Dietary pattern, lifestyle, nutrition status and prevalence of hypertension among traders in Sokoto Central market, Sokoto, Nigeria

Full text

Vol. 6(1), pp. 9-17, January, 2014
DOI: 10.5897/IJNAM2013.0158
ISSN 2141-2340 ©2013 Academic Journals
http://www.academicjournals.org/IJNAM
International Journal of Nutrition
and Metabolism
Full Length Research Paper
Dietary pattern, lifestyle, nutrition status and
prevalence of hypertension among traders in Sokoto
Central market, Sokoto, Nigeria
Awosan, K. J.1*, Ibrahim, M. T. O.1, Essien, E.2, Yusuf, A. A.3 and Okolo, A.C.3
1Department of Community Medicine, Usmanu Danfodiyo University, Sokoto, Nigeria.
2Nutrition Unit, Department of Community Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
3Department of Internal Medicine, Specialist Hospital, Sokoto, Nigeria.
Accepted 27 November, 2013
Poor diet (high consumption of sugar, salt, saturated fat, etc) and unhealthy lifestyle (smoking, alcohol
consumption and physical inactivity) have been identified as major risk factors of cardiovascular
disease and other non-communicable diseases (NCDs). NCDs are the leading causes of death globally,
killing more people each year than all other causes combined. This study was conducted to assess the
dietary pattern, lifestyle, nutrition status and prevalence of hypertension among traders in Sokoto,
Nigeria. A cross sectional descriptive study was conducted among 390 traders selected by multistage
sampling technique from November to December, 2012. Anthropometric and blood pressure
measurements were done for the participants, together with questionnaire administration. High
prevalence of unhealthy eating habits was recorded among the participants; 50.7% eat their largest
meal at dinner, 49.9% eat snacks everyday, 66.7% eat fatty foods, 27.1% and 33.0% drink fruit juice and
carbonated drinks, respectively thrice weekly or more, 56.0 and 58.8% eat fruits and vegetables,
respectively less than thrice in a week or not at all. Also, 50.7% live a sedentary lifestyle, 5.2% currently
smoke cigarette and 10.8% had consumed alcohol within the past 30 days. Similarly, the prevalence of
overweight (28.9%), obesity (28.1%) and hypertension (29.1%) was high among the participants. This
study demonstrated high prevalence of unhealthy eating habits and lifestyle; together with high
prevalence of overweight, obesity and hypertension among traders in Sokoto. Health education and
other interventions to promote healthy eating habits and lifestyle, especially among high risk groups
are suggested.
Key words: dietary pattern, lifestyle, nutrition status, hypertension, prevalence.
INTRODUCTION
Nutrition as the science of food and its relationship to
health has been recognized in recent years as the cor-
nerstone of socioeconomic development (Parks, 2009).
Adequate nutrition is important for a variety of reasons,
including optimal cardiovascular function, muscle
strength, respiratory ventilation, protection from infection,
wound healing and psychological well-being (Martin,
2006). Adequate nutrition entails a diet that contains the
*Corresponding author. E-mail: awosankj1@yahoo.com.

10 Int. J. Nutr. Metab.
constituents (carbohydrate, fats, proteins, vitamins and
minerals) that are required for body building, energy
supply, body defense and regulatory functions in quan-
tities commensurate with the body need. Malnutrition
refers to either inadequate intake of nutrients due to lack
of food, ignorance, socio-cultural factors, and diseases
among other causes, resulting in underweight and other
nutrient deficiency diseases; or intake of nutrients in
excess of body requirements due to poor dietary habit
(erroneously perceived as a sign of affluence), resulting
in overweight and obesity.
Poor diet (high consumption of sugar, salt, saturated
fat, etc) and unhealthy lifestyle (smoking, alcohol con-
sumption and physical inactivity) have been identified as
major risk factors of cardiovascular disease and other
non-communicable diseases (NCDs). Central to the
aetiogenesis of diet induced cardiovascular disease is
atherosclerosis, and the factor most important in causing
atherosclerosis is a high blood plasma concentration of
cholesterol in the form of low density lipoproteins (LDLs).
Cholesterol is present in the diet of all people, besides
the cholesterol absorbed from the gastrointestinal tract
which is called exogenous cholesterol, an even greater
quantity is formed in the cells of the body (principally by
the liver), this is called endogenous cholesterol. An
increase in the amount of cholesterol ingested daily
increases the plasma concentration slightly. When cho-
lesterol is ingested, the rising concentration of cholesterol
inhibits the most essential enzyme for endogenous
synthesis of cholesterol, 3-hydroxy-3-methylglutaryl CoA
reductase, thus providing an intrinsic feedback control
system to prevent excessive increase in plasma
cholesterol concentration. A highly saturated fat diet
increases blood cholesterol concentration by 15 to 25%.
This results from increased fat deposition in the liver
which then provides increased quantities of acetyl-CoA in
the liver cells for production of cholesterol. It is therefore
important to maintain a diet low in saturated fat as to
maintain a diet low in cholesterol in order to decrease the
blood cholesterol concentration (Arthur and John, 2000).
