Descripción de los TCA
2. BULIMIA NERVIOSA
The findings reported in this thesis have broadened the knowledge of the mean levels or prevalence of NCD risk factors in Vietnam at regional and national levels, and have contributed to improved understanding of the NCD risk profiles of the Vietnamese
population. In addition, it has provided evidence of the general acceptability of the STEPS methodology for use in Vietnam but with important limitations identified. Furthermore, it has brought to light several gaps that need to be filled by future research. Those gaps are outlined in the following paragraphs.
First, the associations between summary estimates of NCD risk factors collected by the WHO STEP instrument and other correlations with socio-demographic, geographic and
pathophysiological factors were generally plausible. Verification of this was important because it was likely that users of the data would undertake those associative analyses themselves when making provincial comparisons even it informally. However, these
ecological comparisons were based on data from different regions within a single country and, to confirm its utility more generally for cross-cultural comparisons, further investigation regarding the validity of contrasts between countries is recommended.
Second, there appeared to be a decline in smoking prevalence in recent cohorts of men and successive cohorts of women. This work was based on the re-constructed birth cohort analysis method (25) using data collected at a single point in time. This decline should be confirmed with longitudinal data or by repetition of one of the cross-sectional surveys that have taken place including STEPS survey. Further research exploring factors associated with not taking up smoking (particularly by women) or quitting smoking is also needed.
Third, consumption of alcohol reported in standard drinks had some evidence of predictive validity with blood pressure and hypertension. However, the questions on alcohol
consumption used in the WHO STEPS questionnaire are an adaption of the
quantity/frequency approach (74). Further assessment the comparative validity of questions based on the graduated frequency approach (74) is desirable. One of the principal guidelines of the WHO’s global strategy in reducing the harmful use of alcohol is to consider the national, religious, and cultural context in recommending actions (75). Therefore, more qualitative research exploring the sex-differences and cultural practices in alcohol use is also needed to reduce the risk of harmful/hazardous and binging drinking.
Fourth, accurate measurements of sodium intake are needed to facilitate these analyses, and to inform national/international public health initiatives to reduce sodium consumption. There is strong and consistent evidence from animal studies, epidemiological data and clinical trials both within and across populations implicating high salt intake as an important risk factor for
high blood pressure among both hypertensive and normotensive individuals (76-80), andhigh
salt intake is associated with increased risk of future CVD and stroke (81, 82). Salt intake may be responsible for the differences in blood pressure between urban and rural areas, and for confounded associations between blood pressure and other behavioural risk factors in our
Chapter 7. Summary, implications and future research 160 160 findings. Only self-reported information on the saltiness of diet was considered in the research reported in this thesis, however. In order to quantify the total amount of sodium consumed by individuals per day, collection of urine over a 24-hour period is recommended. However, asking participants to collect their urine over a 24-hour period would be significantly burdensome and is likely to deter participants from being involved in other steps of the survey. Although 24-hour urine collection is generally considered the ‘gold standard’ for estimation of population sodium intake, spot urine collection is increasingly used as a convenient and affordable alternative in low resource settings (83, 84).
Fifth, because reporting of PA varies between those who have stable and unstable work patterns (58) and by season, and because responses to questions on fruit and vegetable consumption differ also by season, the concept of a ‘typical week’ used in the STEPS questionnaire appears not well-suited for use in this population. Further research is required on what reference period is best for reporting these behavioural risk factors.
Sixth, because only 1-in-5 Vietnamese people reported having at least five servings of fruit and vegetables daily, further studies on the barriers to increasing the number of servings of fruit and vegetables are recommended. In addition, the current recommendation of five servings of fruit and vegetables per day requires further attention. The results of a recent meta-analysis have shown that fruit and vegetable intake may have a dose-response relation with all-cause mortality (41), but these studies were mostly conducted in Western countries. The beneficial effects of fruit and vegetables may differ between Asian and Western
populations, and further research on what cut-point is best for each population is desirable.
Finally, to assess the validity of these brief questions on fruit and vegetable intake, additional data on total energy intake is required in validation studies because the STEPS questionnaire does not provide information on total energy intake. These further assessments need also to take into account the seasonal variation in the availability of food, and the different dietary patterns of the regional and socio-demographic groups of the country.
7.8 Conclusions
This thesis provides the first nationally-representative estimates of mean levels or prevalence of NCD risk factors in Vietnam. These data suggest that efforts to limit future growth in
NCDs should be targeted at reducing tobacco smoking and binge drinking by men, encouraging physical activity, and increasing consumption of fruit and vegetables. These interventions should take account of the sex-, urban-rural and regional differences in these risk factors that were identified in this thesis. The results from this research could help to strengthen the implementation Programme of Prevention and Control of Certain Non-
communicable Diseases for the Period 20102020 in Vietnam. In addition, the findings from
the extensive assessment of the application of the STEPS instrument in Vietnam in respect of the measurement of behavioural risk factors, and the analysis, interpretation and reporting of the results, should be of value for other investigators using the instrument and for other users of data.
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