Influence of Marital Status and Quantity of Carbohydrate Consumption on Cardiovascular Risk in Women - Research Paper Example

How Quality of marriage life and quantity of carbohydrate consume influence the cardiovascular risk in women Introduction Qualitative research: The topic of the qualitative research is Marital Status and Quality in Middle-Aged Women: Associations with Levels and Trajectories of Cardiovascular Risk Factors Quantitative research: The topic of the quantitative research is A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women Qualitative: As mentioned by the authors, interpersonal relationships and social support shown to have health benefits in adults. Since marriage primarily provide social and interpersonal support, many studies conducted to reveal the association between marital status and different health conditions (Burman, 1992). However quality of the marriage can also interfere with healthy living but little is known in this regard. Marital stress cans adversely affect the health (Gallo, 2003). Therefore this qualitative study was conducted to find out association of marital status and quality of marriage life with the Cardiovascular Risk Factors in women. Quantitative: High carbohydrate and low fat diets which were thought to have an beneficial effect on coronary heart diseases (CHD) have shown elevated triglyceride levels, insulin resistant and low high density lipoprotein (HDL) levels in many studies. Therefore recommendation of high carbohydrate and low fat diets for CHD patients is controversial (Miller, 1994). Although animal studies and some human studies have shown an association between physical properties of the carbohydrate and CHD, extensive researches are required to draw a more reliable conclusion (Liu, 2000). Glycemic load the product of glicemic index and amount of carbohydrate in particular food, well reflects the physical properties including type, particle size, fiber content of the carbohydrate. This quantitative study was done to find out the effect of dietary glycemic load and carbohydrate intake on of coronary heart disease in women. Literature Review: Qualitative paper: Authors of this study have summarized literature of similar studies conducted in last two decades. Most of these studies focused at the marital status (whether married or not) rather than the quality of the marriage (Gallo, 2003). The literature provided by the authors is adequate to provide background information and highlighted the important of conducting current study. They have summarized the important results of the early studies relevant to this field and showed why those results are inadequate to draw a conclusion. Quantitative paper: Authors have summarized adequate literature about the findings of past studies on carbohydrate and cardio vascular risk. From the past literature they have clearly showed potential association of glycemic load and importance of finding the association between glycemic load and cardio vascular risk emphasizing the limited knowledge. They have summarized the major results of the early studies and strongly showed limitation of them to draw conclusion on glycemic load (Liu, 2000). Methodology: Qualitative: This qualitative 12-year follow-up study recruited 493 women from the Healthy Women Study, a longitudinal study to assess change in CHD risk factors in menopause. These women were 42-50 years of age and were not menopause at the baseline. The eligibility screening criteria required bleeding for last 3 months, no surgical menopause, diastolic blood pressure less than 100 Hgmm, no hormone replacement therapy and not on medicines that alter the CHD risk. Subjects were excluded if marital status or satisfaction on marriage were changed during the study (Gallo, 2003). CHD risk was measured by blood pressure, high and low density lipoprotein (HDL and LDL), triglycerides, fasting blood glucose, body mass index, smoking and exercise. Psychological risk factors such as depression, anxiety, anger etc. were measured using the questionnaires developed in the early studies. Risk factors were assessed more than five occasions during the study period (Gallo, 2003). Their relationships (married or cohabiting.) were identified at the baseline and their satisfaction in relationship was measured by questions with 4-point scale that finally summed to obtain score ranged from 0-21. Level of satisfaction proportionate was to the score (Gallo, 2003). Statistical analysis: Women who scored below the lower third of the scale were categorized as the unsatisfactory while others belonged to satisfactory and moderately satisfactory groups. HLM 5.04 software was used to analyze the risk factor trajectories. Chi-square test was done to find the significance (Gallo, 2003) . Sociodemographic characteristics were summarized and racial disparity was prominent. Majority of white women were satisfied in their marriage life while most of the African Americans felt low satisfaction in marriage. Covariate analysis found significantly lower CHD risk factors (blood pressure, HDL, physical inactivity, BMI) in women who were satisfied than that of the unsatisfied women. However LDL level, triglycerides and fasting blood glucose levels were not significantly different between groups (Gallo, 2003). Quantitative: This large 10-year follow-up study initiated in 1984 and 75,521 female nurses from the famous “Nurses’ Health Study” were participated. They were between 38-63 years of age, apparently healthy and had not been diagnosed with diabetes and cardio vascular diseases at the baseline screening. The end point was the incident of CHD (fatal or non fatal) that had been confirmed by the medical reports. Participants were followed until the end point or up to 10 years if they were free from the disease during the study. Their dietary intake was assessed by 126-itemed food-frequency questionnaire in 1984, 1986 and 1990 and glycemic load was calculated by multiplying carbohydrate content, glycemic index and frequency of intake together (Liu, 2000). Statistical analysis: Estimated relative risk was the measure of association. Participants were categorized in quintiles based on glycemic load and relative risk was calculated for each quintile and adjusted for compounding factors by multivariate analysis and pooled logistic regression (Liu, 2000). Seven hundred sixty one (761) incidents of which 208 fetal and 533 non fatal were observed throughout the follow-up. Estimated relative risk for CHD was 1.57 (95% CI, 1.27-1.97) in women in the highest quintile even after adjusted for possible compounding factors. Neither simple or complex carbohydrates significantly associated with CHD (Liu, 2000). Critical Evaluation to research question: Qualitative paper: According to the authors, there were limited researches have been conducted on the similar area (Gallo, 2003). However research question has no significant impact due to its typical nature. (i.e. it is generally accepted that quality of marriage life can influence