This fact is corroborated by the findings in ‘the strong
heart study’ that reported total fat, saturated fat and
monounsaturated fatty acid intake as strong predictors of
coronary heart disease (CHD) mortality in American
Indians aged 47 to 59 years independent of other
established CHD risk factors (Xu et al., 2006). Reports
from several studies also show very strong association
between diet and development of non-communicable
diseases. In a study among female nurses, overweight or
obesity was the single most important predictor of
diabetes mellitus; also, lack of exercise, a poor diet,
current smoking and abstinence from alcohol were all
associated with a significant increased risk of diabetes,
even after adjustment for the body mass index (Hu et al.,
2001).
Similarly, in another study in Taiwan by Hung et al.
(2004), consumption of preserved and overheated foods
was found to be associated with increased risk of
esophageal cancer, whereas intake of fresh fruits,
vegetables, and tea was inversely associated with this
risk. Fruits and vegetables contain phytochemicals and
antioxidants that protect the body cells from developing
cancer. Non-communicable diseases are the leading
cause of death globally, killing more people each year
than all other causes combined. According to the World
Health Organization (WHO) estimates, 36 million, out of
the 57 million deaths (almost two thirds) that occurred
globally in 2008 were due to non-communicable diseases
(NCDs), comprising mainly cardiovascular diseases,
cancers, diabetes mellitus and chronic lung diseases
(WHO, 2011a).
According to the United Nations, nearly 870 million
people of the 7.1 billion people in the world, or one in
eight, suffered from chronic undernourishment in 2010 to
2012. Almost all the hungry people, 852 million, live in
developing countries, representing 15% of the population
of developing countries. In Africa, nearly one in four
people are hungry; the number of hungry people grew
over this period from 175 to 220 million, with nearly 20
million added in the last few years. Only 16 million
undernourished people reside in the developed countries
(FAO, 2012).
Ironically, overweight and obesity are linked to more
deaths worldwide than underweight. For example, 65% of
the world's population live in countries where overweight
and obesity kill more people than underweight (this
includes all high-income and most middle-income
countries). Once considered a high-income country
problem, overweight and obesity are now on the rise in
low- and middle-income countries, particularly in urban
settings. In 2008, more than 1.4 billion adults, 20 years
and older, were overweight. Of these, over 200 million
men and nearly 300 million women were obese. 35% of
adults aged 20 years and over were overweight in 2008,
and 11% were obese. Overweight and obesity are the
fifth leading risk for global deaths. At least 2.8 million
adults die each year as a result of being overweight or
obese. In addition, 44% of the diabetes burden, 23% of
the ischemic heart disease burden and between 7 and
41% of certain cancer burdens are attributable to
overweight and obesity (WHO, 2013a).
Although tobacco deaths rarely make headlines,
tobacco kills one person every six seconds. Tobacco kills
a third to half of all people who use it, on average 15
years prematurely. Today, tobacco use causes 1 in 10
deaths among adults worldwide – more than five million
people a year. Tobacco will kill over 175 million people
worldwide between now and the year 2030 and by 2030,
unless urgent action is taken, tobacco’s annual death toll
will rise to more than eight million. If current trends continue

unchecked, it is estimated that around 500 million people
alive today will be killed by tobacco (WHO, 2008).
Alcohol consumption is the world’s third largest risk
factor for disease and disability; in middle-income
countries, it is the greatest risk. Alcohol is a causal factor
in 60 types of diseases and injuries and a component
cause in 200 others. Almost 4% of all deaths worldwide
are attributed to alcohol, greater than the deaths caused
by human immunodeficiency virus/acquired immuned
deficiency syndrome (HIV/AIDS), violence or tubercu-
losis. Alcohol is also associated with many serious social
issues, including violence, child neglect and abuse, and
absenteeism in the workplace. The harmful use of alcohol
is a particularly grave threat to men. It is the leading risk
factor for death in males aged 15 to 59 years, mainly due
to injuries, violence and cardiovascular diseases.
Globally, 6.2% of all male deaths are attributable to alco-
hol, compared to 1.1% of female deaths. Men also have
far greater rates of total burden attributed to alcohol than
women – 7.4% for men compared to 1.4% for women
(WHO, 2011b).
Physical inactivity has become a public health problem
all over the world. Globally, around 31% of adults aged
15 years and over were insufficiently active in 2008 (men
28% and women 34%). Approximately 3.2 million deaths
each year are attributable to insufficient physical activity.
The current high level of physical inactivity is believed to
be partly due to insufficient participation in physical
activity during leisure time and an increase in sedentary
behavior during occupational and domestic activities
(WHO, 2013b).
Globally, the overall prevalence of raised blood
pressure in adults aged 25 years and over was around
40% in 2008. Across the WHO regions, the prevalence of
raised blood pressure was highest in Africa, where it was
46% for both sexes combined. Both men and women
have high rates of raised blood pressure in the Africa re-
gion, with prevalence rates over 40%. Worldwide, raised
blood pressure is estimated to cause 7.5 million deaths,
about 12.8% of the total of all deaths. This accounts for
57 million disability adjusted life years (DALYS) or 3.7%
of total DALYS (WHO, 2013c).
