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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.

CHAPTER ONE

INTRODUCTION

1.1 Background to 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.

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. 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).