ABSTRACT
The study was designed to assess the nutritional status of patients with type II diabetes mellitus attending Federal Medical Centre (FMC), Umuahia. A total of 76 respondents were selected using simple random sampling technique. A structured questionnaire was used to determine their socio-economic characteristics, health information and food habits of the respondents. World Health Organization reference standards were used to categorize the anthropometric and fasting blood glucose levels. Results revealed that there were more females (57.9%) than male (42.1%) respondents involved in this study. Some (50.0%) had secondary education. Occupational status of the respondents revealed that few (35.5%) were traders. Some (40.8%) of the respondents earned 21,000-40,000 every month. Some (50.2%) of respondents were between 4-5 number in their household. Family history of type II diabetes was implicated in uncles (11.8%) and mothers (11.8%). Most (78.9%) of the respondents were diagnosed of diabetes by doctors. Some (55.3%) of the respondents managed their condition with food and drugs only. Some (48.7%) of the respondents monitored their blood glucose level on weekly basis. Few (19.7%) of the respondents had other health problem such as hypertension. Food habits revealed that some (44.7%) of the respondents consumed food twice daily. Breakfast, lunch and dinner were skipped by 30.3%, 6.6% and 7.9% respectively. None of the respondents were current smokers, while only a few (5.3%) still of them consumed alcohol. Majority (97.4%) of the respondents do obtain their meals mainly from home. Body mass index status revealed that some (52.7%) of the respondents were overweight. There were preponderance of female subjects (90.9%) with abnormal waist/hip ratio when compared to the male respondents (12.5%). Results further revealed that the mean fasting blood glucose of the respondents is 132.32 mg/dl. Correlation analysis revealed that a strong positive association exist between blood glucose and BMI (r =0.362; P= 0.01).Diabetes mellitus is a major public health problem that requires proper medical and dietary management to control high blood glucose level and its complications.
TABLE OF CONTENT
Title
Page i
Certification ii
Dedication iii
Acknowledgement iv
Table
of content v
List of
tables ix
Abstract x
CHAPTER 1:
INTRODUCTION
1.1 Background of the study 1
1.1.1 Definition of nutrition 1
1.1.2 What is assessment 1
1.1.3 What is nutritional assessment 1
1.1.4 What is diabetes mellitus 2
1.1.5 What is type II diabetes mellitus 3
1.2 Statement of the problem 3
1.3 Objectives of the study 4
1.3.1 General objective of the study 4
1.3.2 Specific Objective of the study 4
1.4 Significance of the study 5
CHAPTER 2:
LITERATURE REVIEW
2.1 History of diabetes mellitus 6
2.2 Classification of diabetes mellitus 6
2.2.1 Type 1 diabetes mellitus 7
2.2.2 Type II diabetes mellitus 7
2.2.3 Gestational Diabetes Mellitus (GDM) 8
2.2.4 Other specific type (Monogenic diabetes) 8
2.3 Concept of type II diabetes mellitus 8
2.4 Risk factors or causes of type II diabetes
mellitus 10
2.4.1 Primary factors 10
2.4.2 Secondary factors 12
2.5 Complications of type II diabetes mellitus 12
2.6 Compliance of the patients 15
2.6. Management of type II diabetes mellitus 16
2.7 Dietary requirements of diabetic patients 16
2.7.1 Calorie 16
2.7.2 Carbohydrates 17
2.7.3 Protein 17
2.7.4 Fats 18
2.7.5 Vitamins and Minerals 19
2.7.6 Dietary Fibre 19
2.7.7 Alcohol 20
CHAPTER 3:
MATERIALS AND METHODS 3.1 Study
design 21
3.2 Area of study 21
3.3 Population of the study 22
3.4 Sampling and sampling technique 22
3.4.1 Sample size 22
3.4.2 Sampling procedure 23
3.5 Preliminary activities 24
3.5.1 Preliminary visit 24
3.5.2 Ethical committee 24
3.5.3 Letter of informed consent 24
3.5.4 Training of research assistants 24
3.6 Data collection 25
3.6.1 Questionnaire 25
3.7 Anthropometric measurement 25
3.7.1 Weight measurement 25
3.7.2 Height measurement 25
3.7.3 Body Mass Index (BMI) Calculation 26
3.7.4 Waist circumference 26
3.7.5 Hip circumference 26
3.7.6 Waist-hip ratio circumference 27
3.7.7 Biochemical assessment 27
3.8 Data analysis 27
3.9 Statistical analysis 29
CHAPTER 4: RESULTS
AND DISCUSSION
4.1 Socioeconomic characteristics of respondents 30
4.2 Health history of diabetes patients 34
4.3 Food habits 38
4.4 24 hours dietary recall of respondents 44
4.5 Anthropometric indices of respondents 46
4.6 Blood glucose level of respondents 48
4.7 Relationship between anthropometric indices and
blood glucose level 50
CHAPTER 5: CONCLUSION
AND RECOMMENDATIONS
5.1 Conclusion 51
5.2 Recommendations 51
REFERENCES 53
APPENDIX:
QUESTIONNAIRE 64
LIST
OF TABLES
Table 2.1 Calorie recommendation for diabetic patients 17
Table 3.1 BMI classification 28
Table 3.2 Diagnostic criteria for blood glucose levels
for normal person
and in pre-diabetes and diabetes 29
Table 4.1 Socioeconomic characteristics of respondents 31
Table 4.2 Health history 35
Table 4.3a Food habits of respondents 39
Table 4.3b Food habits of respondents 40
Table 4.4 24 hours dietary recall of respondents 45
Table 4.5 Anthropometric status of respondents 47
Table 4.6 Relationship between anthropometric indices
and blood glucose level 50
CHAPTER 1
INTRODUCTION
BACKGROUND OF THE STUDY
1.1.1 Definition of Nutrition
Nutrition
is the science of food, its components, their actions, interactions and
balances within the body. Nutrition includes the study of processing food
within the body(digestion, absorption, transport, function and disposal of the
end products) for its utilization, provision of energy, building of body tissue
and their repair, protection from microorganisms, heat and other stressors
(Anjana and Shobha, 2014).