Identification of these major risk factors and the imple-
mentation of control strategies (for example, community
education and targeting of high risk individuals) have
contributed to the fall in NCDs mortality rates observed in
industrialized nations (Ford et al., 2007). In addition,
dietary regimen (often combined with regular moderate
intensity physical activity such as brisk walking, cycling
etc, lasting for at least 30 min, to be observed at least
thrice weekly) are now available for the prevention and/or
treatment of many non-communicable diseases. One of
such regimen is the Dietary Approach to Stop
Hypertension (DASH) eating plan, which has been found
to be more effective in lowering blood pressure if combined
Awosan et al. 11
with reduced salt intake (National Institute of Health
(NIH)/National Heart, Lung and Blood Institute (NHLBI),
2006).
Central to eco-social theory and epidemiological inquiry
is a construct known as embodiment; it is the process
through which extrinsic factors experienced at different
life stages are inscribed into an individual’s body func-
tions or structures, and the result of such processes. It
recognizes humans as simultaneously social beings and
biological organisms, and as such their bodies tell stories
about, and cannot be studied divorced from the condition
of their existence. Such stories often, but not always
match peoples stated account; and the bodies even tell
stories that people cannot or will not tell either because
they are unable, forbidden or chose not to tell (Krieger,
2005).
Embodiment therefore underline the use of a com-
bination of appraisal of dietary intake (based on recall of
type and frequency of food eaten) and appraisal of
nutritional status (based on anthropometric, clinical and
biochemical assessments) for a comprehensive
assessment of malnutrition.
The market as a meeting place for distributors of goods
(and even producers of some goods, especially food
items produced by small scale farmers) and consumers,
represents the soul of every community. Traders
therefore represent an important productive sector of the
economy. A study by Ulasi et al. (2011) reported a high
prevalence of hypertension (42.0%) in a market po-
pulation in Enugu, Nigeria. Another study by Odugbemi et
al. (2012) also reported high prevalence of hypertension
(34.8%), physical inactivity (92.0%), cigarette smoking by
males (17.5%), obesity (12.3%) and overweight (39.9%)
among traders in Lagos. However, previous studies
among traders in Nigeria, majorly examined lifestyle and
prevalence of non-communicable diseases (NCDs) or
their risk factors, there is a dearth of literature on their
dietary pattern and its correlation (if any), with the
observed high prevalence of NCDs among them, even
though they are prone to consuming the high energy
dense foods that they sell to people. This study was
conducted to assess the dietary pattern, lifestyle, nutrition
status and prevalence of hypertension among traders in
Sokoto, Nigeria.
METHODOLOGY
Study design and population
This cross sectional descriptive study was carried out among
traders in Sokoto Central Market, Sokoto, North Western Nigeria,
from November to December, 2012. The Sokoto Central Market is
the largest market in North Western Nigeria, built on a 24 hectares
land donated by the late Sultan Abubakar III. It was established to
cater for the growing population of Sokoto town which has now
grown into a city with a population of 427,760 by the 2006 National

12 Int. J. Nutr. Metab.
Census (National Population Commission (NPC), 2006); and to
prevent the frequent fire outbreak at the old market known as ‘YAR
DOLE’, situated along Sultan Bello W ay, about 400 m away from
the new market. The market has 5,095 stalls (comprised of 3,346
lock up stalls and 1,749 open stalls) grouped into 16 clusters
designated as Areas (A to S). The facilities in the market included;
mosque, clinic, area court, police station, motor parks,
administrative block, fire service unit, restaurants, 18 toilet blocks,
workshop and information centre.
Traders aged 18 years and above, and have worked in the mar-
ket in a stall for at least 6 months were considered eligible, while
those aged below 18 years, or have spent less than 6 months, or
sell in open spaces were excluded. The sample size was estimated
at 367 and adjusted to 390 using the statistical formula for
calculating sample size for cross sectional descriptive studies
(Ibrahim, 2009), 39.5% prevalence of hypertension among traders
from a previous study (Aghaji, 2008), precision level of 5% and an
anticipated response rate of 95%. The eligible participants were
selected by multistage sampling technique. At the first stage 8 of 16
areas were selected by simple random sampling using the ballot
option. At the second stage, selection of stalls in each of the
selected area was done by systematic sampling technique using
the list of stalls in each area to constitute the sampling frame.
Proportionate allocation (based on number of stalls) was applied in
the selection of stalls in the selected Areas. From each stall
selected, the first trader encountered and fulfilling the eligibility
criteria for the study was enrolled. In the event of a selected stall
being under lock, or not having an eligible trader, an eligible trader
was selected from the next accessible stall.
Data collection
The methods of data collection comprised of personal interview and
physical assessment (anthropometric and blood pressure
measurements). A standardized, semi-structured, interviewer-
administered questionnaire was used to obtain information on the
socio-demographic characteristics of the study participants, dietary
pattern and lifestyle. The questions on types of food consumed
were adapted from the survey tool that was used for the Nigerian
Food Consumption and Nutrition Survey (2001 to 2003)
(International Institute of Tropical Agriculture (IITA), 2004). The
questions on current eating habits were adapted from the National
Institute of Health (NIH)/National Heart Lung and Blood Institute
(NHLBI) format for the assessment of current eating habit for
Therapeutic Lifestyle Change Diet (NIH/NHLBI, 2002). The ques-
tions on behavioural measurements were adapted from the WHO
STEPS instrument for chronic diseases risk factors surveillance that
was used for a national survey on health behaviour monitor among
Nigerian adult population (NHF/FMoH, 2003). The instruments were
pre-tested in a pilot study among 20 traders at Gawo Nama Market,
Sokoto; the necessary adjustment was effected based on the
observations made during the pre-test.