health) also early studies have shown it clearly. On the other hand quality of marriage life can be affected by many factors such as economical status, education level of the partner, alcohol addiction of the partner etc (Burman, 1992). Therefore even if the researchers find an association between quality of the marriage life and the cardiovascular risk, impact on the society is negligible. Usually factors affecting the quality of marriage life are hard to change even if the affected person strongly feels the neediness. Considering all above significance of the research question is low although the knowledge of the exact field is limited. Quantitative paper: This research question has a great importance since its was created to find a new trend and may have a significant impact (Liu, 2000). (i.e. research question tests the effect of glycemic load on CVD rather than glycemic index). Association between glycemic index of different food items and its effect on blood glucose level is widely studies and it was well established that foods with higher glycemic index increase the blood glucose level than low glycemic index foods when consumed in same quantities (Miller, 1994). There by long standing practice was the restriction of high glycemic index food for diabetics (Miller, 1994). However effect of the quantity of carbohydrate rich foods on blood glucose level is not well studied. Glycemic load is the product of glycemic index and quantity of food consumed and provides more clear idea to select foods (type and quantity) (Miller, 1994). If researchers find a significant association it has a greater impact since individuals with diabetics can change there food selection, which is simply possible and hardly influenced by other factors. Evaluations of validity, authenticity and reliability in the two studies Qualitative: The study recruited only 493 subjects to be followed–up for 13 years. Although the number covers the minimum statistical requirement when compared with studies which follow similar methodologies and usually recruit large number of participants, reliability of the finding can be low. However the authors have done all possible measures to minimize the potential errors throughout the follow-up. They have followed the subject closely and frequently to obtain measurements regularly. Further the data gathered consisted most of the details of the possible compounding factors. Also have used reliable methods to collect data and practice direct data gathering whenever it was possible (such as direct measuring of blood pressure than accepting self stated) (Gallo, 2003). Finally they have specially adapted a statistical model to obtain result with minimal error adjusting the possible compounding factors. Therefore the methodology and carefully adopt statistical modeling of this study has eliminated the most of the possible biasness. Quantitative: This was a large study which followed more than 75000 of subjects for 10 years. These researchers also have frequently monitored (every two years) the subjects throughout the study period. They have posted semiquantitative food-frequency questionnaire to collect data on glycemic index. Although self stated questionnaires have high withdrawal rates and several problems regarding the reliability, this is the usual feasible and accepted practice in large studies like this. The cardiovascular disease diagnosis was done by medical reports and autopsy reports if the subject died during the study. These are the most reliable methods than self stated diagnosis. The hypothesis was supported by the result stressing glycemic load as an independent risk factor. Authors further claimed that the results were more reliable due to minimum biasness (such as recall error) occurred through prospective design (Liu, 2000). Although errors in dietary assessment are possible authors assured no major changes that can affect the major findings. This study also performed appropiate statistical adjustment to minimize the effect of compounding factors thereby making the result more reliable. Ethics issue in the two papers: Qualitative: For the current study, volunteers were recruited from the on going well recognized Healthy Women Study. This is a follow-up or longitudinal study which did not need to change ordinary lifestyle and did not need to undergo experimental trials or restrictions. The age range of the study subject lie between 42-50 years where the underage or elderly subjects were not considered (Gallo, 2003). Therefore it is ethical concern is minimal. Although it may be annoying to an individual to participate in such a long time study that have regular clinical visits, they have given full freedom to withdraw from the study if they are not interested or if the find difficulties. Therefore it is ethical concern is minimal. Quantitative: For the current study, volunteers were recruited from the on going, large and well recognized Nurses’ Health Study. This is also a longitudinal study in which, changes of lifestyle, avoidance, restrictions or participation in experimental trials were not required. The study was conducted according to the ethical guidelines of Brigham and Women’s Hospital, Boston. The age range of the subject was between 38-68 years thereby underage and elderly were not considered (Liu, 2000). In this study the authors have used the data of the ongoing Nurses’ Health Study. Therefore subjects did not bear extra burden. The data collected via self answered questionnaire posted to the participants and returned back by the subjects. They did not have to make clinical visits and if found annoying they were free to withdraw from the study at anytime (Liu, 2000). Therefore significant ethical issue is unlikely to occurs. Conclusion of both papers: Qualitative: The findings of this study revealed rather than marital status; marriage satisfaction provides health benefits including CHD prevention. Although, the impact of the study is not very significant, results can be considered as reliable. Quantitative: Since the association between glycemic load and CHD was significant even after adjusted for all known CHD risk factors glycemic load remains as an independent risk factor for CHD. This result is important and has an impact on the society and future researches and can be considered as reliable. Referencing: 1. Burman, B., & Margolin, G. (1992). Analysis of the association between marital relationships and health problems: An interactional perspective. Psychological Bulletin, 112, 39–63. 2. Gallo, L. C., Troxel, W. M., Matthews, K. A., Kuller, L. H. (2003). Marital Status and Quality in Middle-Aged Women: Associations with Levels and Trajectories of Cardiovascular Risk Factors. Health Psychology, 22: 5, 453–463 3. Liu, S., Willett, W. C., Stampfer, M. J., Franz, M., Sampson, L., Hennekens, C. H. and Manson, J. E. (2000). American Journal of Clinical Nutrition;71:1455–61 4. Miller, J.C. (1994) Importance of glycemic index in diabetes. American Journal of Clinical Nutrition, 59:747S–52S. Read More