypertension, 31: 131-138. Schlenker, E.D. and S. Long, 2007. William's Essentials of Nutrition and Diet Therapy. 9th edition. Mosby. Seppo, L., T. Jauhiainen, T. Poussa and R. Korpela, 2003. A fermented milk high in bioactive peptides has a blood pressure-lowering effect in hypertensive subjects. Am J Clin Nutr., 77(2): 326-330. From: http://www.ajcn.org/content/77/2/326.long Shishani, K., 2010. Cardiovascular nursing in Jordan: a need for an action. TAF Preventive Medicine Bulletin, 9(5): 523-528. 3177 Aust. J. Basic & Appl. Sci., 5(12): 3171-3178, 2011 Singh, R.B., S.A. Mengi, Y.N. Xu, A.S. Arneja and N.S. Dhalla, 2002. Pathogenesis of atherosclerosis: A multifactorial process. Exp Clin Cardiol, 7(1): 40-53. Takruri, H., R. Alkurd and M. Faris, 2011. Trends of the energy and macronutrients intakes of Jordanians (In Arabic). Journal of Saudi Society for Food and Nutrition, 6(2). USDHHS (United States Department of Health and Human Services), U.S., 2005. Department of Agriculture: Dietary Guidelines for Americans. From: www.healthierus.gov/dietaryguidelines Verbalis, J.G., S.R. Goldsmith, A. Greenberg, R.W. Schrier and R.H. Sterns, 2007. Hyponatremia treatment guidelines 2007: expert panel recommendations. The American Journal of Medicine, 120(11A): S1-S21. Whelton, P.K., J. He, J.A. Cutler, F.L. Brancati, L.J. Appel, D. Follmann and M.J. Klag, 1997. Effects of oral potassium on blood pressure: meta-analysis of randomized controlled clinical trials. JAMA, 277(20): 16241632. From: http://jama.ama-assn.org/content/277/20/1624.full.pdf+html WHO, 2006. From: http://www.pdfdownload.org/pdf2html/pdf2html_vuzit.php?url=http%3A%2F%2Frds%2Eyahoo%2Ecom %2F%5Fylt%3DA0oG7hl7kdhMdAcAHiJXNyoA%3B%5Fylu%3DX3oDMTEydjYwNHFsBHNlYwNzcgRw b3MDMwRjb2xvA2FjMgR2dGlkA0RGRDVfOTU%2D%2FSIG%3D12koksv3n%2FEXP%3D1289347835%2 F%2A%2Ahttp%253a%2F%2Fwww%2Ewho%2Eint%2Fwhosis%2Fmort%2Fprofiles%2Fmort%5Femro%5Fj or%5Fjordan%2Epdf&images=no WHO, 2003. Country Cooperation Strategy for WHO and Jordan 2003–2007. Yu-Poth, S., G. Zhao, T. Etherton, M. Naglak, S. Jonnalagadda and P.M. Kris-Etherton, 1999. Effects of the National Cholesterol Education Program's Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis. American Journal of Clinical Nutrition, 69(4): 632-646. 3178