Weight was measured with shoes off to the nearest 0.5 kg using
a seca optimal scale; it was validated with a standard weight and
corrected for zero error. Height was measured without shoes to the
nearest 0.5 cm using a stadiometer. Blood pressure was measured
using a sphygmomanometer (Dekamet MG3, England) and
stethoscope (Littman quality) with all tight clothing and other similar
materials removed from the arm and in the sitting position. The first
measurement was taken after the participant had rested for at least
10 min in a sitting position with the arm rested on a table such that
the middle of the forearm was about the level of the heart. The
second measurement was taken at the end of the interview; the
mean of the 2 readings was used in the analysis. Four medical
officers and four nurses assisted in data collection after pre-training
on the objectives, selection of participants and use of survey instru-
ments. Institutional ethical clearance was obtained from the Ethical
committee of Specialist Hospital Sokoto; permission was obtained
from the management of the market and informed written consent
was also obtained from the participants before data collection.
Operational definition of terms
Body mass index (BMI) was calculated as weight (kg) divided by
height2 (m2) and used as marker for nutritional status (Tsigos et al.,
2008). Underweight was defined as BMI less than 18.5 kg/m2,
normal weight was defined as BMI of 18.5 to 24.9 kg/m2,
overweight was defined as BMI of 25.0 to 29.9 kg/m2, while obesity
was defined as BMI of 30.0 kg/m2 and above. Hypertension was
defined using the World Health Organization and International
Society of Hypertension criteria (WHO and ISH, 2003) as systolic
blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure
(DBP) ≥ 90 mmHg or both or self reported antihypertensive
medication during the past 1 week.
Data analysis
Data was analyzed using the statistical package for social sciences
(SPSS) version 17 computer statistical software package.
Frequency distribution tables were constructed; cross tabulations
were done to examine relationship between categorical variables.
The Chi-square test was used to compare differences between
proportions. Logistic regression analysis was used to determine the
variables that predict nutrition status and hypertension among the
participants. All statistical analysis was set at 5% level of
significance (p < 0.05).
RESULTS
Only 381 of the 390 questionnaires administered were
useable. The age of the traders ranged from 20 to 69
years (Mean = 35.38; SD = 8.34). Majority, 168 (44.1%)
of the 381 participants were in the 30 to 39 years age
group, followed by the 20 to 29 years age group (28.3%).
There was a slight preponderance of males (53.0%) com-
pared to females (47.0%). Most of the participants were
married (62.7%), and practiced Islam as religion (66.1%).
A larger proportion of the participants (47.8%) had
secondary education, followed by primary education and
below (39.4%), only a few among them (12.9%) had
tertiary education (Table 1).
Dietary pattern of participants
Majority, 258 (68.8%) of the 375 participants that
responded to the question on the number of times they
eat in a day, eat thrice daily, 91 (24.3%) eat twice daily,
while 25 (6.4%) eat more than three times in a day. Also,
268 (71.5%) reported meal skipping; while 120 (32.0%)
reported overeating as a result of stress, majority 211
(56.3%) reported loss of appetite while stressed.

Table 1. Socio-demographic profile of participants
Socio-demographic profile
Frequency (%)
Age groups (in years)
20-29
108 (28.3)
30-39
168 (44.1)
40-49
86 (22.6)
50-59
14 (3.7)
60-69
5 (1.3)
Sex
Male
202 (53.0)
Female
179 (47.0)
Marital status
Single
103 (27.0)
Married
239 (62.7)
Separated
13 (3.4)
Divorced
16 (4.2)
Widowed
10 (2.6)
Education
Primary and below
150 (39.4)
Secondary
182 (47.8)
Tertiary
49 (12.9)
Religion
Christianity
252 (66.1)
Islam
129 (33.9)
Table 2 shows the food habit of the participants, most
190 (50.7%) of the 375 participants that responded to the
question on the time they eat their largest meal, eat their
largest meal at dinner, 143 (38.1%) eat their largest meal
at lunch, while 44 (11.2%) eat their largest meal at
breakfast. Bread and tea are taken at breakfast by most
of the participants (83.4%), likewise pap (65.2%). Fura is
mostly taken at lunch (44.8%); likewise, tuwo, pounded
yam, semovita, amala and rice (58.2%).
The frequency of snacking and consumption of
specified snacks, fruits and vegetables are shown in
Table 3. Almost half, 187 (49.9%) of the 375 participants
that responded to the question on snacking reported
eating snacks every day (mostly once a day). While most
of the participants that reported eating doughnut and
biscuit do so once in a week, a noticeable proportion of
the participants reported eating fried foods (21.4%) and
drinking fruit juice (27.1%) and carbonated drinks (33.0%)
up to thrice and above in a week. Majority of the partici-
pant reported consumption of fruits (56.0%) and vege-
tables (58.8%) less than thrice in a week or not at all.