1.1.2 What is assessment?
Assessment
refers to the gathering of data from clients. Assessment involves the
collection of information about the clients perceived needs, his attitude to
food, good practices and nutritional status (Anjana and Shobha, 2014).
1.1.3 What is nutritional
assessment?
Nutritional
assessment is an in-depth evaluation of both objectives and subjective data
related to an individual’s food and nutrients intake, lifestyle, medical
history and social history (Grant et al.,
1999).
1.1.4 What is diabetes
mellitus?
Diabetes
mellitus is a clinical syndrome characterized by high disordered metabolism and
inappropriately high blood sugar (hyperglycemia) resulting from low levels of
the hormone insulin or from abnormal resistance to insulin secretion (Tierney et al., 2002). Diabetes mellitus is a
chronic disease that has affected mankind throughout the world. Diabetes
mellitus is considered to be an inborn error of metabolism in which the body is
unable to utilize glucose completely and sugar is excreted in the urine (glucosuria)
(Pederson et al., 1990). Glucosuria
is usually associated with polyuria (excessive urination), polydipsia
(excessive thirst), polyphagia (increased appetite), wasting, ketoacidosis
(accumulation of ketone bodies in the blood stream) which is a dangerous but a
treatable medical emergency (Davidson, 1993).
Diabetes affects the quality of life of individuals or
families; having a 5-fold risk of cardiovascular diseases and 3-fold of stroke.
It is the third cause of death from disease and complications (Ikhesimoje,
2006; Smeltzer et al., 2008) and the
second of the 4 killer non communicable diseases (Sridhar, 2011). Diabetes
affects all socio-economic groups but the low income groups are more affected
(Smeltzer et al., 2008). In Nigeria
and other Sub-Saharan African countries, the active productive age groups
(30-45years) are mostly affected (Azevedo and Allai, 2008; Obayendo, 2008).
1.1.5 What is type II diabetes
mellitus?
Type
II diabetes mellitus is known as non-insulin dependent diabetes mellitus
(NIDDM). Type II diabetes mellitus is associated with poor utilization of
insulin by peripheral tissues or overproduction of glucose in the body. It is
the most common type of diabetes accounting for over 90% of total cases of
diabetes mellitus (Jamieson et al.,
2010). This type II diabetes mellitus is treated with diet and exercise, and if
elevated glucose levels persist, diet is supplemented with oral hypoglycemic
agents.
1.2 STATEMENT OF THE PROBLEM
Type II
diabetes is preventable and controllable but increasing healthcare cost is a
major challenging accessing quality health care in Nigeria (Soyibo et al., 2009).
Dietary
compliance has always been a problem for both diabetics and their physician.
Diabetics find it difficult to adhere to their diet due to the poor
understanding of the principles, strategies, priorities and methods of diet
therapy. Also, failure to individualize the diet to patient’s cultural, sociological
and economic background possess a problem. Some patients also express strong
feelings of independence and therefore do not like to be told what to eat and
what not to eat. Some feel that is too expensive to buy some foods. The degree
of family support could be a problem e.g. some families and friends bring those
tempting foods to eat in front of them and the older persons eat more food when
with friends than when alone. In most diabetic cases, proper care requires
self-management using diet, drugs and insulin therapy. Although diet is the
cornerstone of the treatment of diabetes mellitus, patients find the area of
adherences and compliance so difficult (Abioye-Kuteyi et al., 2005). Poor relationship of patients and clinic can be a
problem.
1.3 OBJECTIVES OF THE
STUDY
1.3.1 General Objective
of the Study
The
general objective of the study is to assess the nutritional status of patients
with type II diabetes mellitus attending Federal Medical Centre (FMC), Umuahia.
1.3.2 Specific Objectives
of the Study
The
specific objectives of the study are to:
1. Assess
their socio-economic characteristics.
2. Determine
their health history
3. Determine
their food habits
4. Assess
the 24 hours dietary recall.
5. Determine
the anthropometric indices of the patients.
6. Ascertain
their blood glucose level.
7. Determine
the relationship between their anthropometric indices and blood glucose level
of the patients.
1.4 SIGNIFICANCE OF THE
STUDY
The
information for this study will go a long way in determining the nutritional
status of type II diabetes and provide information that will assist doctors,
nurses, nutritionist, dieticians and those in related profession to gain
knowledge so as to advice their patients on the treatment and management of
their diseases. The result will help future researchers have a baseline data.
It will also provide reference material for future researchers. The findings
from this work will have important implication for nutrition education research
and practices. It will also help in planning and evaluation of public health
programs.
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