Association of Nutrition Knowledge, Attitudes, Beliefs and Practices with Cardiometabolic Diseases Risk Factors among Adults

Aim: Adults living in the Free State province of South Africa have a high prevalence of cardiometabolic diseases (CMD) risk factors. Therefore, to decrease the prevalence of CMD risk factors, it is important to improve adult’s nutrition knowledge, attitudes, beliefs, and practices (NKABP) towards healthy eating, which have to the potential to lead to a healthier eating patterns and reduced risk for CMD. Tailored nutrition education interventions are necessary to improve CMD risk factors. To develop effective nutrition education interventions to improve CMD risk factors understanding the association between NKABP and CMD risk factors among adults is important. Therefore, the aim of this study is to assess the association between NKABP and CMD risk factors among adults in the Free State province of South Africa. Method: This sub-study forms part of the Assuring Health for All in the Free-State, which is cross-sectional study conducted in both urban and rural areas of the Free State province of South Africa. A total of 586 adults aged 25 - 65 years old without CMD were included in this sub-study. To assess the association between NKABP and CMD risk factors Spearman’s correlation test was used. Fisher’s exact test was used to evaluate the differences in NKABP between adults with normocholesterolemia and hypercholesterolemia, normal serum glucose (GLU) and impaired/high serum GLU, normal and high blood pressure (BP) and among body mass index (BMI) categories. Results: In this study, 77.1% were women with the majority of adults belonging to the Black race (81.5%). Almost half of the participants had no or primary school education (54.4%) and 55.7% had income levels below < ZAR1000 (~ $130 US). Our findings demonstrated that nutrition knowledge (NK) was significantly and positively correlated with triglycerides (TG) and systolic and diastolic blood pressure (BP). However, only a higher proportion of adults with hypertension had good levels of NK. There was a significant positive correlation of nutrition attitudes (NA) with serum GLU, while only a higher proportion of adults with overweight/obesity had good levels of NA compared to those with normal weight. With regards to nutrition beliefs (NB), there was significant and positive correlations of NB with low-density lipoprotein-cholesterol (LDL-C), total cholesterol (TC), TG, serum GLU, HBA1c, body mass index (BMI), and waist circumference (WC), however, only those with overweight/obesity had significantly higher proportion of adults with good levels of NB. Finally, there was a negative correlation between nutrition practices as measured by dietary diversity score (DDS) and HDL-C, while DDS was positively correlated to LDL-C, TG, GLU, HBA1c, BMI and WC. Only those adults with hypercholesterolemia had significantly higher proportion of adults with high DDS compared to those with normocholesterolemia. Conclusion and recommendations: The overall positive and negative correlations of NKABP with CMD risk factors in this study indicates that an increase in NKABP occurs with an increase in CMD risk factors among adults in the Free State province of South Africa. Therefore, it is important to implement preventative and tailored nutrition education interventions that focus on adults to improve their NKABP towards a healthy dietary pattern, which has the potential to prevent the development of CMD risk factors.

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