Awosan et al. 13
Participants’ lifestyle
Figure 1 shows the lifestyle of participants, one hundred
and ninety three (50.7%) of the 381 participants live a se-
dentary lifestyle (by virtue of; use of motor cycle or car to
work, lack of moderate physical activity at work, and lack
of moderate leisure exercise). Sedentary lifestyle was
marginally more prevalent among males than females
(males 50.3%, females 49.7%) but the difference was not
statistically significant (2 = 1.196, p = 0.161). Twenty
(5.2%) of the 381 participants reported current cigarette
smoking. Current cigarette smoking was almost nine
times more prevalent among males compared to females
(males 8.9%, females 1.1%) and the difference was
statistically significant (2 = 11.590, p < 0.001). Forty one
(10.8%) of the 381 participants reported alcohol consum-
ption within the past 30 days. Alcohol consumption within
the past 30 days was more prevalent among males than
females (males 11.9%, females 9.5%), but the difference
was not statistically significant (2 = 0.562, p = 0.280).
Majority, 254 (66.7%) of the 381 participants reported
consumption of fatty foods; consumption of fatty foods
was slightly more prevalent among males than females
(males 68.8%, female 64.2%), the difference was also
not statistically significant (2 = 0.890, p = 0.202).
Participants’ nutrition status and prevalence of
hypertension
Figure 2 shows participants’ nutrition status and
prevalence of hypertension. Only 5 (1.3%) of the 381
participants were underweight, underweight was slightly
more prevalent among females than males (males 1.0%,
females 1.7%). One hundred and fifty nine (41.7%) had
normal weight, with a larger proportion of participants
with normal weight among males compared to females
(males 48.0%, females 34.6%). One hundred and ten
(28.9%) were overweight, and it was more prevalent
among males than females (males 35.1%, females
21.8%). One hundred and seven (28.1%) were obese;
obesity was almost thrice as prevalent among females
compared to males (males 15.8%, females 41.9%) and
the difference was found to be statistically significant (2
= 33.227, p < 0.001). No uniform pattern of variation in
nutrition status across the age groups was observed.
Also, in logistic regression models, no predictor of
nutrition status was obtained.
One hundred and eleven (29.1%) of the 381 participants
were hypertensive; hypertension was more prevalent
among females than males (males 26.2%, females
32.4%) but the difference was not statistically significant
(2 = 1.747, p = 0.113). The prevalence of hypertension
increased progressively and statistically significantly
across the age groups. The prevalence of hypertension

14 Int. J. Nutr. Metab.
Table 2. Food habit of participants
Variable
Meal schedule
None
[N (%)]
Breakfast
[N (%)]
Lunch
[N (%)]
Dinner
[N (%)]
Eat largest meal (N = 375)
-
42 (11.2)
143 (38.1)
190 (50.7)
Eat bread and tea (N = 373)
34 (9.1)
311 (83.4)
8 (2.1)
20 (5.4)
Drink pap (N = 371)
89 (24.0)
242 (65.2)
15 (4.0)
25 (6.7)
Drink fura (N = 368)
146 (39.7)
36 (9.8)
165 (44.8)
18 (4.9)
Eat tuwo / pounded yam/semovita/amala/rice (N = 370)
-
9 (2.4)
215 (58.2)
146 (39.5)
Table 3. Snacking and consumption of specified snacks, fruits and vegetables.
Variable
Frequency of consumption
None
[N (%)]
Once
[N (%)]
Twice
[N (%)]
Thrice
[N (%)]
More than
thrice [N (%)]
Eat snacks in a day (N = 375)
188 (50.1)
160 (42.7)
14 (3.7)
8 (2.1)
5 (1.3)
Eat doughnut in a week (N = 374)
137 (36.6)
123 (32.9)
42 (11.2)
42 (11.2)
30 (8.0)
Eat biscuit in a week (N = 369)
140 (37.9)
127 (34.4)
42 (11.2)
23 (6.2)
37 (10.0)
Eat fried yam or plantain in a week (N = 374)
63 (16.8)
142 (38.0)
89 (23.8)
35 (9.4)
45 (12.0)
Drink fruit juice in a week (N = 373)
103 (27.6)
100 (26.8)
69 (18.5)
32 (8.6)
69 (18.5)
Drink carbonated soft drink in a week (N = 373)
72 (19.3)
117 (31.4)
61 (16.4)
32 (8.6)
91 (24.4)
Eat fruits in a week (N = 375)
25 (6.7)
108 (28.8)
77 (20.5)
48 (12.8)
117 (31.2)
Eat vegetables in a week (N = 374)
46 (12.3)
108 (28.9)
66 (17.6)
37 (9.9)
117 (31.3)
Table 4. Predictors of hypertension among participants.
Variable
Odds ratio
(OR)
Sig.
