EVALUATION OF NUTRITIONAL STATUS AND DIETARY MANAGEMENT OF IN-PATIENT DIABETICS IN UNIVERSITY OF NIGERIA TEACHING HOSPITAL
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EVALUATION OF NUTRITIONAL STATUS AND DIETARY MANAGEMENT OF
IN-PATIENT DIABETICS IN UNIVERSITY OF NIGERIA TEACHING HOSPITAL
ABSTRACT
The study was carried out using randomized 121 in-patient
diabetics in medical wards of University of Nigeria Teaching Hospital (UNTH)
Ituku-Ozalla. The instrument for data collection was structured, validated
pre-tested questionnaires, anthropometry and dietary study. Body mass index was
calculated for each patient using weight and height measurements. The adequacy
of nutrient intake was assessed by comparing the energy and nutrient intakes of
patient with FAO/WHO requirements. The contribution of macronutrients
(carbohydrate, protein and fat) to the total daily energy consumption was
assessed using American Diabetes Association (ADA). Data collected were coded
into the computer. Descriptive statistics such as frequencies, percentages,
means and standard deviations were calculated. Mannwhitney’s and Kruskawalli’s
tests were used to compare means. Results showed that the subjects were made up
of 54.5% males and 45.5% females. The BMI of the females (27.55±6.61kg/m2) was
significantly (p<0.05) higher than that of males (24.53±4.64kg/m2). The
study also showed that the BMI of patients from rural areas (23.70kg/m2) was
significantly (p<0.05) lower than that of the urban (26.81kg/m2) and
suburban (26.20kg/m2). There was no significant difference (p>0.05) between
the waist circumference of males (95.59±10.97cm) and females (88.41±13.24cm).
The mean waist/hip ratios for male and female diabetics were 0.96±0.08 and
0.91±0.10 respectively. The overall mean daily intake of energy of both male
and female diabetics was 99.32% of the prescribed energy level. The overall
daily intake of energy for male diabetics was 75.50% while that of females was
96.06% of FAO/WHO requirement. The mean daily protein intake for males and
females were 164.7% and 179.3% of FAO/WHO respectively. The mean daily intake
of protein by patients was 77.90g which contributed 15.30% of the total daily
energy intake. Carbohydrate was 281.44kg (1125.79kcal), contributing 52.7% of
the total daily energy consumed. The mean daily fat intake of patients was
77.23g (695.07kcal), contributing 32.65%. The micronutrient intake of diabetics
(male and female combined) was adequate for vitamin A, C, thiamine and calcium.
The iron intake of the male diabetics was 156.02% of the FAO/WHO requirement
while that of female diabetics was 80.80%. Other micronutrients such as niacin
and riboflavin were less than 100% FAO/WHO requirement for both males and
females (63.90% and 88.50%) and (39.62% and 52.91%) respectively. The overall
dietary intake of the in-patient diabetics was adequate for energy and
macronutrients for females, but close to adequate for the male diabetics.
Intakes of micronutrient were adequate except for riboflavin and niacin.
1.1 Background of the Study
Diabetes mellitus is a chronic condition that arises when the
pancreas fails to produce enough insulin or when the body cannot use the
insulin produced effectively (Alva, 2000). There are currently an estimated 143
million people with diabetes worldwide and this figure is estimated to rise to
300 million by 2025 (Alva, 2000).
In the past, diabetes was considered a single condition.
However, it is now clear that diabetes is a heterogeneous metabolic condition
caused by many different mechanisms.
Diabetes is now categorized based on differences in cause,
natural history and clinical characteristics (Albert, 1998). There are two
basic forms of diabetes: type 1 requiring insulin for survival and type 2 which
may require insulin for metabolic control. Type 1 is more common in children
and adolescents and accounts for between 10 – 15% of all diabetes (Alva 2000).
More than 90% of all people with diabetes have type 2 diabetes mellitus
(www.ext.colastate).
Diabetes mellitus can lead to long term complications many of
which can be fatal, if not prevented and all of which have the potential to
reduce quality of life for people with diabetes (JAMA, 2002). The underlying
pathophysiology and management of both forms are different, a common feature is
development of long-term micro and macro vascular complications such as
retinopathy, nephropathy macro vascular disease peripheral and autonomic
neuropathy. These complications are associated with increased morbidity and
mortality (Diabetes Control and Complications Trial, DCCT, 1993).
Diabetes management should consider nutrition, physical
activity and pharmacologic therapies (www.ext.colastate).Globally, there is
increasing use of complementary therapies by the general population and health
professionals in management of diabetes mellitus (Dunning, 2002). Complementary
therapies are known by varieties of terms such as “alternative”, “natural”, and
“traditional”. Most importantly, although complementary therapies have common
philosophical basis, they are very heterogeneous in their approach and each
therapy is different from others (Wood-Hart, 2002). Diet and exercise are the
first line of treatment for all people with diabetes (International Diabetes
Federation, IDF, 2002). This research will place emphasis on dietary management
of diabetics. Researchers have indicated that diet therapy is the corner stone
of management in patients with diabetes, especially type 2 diabetes (Garg,
1996).
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