الفهرس 
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Abstract
IHD is a multifactorial disease with established risk factors as hypertension, and diabetes mellitus. Since the emergence of the heart –diet hypothesis, after the Second World War, nutrition and heart diseases has been extensively studied. Early studies have focused on dietary cholesterol as the main lipid raising nutrient. But later studies, especially on dietary pattern of Mediterranean region, demonstrated the significant role of other dietary factors. Not only the total fat that may raise serum cholesterol, but the individual types of fat consumed as saturated, or unsaturated were found to have different effects on blood cholesterol. Other food items such as carbohydrates, proteins, antioxidants and fibers were also studied. However, diet is one aspect of the lifestyle practices that affect health greatly. Physical inactivity, high body weight, cigarette smoking, and faulty dietary habits are major environmental factors that affect the incidence of IHD. The general aim of the present study was to identify the possible risk factors of IHD in adult females; while the specific aim was to assess the role of dietary factors in the occurrence of IHD in adult females. Moreover, to try to conclude operational recommendations as a preventive measure against IHD in females. During a period of six months, a case control study was conducted in the Internal Medicine Departments of three main hospitals in Alexandria; the Main University, Gamal Abdel Nasser and Medical Research Institute hospitals. All female patients aged 35 years and more who had a newly diagnosed IHD were selected. For each case, one control female patient who was matched for age and admitted on the same day for other causes. All female participants were interviewed to answer a pre-designed questionnaire. It included demographic and socioeconomic characteristics, reproductive history, medical and family histories, history of drug intake, and data on lifestyle practices. Clinical examination was conducted to examine the presence of xanthomas or thickened Achilles tendon. Also blood pressure was measured. Height and weight was recorded, and waist and hip circumferences were also measured. Then body mass index and waist to hip ratio were calculated. Blood samples were taken after 12 hours over night fast to test the lipid profile and fasting blood glucose. All participants were also interviewed to answer a pre-designed semiquantitative food frequency questionnaire. It included different food groups, type of fat and oil used in cooking, as well as data on some food habits and cooking methods. After the completion of data collection data were fed to the computer. A nutrient database was designed to calculate nutrient intake. Univariate and multivariate analyses were used to identify significant association between IHD and the studied risk factors, as well as tabulation of the results for their presentations. 1) Results of univariate analyses indicated that: • Lower educational level as well as socioeconomic level, was found to raise the risk of the disease significantly. • High parity and using contraceptive pills increased the risk of these females of having IHD. • Also it was found that hypertension and diabetes mellitus are important risks factors. • Faulty lifestyle practices increase the risk for IHD as sedentary life, exposure to tobacco smoke and heavy consumption of boiled tea especially with high amounts of added sugars. • Blood analyses of the studied females provide a typical risky profile, where results signifies the role of low HDL, high TG levels, and high TC/HDL ratio as significant risk factors for females. • Obesity including high BMI and abdominal obesity add significantly to the risks of IHD among the studied sample. The dietary assessment of these females revealed the following: a. Overnutrition due to consumption of very high amount of energy from macronutirnts (total fat, carbohydrate and protein), which may affect body weight, lipid profile and the overall risk of IHD. b. Higher amounts of fat were used both oils and margarine in food preparation that significantly increased the risk of IHD. c. The intake of saturated fats and cholesterol was high due to high consumption of full cream dairy products, eggs and liver in cases compared to controls. d. Cases used high amounts of hard margarine mainly made of palm oil that is highly saturated oil than controls, unfortunately due to perceived health benefits as well as economic reasons. e. Concerning the consumption of food of meat group as meat, poultry, and processed meat, the consumption of cases was less frequent than controls. Meanwhile the main source of animal protein among cases was dairy products, liver, and egg, which seem to raise the risk. f. Regarding carbohydrates, cases were consuming higher amounts of carbohydrates than controls and there was a significant trend of increased risk with frequent consumption of CHO, and the main source of it was balady bread and added sugars. g. Tthe consumption of fresh fruits and vegetables was less frequent among cases than controls. These fresh foods contain important antioxidants as B-carotene and vitamin C. h. Also it was revealed that method of cooking play an important role regarding the risk, as for example the consumption of fried foods as liver, fish and potatoes was associated with excess risk. i. Lastly the aggregation of these major risks found among the studied cases together with the faulty dietary habits, all of them favour the insuling resistance syndrome which is a signififcant risk especially among women. 2) Stepwise logistic regression analyses indicated that: • The nondietary factors that were significantly associated with elevated risk of IHD were low educational level, exposure to tobacco smoke, obesity, diabetes, hypertension, low HDL, and family history of obesity. While the dietary factors were high carbohydrate diet, high amount of added sugar, and frequent consumption of balady bread, as well as liver. Therefore we came to the following operational recommendations, which can be impliminted through three approaches: First: Population approach Using all mass media channels to promote healthy life habits by health education regarding the following: 1. Avoiding obesity and trying to achieve and manintain a healthy body weight by decreasing total energy intake and performing regular physical excersises. 2. Avoiding passive exposure to smoking. 3. Promoting healthy eating patterns, as the following: i. Reduce intake of foods rich in saturated fats and cholesterol. ii. Reduce intake of hydrogenated margarine and shift toward natural oils. iii. Reduce intake of added sugar and salts. iv. Increase daily consumption of fruits, vegetables and legumes. v. Decrease intake of full cream milk and other dairy products and shift toward low fat and fat free alternatives. vi. Remove fats from meat and skin from poultry before eating. vii. Choose the correct method of cooking as boiling and steaming and avoid frying. viii. Simple practices regarding tea preparation should be encouraged as stopping the habit of boiling tea. Second: Clinical approach It is the role of the health team to incorporate therapeutic dietary management as a basic element in treating cases of IHD in hospitals for facilitating health education, where women are in state of high acceptance and help them to make good food choices according to their needs and social levles. Third: Ministerial approach 1. Carefull assessment of the pattern of the Egyptian diet, which will highlight the weak points that need careful intervention. 2. The development and implementation of national cardiovascular diseases control program, as an integral part of the health care system in Egypt is highly needed together with controlling major risk factors of hypertension and diabetes. 3. Intinsification of community development programs concerning women, like fighting illiteracy, family planning and social security.