(p-value)
95% CI
Lower Upper
Age
4.158
<0.001
0.105-0.293
Sex
0.134
0.893
- 0.088-0.101
Marital status
0.010
0.992
- 0.059-0.060
Sedentary lifestyle
1.636
0.103
- 0.165-0.016
Cigarette smoking
0.133
0.894
- 0.189-0.216
Alcohol consumption
1.016
0.310
- 0.050-0.157
Overweight / obesity
2.822
0.005
0.061-0.345
hypertension among the participants in their 20s, 30s,
40s, 50s and 60s were; 11.1, 29.8, 41.9, 64.3 and 80.0%,
respectively (2 = 38.415, p < 0.001). Hypertension was
statistically significantly (2 = 24.597, p < 0.001) twice as
prevalent among participants with overweight and obesity
(39.2%) compared with those with underweight and
normal weight (15.9%). In logistic regression models, the
predictors of hypertension among the participants
included age (OR = 4.158, p < 0.001, 95% confidence in-
terval (CI) = 0.105 to 0.293) and overweight/obesity (OR =
2.822, p = 0.005, 95% confidence interval (CI) = 0.061 to
0.345) as shown in Table 4.
DISCUSSION
High prevalence of unhealthy eating habits was recorded
among the participants in this study. While the relatively
high prevalence of snacking (49.9%) among the partici-
pants in this study is at variance with the very high
prevalence of snacking (92.4%) reported in a study by
Chung et al. (2003) among female college students in

Awosan et al. 15
Figure 1. Participants’ lifestyle.
Figure 2. Participants’ nutrition status and prevalence of hypertension.
students in Seoul, South Korea, it is in agreement with
33.0% prevalence of snacking reported in another study
by Olumaikaye et al. (2010) among adolescents in Osun
State, Nigeria. In contrast to the findings in this study
wherein majority (56.3%) of the participants reported loss
of appetite while stressed, Potocka and Moscioka (2011)
reported stronger tendency to habitual and emotional
eating among Polish employees with high job stress
compared to those with medium level of job stress. This
could be due to differences in socio-cultural factors in the
two study settings.
Contrary to the high prevalence of consumption of fruit
juice (27.1%) and carbonated drinks (33.0%) thrice in a
week and above among the participants in this study,
Arulogu et al. (2011) reported a lower prevalence (17.1%)
of consumption of carbonated drinks in a study among a
younger population (undergraduates of the University of
Ibadan, Nigeria). The high prevalence of consumption of
high energy dense foods and drinks among the parti-
cipants in this study is of serious concern, considering the
fact that apart from the increased impairment of glucose
metabolism with advancement in age, epidemiological
studies have provided evidence of a trend towards
increased incidence and prevalence of type 2 diabetes in

16 Int. J. Nutr. Metab.
African populations, linked to unhealthy eating habits and
lifestyles (sequel to urbanization and industrialization),
compared with the 1990s when it was considered a rare
medical condition in sub-Sahara Africa (Sobngwi et al.,
2001).
The International Diabetes Federation (IDF) had
estimated that in 2003 the number of people age 20 to 79
years with diabetes in Sub-Saharan Africa was over 7
million for a population of more than 295 million, giving a
prevalence rate of 2.4%. About 65% of those affected
with diabetes lived in the urban areas, whereas 35% lived
in the rural communities. Nigeria is the first of the top five
countries with the highest number of people affected by
diabetes in Sub-Saharan Africa with about 1.2 million
people affected by the disease. The other countries
included; South Africa, the Democratic Republic of
Congo, Ethiopia and Tanzania with 841,000, 552,000,
550,000 and 380,000 people, respectively affected by
diabetes (IDF, 2003).
The high proportion of participants that eat fruits
(56.0%) and vegetables (58.8%) less than three times in
a week or not at all, and those that eat fried foods
(45.2%) twice or more in a week in this study compares
well with the findings in a study by Ganasegeran et al.
(2012) that reported consumption of fruits less than thrice
in a week by 73.5% of participants, and consumption of
fried foods twice or more in a week by 50.5% of
participants.
A relatively low prevalence of current cigarette smoking
(5.2%) and alcohol consumption (10.8%) was recorded
among the participants in this study compared to the high
prevalence of smoking (29.3%) and alcohol consumption
(38.4%) reported in a study among 11 to 16 years old
adolescents in Boenos Aires, Argentina (Mulassi et al.,
2010). This could be due to the fact that most of the
participants in this study practiced Islam (which prohibits
alcohol consumption) as religion. The low prevalence of
cigarette smoking among the participants in this study
could be related to the low prevalence of alcohol
consumption among them. Substance use disorders
(such as alcohol consumption and smoking) have been
found to be related and co-morbid (Schneider et al.,
2009). The high prevalence of daily consumption of
snacks (49.9%) among the participants in this study
agrees with the high prevalence of snacking (84.3%)
reported in a study among employees of Federal Airport
Authority of Nigeria in an urban population in Nigeria by
Abidoye et al. (2002). A high prevalence of sedentary
lifestyle (50.7%) was observed among the participants in
this study. This is almost double the 29.6% prevalence of
sedentary lifestyle reported in a study among bankers (a
profession considered to be largely sedentary in nature)
in Ilorin, Nigeria (Jogunola and Awoyemi, 2010).
The high prevalence of overweight (28.9%) and obesity
(28.1%) recorded in this study compares well with the
reported 31.3 and 16.3% prevalence of overweight and
obesity, respectively, among female traders in Ibadan,
Nigeria (Balogun and Owoaje, 2007). This could be
related to the high prevalence of unhealthy eating habits
and sedentary lifestyle among the participants in this
study. A study by Bhargava et al. (2002) had reported
negative association between physical activity and body
weight.
While the 29.1% prevalence of hypertension observed
among the participants in this study is higher than the
13.16% prevalence of hypertension reported by Asekun-
Olarinmoye et al. (2013) in a rural adult population of
Osun State, Nigeria, it compares well with the 31.0%
prevalence of hypertension reported by Ogah et al.
(2013) in rural and urban populations of Abia State,
Nigeria, and less than half of the 68.9% prevalence of
hypertension reported by Ordinioha and Brisibe (2013)
among an elderly population of traditional chiefs in an
urban population in south - south Nigeria.
The findings in these studies not only highlight the high
burden of hypertension across the populations in Nigeria,
but also corroborate the documented pattern of rise in the
prevalence of hypertension with age, and preponderance
of its prevalence in urban compared to rural populations
in several studies across the globe. To put it succinctly,
there is high burden of hypertension and it has become a
big challenge to public health in Nigeria, with its pre-
valence in rural and semi-urban populations across the
country approaching the estimated national prevalence of
42.8% in 2008 (World Health Organization (WHO),
2011c). This underscores the need for a re-invigorated
and consistent implementation of public health
interventions for its prevention and control in Nigeria.
Conclusion
This study demonstrated high prevalence of unhealthy
eating habits and lifestyle; together with high prevalence
of overweight, obesity and hypertension among traders in
Sokoto. Health education and other interventions to
promote healthy eating habits and lifestyle, especially
among high risk groups are suggested.
ACKNOWLEDGEMENTS
The authors would like to thank the Management of the
Sokoto Central Market, and all the traders who
participated in the study for their cooperation.
REFERENCES
Abidoye RO, Madueke LA, Abidoye GO (2002). The relationship
between dietary habit and body mass index using the Federal Airport
Authority of Nigeria as the sample. Nutr. Hlth. 16(3):215-27.

Aghaji MN (2008). Hypertension and risk factors among traders in
Enugu, Nigeria. J. Coll. Med. 13(2):111-115.
Arulogun AS, Owolabi MO (2011). Fast food consumption pattern
among undergraduates of the University of Ibadan: implications for
nutrition education. J. Agric. F. Tech. 1(6):89-93.
Arthur CG, John EH (2000). Textbook of medical physiology. 10th ed.
Philadelphia: WB Saunders Company.
Asekun-Olarinmoye E, Akinwusi P, Adebimpe W, Isawumi M, Hassan
M, Olowe O, Makanjuola O, Alebiosu C, Adewole T (2013).
Prevalence of hypertension in the rural adult population of Osun
State, southwestern Nigeria. Int. J. Gen. Med. 6:317-22.
Balogun MO, Owoaje ET (2007). Work condition and health problems of
female traders in Ibadan, Nigeria. Afr. J. Med. Med. Sci. 36(1):57-63.
Bhargava A, Guthrie JF (2002). Unhealthy eating habits, physical
exercise and macronutrient intakes as predictor of anthropometric
indicators in the W omen’s Health Trial Feasibility Study in Minority
Population. Br. J. Nutr. 88 (6):719-28.
Chung HT, Song MK, Park MH (2003). A study of anthropometric
indices and eating habits of female college students. J. Comm. Nutr.
5(1):21-28.
FAO (2012). The state of Food Insecurity in the World 2012. Food and
Agriculture Organization of the United Nations. Rome. Available at:
http://www.fao.org/docrep/016/i3027e/
Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE,
Giles WH, Capewell S (2007). Explaining the decrease in U.S. deaths
from coronary disease, 1980-2000. N Engl. J. Med. 356:2388–2398.
Ganasegeran K, Al - Dubai SA, Qurechi AM, Al – Abed AA, An R,
Aljunaid SM (2012). Social and psychological factors affecting eating
habits among university students in a Malaysian medical school: a
cross sectional study. Nutr. J. 11:48.
Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, Willett
WC (2001). Diet, lifestyle, and the risk of type 2 diabetes mellitus in
women. N. Engl. J. Med. 345(11):790-7.
Hung HC, Huang MC, Lee JM, Wu DC, Hsu HK, Wu MT (2004).
Association between diet and esophageal cancer in Taiwan. J.
Gastroenterol. Hepatol. 19(1):632-7.
Ibrahim T (2009). Research methodology and dissertation writing for
health and allied health professionals. Abuja: Cress Global Link
Limited.
IDF (2003). Diabetes Atlas 2003. 2nd ed. International Diabetes
Federation, Brussels.
IITA (2004). Nigeria Food Consumption and Nutrition Survey 2001 –
2003. International Institute of Tropical Agriculture, Ibadan, Nigeria.
Jogunola OO, Awoyemi AO (2010). Prevalence of sedentary lifestyle
among bankers in Ilorin metropolis. Nig. J. Med. Rehab. 15(1&2):44-
50.
Krieger N (2005). Embodiment: a conceptual glossary for epidemiology.
J. Epidemiol. Comm. Health 59(5):350-55.
Martin AC (2006). Clinical chemistry and metabolic medicine. 7th ed.
London, UK: Edward – Arnold (Publishers) Ltd.
Mulassi AH, Hadid C, Borracci RA, Labruna MC, Picarel AE, Robilotte
AN, Redruello M, Masoli O (2010). Eating habits, physical activity,
smoking and alcohol consumption in adolescents attending school in
the province of Boenos Aires. Arch. Argent. Paediatric. 105(1):45-54.
National Institute of Health (NIH) / National Heart, Lung and Blood
Institute (NHLBI) (2006). Your guide to lowering your blood pressure.
DASH eating plan. US Department of Health and Human Services.
Available at: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/
National institute of Health (NIH) / National Heart, Lung and Blood
Institute (NHLBI) (2002). Third Report of the National Cholesterol
Education Program (NCEP) Expert Panel on Detection, Evaluation
and Treatment of High Blood Cholesterol in Adults (Adult Treatment
Panel III). Circulation 106: 3143 – 3421.
NHF and FMoH (2003). Health behavior monitor among Nigerian adult
population. Nigeria Heart Foundation and Federal Ministry of Health,
Abuja, Nigeria.
Awosan et al. 17
NPC (2006). National Population Commission of Nigeria. Available at:
http://www.population.gov.ng
Odugbemi TO, Onajole AT, Osibogun AO (2012). Prevalence of
cardiovascular risk factors amongst traders in an urban market in
Lagos, Nigeria. Niger. Postgrad. Med. 19(1):1-6.
Ogah OS, Madukwe OO, Chukwuonye I, Onyeonoro UU, Ukegbu AU,
Akhimien MO, Onwubere BJ, Okpechi IG (2013). Prevalence and
determinants of hypertension in Abia State, Nigeria: results from the
Abia State Non- Communicable Diseases and Cardiovascular Risk
Factors Survey. Ethn. Dis. 23(2):161-7.
Olumakaiye MF, Atinmo T, Olubayo–Fatiregun MA (2010). Food
consumption patterns of Nigerian adolescents and effect on body
weight. J. Nutr. Educ. Behav. 42(3):144-51.
Ordinioha B, Brisibe S (2013). Prevalence of hypertension and its
modifiable risk factors amongst traditional chiefs of an oil – bearing
community in south – south Nigeria. Sah. Med. J. 16(1):24.27.
Park K (2009). Park’s textbook of preventive and social medicine. 20th
ed. Jabalpur, India: M/s Barnasidas Bhanot.
Potocka A, Moscioka A (2011). Occupational stress, coping strategies
and eating habits among Polish employees. Med. Prac. 62(4):377-88.
Schneider M, Bradshaw D, Steyn K, Norman R, Laubscher R (2009).
Poverty and non-communicable diseases in South Africa. Scand. J.
Pub. Health 37(2):176-186.
Sobngwi E, Mauvais-Jarvis E, Vexiau P, Mbanya JC, Gautier JF (2001).
Diabetes in Africans. Part 1: epidemiology and clinical specificities.
Diab. Metabo. 27:628–34.
Tsigos C, Hainer V, Basdevant A, Finer N, Friend M, Maths-Vliegen E,
Micic D, Maislos M, Roman G, Schutz Y, Toplak H, Zahorska-
Markiewicz B (2008). Management of Obesity in Adults: European
Clinical Practice Guidelines. Obesity Facts 1(2):106-116.
Ulasi II, Ijoma CK, Onwubere BJC, Arodiwe E, Onodugo O, Okafor C
(2011). High prevalence and low awareness of hypertension in a
market population in Enugu, Nigeria. Int. J. hypertens. Article ID
869675, 5 pages.
WHO (2013a). Obesity and overweight. WHO Fact Sheet. World Health
Organization. Geneva, Switzerland. Available at:
http://www.who.int/mediacentre/factsheet/
WHO (2013b). Global strategy on diet, physical activity and health.
WHO Fact Sheet. World Health Organization, Geneva, Switzerland.
Available at: http://www.int/dietphysicalactivity/
WHO (2013c). Raised blood pressure. Global Health Observatory.
World Health organization. Geneva, Switzerland. Available at:
http://www.int/gho/ncd/risk_factors/
WHO (2011a). Global status report on non-communicable diseases in
2010. World Health Organization, Geneva, Switzerland.
WHO (2011b). Global status report on alcohol and health. WHO Library
Cataloguing -in- Publication Data. World Health Organization,
Geneva, Switzerland. Available at:
http:www.who.int/substance_abuse/publications/global_alcohol_repor
t/
WHO (2011c). Non-communicable Diseases, Country Profiles 2011.
World Health Organization, Geneva, Switzerland.
WHO (2008). WHO report on the global tobacco epidemic 2008. World
Health Organization, Geneva, Switzerland. Available at:
http://www.who.int/tobacco/mpower/
WHO/ISH (2003). World Health Organization /International Society of
Hypertension statement on management of hypertension. J.
Hypertens. 21(11):1983-1992.
Xu J, Eilat-Adar S, Loria C, Goldbourt U, Howard BV, Fabsitz RR,
Zephier EM, Mattil C, Lee ET (). Dietary fat intake and risk of
coronary heart disease: the strong heart study 1’2’3’4. Am. J. Clin.
Nutr. 84(4):894-902.