Báo cáo nghiên cứu khoa học: "Mô hình ăn uống và tình trạng dinh dưỡng của loại 2 bệnh nhân tiểu đường kiểm soát đường huyết ở Nongbualumphu bệnh viện, Thái Lan" ppsx

297 JOURNAL OF SCIENCE, Hue University, N 0 61, 2010 EATING PATTERNS AND NUTRITIONAL STATUS OF TYPE 2 DIABETIC PATIENTS WITH GLYCEMIC CONTROL IN NONGBUALUMPHU HOSPITAL, THAILAND Muktabhant B Faculty of Public Health, Khon Kaen University Thonguthaisiri A Nongbualumphu Hospital Thailand SUMMARY Introduction: Diabetic patients are requested to control their dietary intake in order to keep their blood glucose levels at an acceptable level. This study aimed to determine eating patterns and the nutritional status of inhabitants of Northeastern Thailand suffering from type 2 diabetes with good glycemic control (GC) compared with those with poor glycemic control (PC). Methodology: During 2007, we performed a cross-sectional study of 284 type 2 diabetic patients who attended diabetic outpatient clinics at Nongbualumphu Hospital, Thailand. 142 patients were in each group, GC (HbA 1c of <7%) and PC (HbA 1c of ≥7%),. Face to face interviews were based on a questionnaire that included eating habits, and food frequency information. Body mass index (BMI) was used to indicate the nutritional status of the diabetic patients. Chi-square tests were used to analyse and compare eating patterns, and nutritional status between two groups. Results: Most of the patients (>90%) in both the GC and PC groups ate three meals a day. About 70% of GC patients, while 53% of PC patients had breakfast and dinner punctually (p<0.05). There were a higher proportion of GC patients who restricted the amount of food consumed than PC patients (p<0.05). Moreover the GC patients ate stir-fried dishes, sweet fruits and Thai fast food less frequently than the PC patients did (p<0.05). Fifty- five percents of the subjects in both groups were obese. This difference was not statistically significant. Conclusions: Better dietary control of diabetic patients should be encouraged to improve their glycemic control and reduce long term complications. Key words: Eating pattern, Diabetes mellitus, Glycemic control, Nutritional status 1. Introduction The ultimate goal of management of type 2 diabetes patients is to prevent complications. Good glycemic control can prevent retinopathy, kidney failure; and cardio-vascular events, as well as other complications. Current guidelines set a hemoglobin A 1C level less than 7.0% as the goal of treatment. A dietary strategy is 298 recognized as a key component in prevention and management of type 2 diabetes (T2DM). The diabetic patients are therefore requested to control their dietary in order to keep their blood glucose levels at an acceptable level. However, only 30% of the T2DM patients in Thailand are good control of their glycemic levels. This study aimed to determine eating patterns and the nutritional status of inhabitants of Northeastern Thailand suffering from type 2 diabetes. Two groups had been compared namely individuals with a good- (GC), and those with poor control of their blood glucose levels (PC). 2. Methodology During 2007, a cross-sectional study was conducted with 284 diabetic patients, of 142 with good glycemic control and 142 with poor glycemic control. All patients did attend the diabetic outpatient clinics at the Nongbualumphu Hospital, within the province of the same name in Thailand. Good glycemic control was defined as HbA 1c of <7%, and HbA 1c >7% was considered as an indication of a poor glycemic control. Face to face interviews were based on a questionnaire that included eating habits, and food frequency information. The weight and height of the patients was measured, and the body mass index (BMI) was calculated. For classifying the nutritional status, the Asian criteria was applied in defining a BMI of 18.5 to 22.9 kg/m 2 as normal, a BMI of 23.0 to 24.9 kg/m 2 as overweight and a BMI>25 kg/m 2 as obese. The chi-square test was used to test whether there was a statistically significant difference between the GC and the PC group or not. 3. Results 3.1 Demographics Seventy four percent of individuals in both the GC- and the PC group were female. The average age of the patients was 59.7 for the GC and 55.3 years for the PC patients. Most of the study participants finished primary school. About half of them had no stable occupation. (Table 1) Table 1. Characteristics of the subjects Characteristics GC group (n=142) PC group (n=142) % % Sex: Male Female 26.1 73.9 26.1 73.9 Age: <40 40-59 ≥60 4.3 40.9 54.9 4.3 63.4 32.4 299 X ± SD 59.7 ±10.7 55.3 ± 8.8 Educational level: No school Primary school Secondary school Higher than Secondary school 4.9 90.2 3.5 1.4 7.0 81.0 9.9 2.1 Occupation: No occupation Farmers Merchants Laborers Officers 54.2 27.5 6.3 10.6 1.4 48.6 32.4 7.8 5.6 5.6 3.2 Eating habits Most of the study participants (>90%) in both groups ate 3 meals a day. Punctuality of meal time was less consistent, with a little less than 70% of the GC group being punctual for breakfast and dinner and only half reported being punctual for lunch. While just 52% of the PC group reported punctuality for breakfast and dinner and only 44% of them for lunch. The proportion of individuals of the GC group controlling the amount of food consumed was better than the PC group including rice, sweet fruits, desserts and sweet drinks as well.(Table 2) Table 2. Eating habits of the GC and PC patients Categories GC group PC group P-value* % % Number of meals 0.24 2 meal/day 8.5 4.9 3 meal/day 91.6 95.1 Punctuality of meal time For breakfast 69.7 52.1 0.009 For lunch 53.5 44.4 0.15 For dinner 68.3 52.8 0.007 300 Controlling the amount of food intake For breakfast 78.2 66.2 0.08 For lunch 77.5 66.2 0.02 For dinner 75.4 65.5 0.04 Controlling the amount of rice intake 30.1 14.8 0.002 Controlling the amount of sweet fruits intake 67.6 48.6 0.002 Controlling the intake of desserts 63.4 48.6 0.01 Controlling the consumption of sweet drinks 66.2 49.3 0.001 * p-value by χ 2 test Frequency of Food Intake The GC patients ate stir-fried dishes, sweet fruits and Thai fast food (ready to eat dish such as Pad Thai, Kaw Pad) less frequently than the PC patients (p<0.05). The percentage of the GC and PC groups were similar in the frequency of intake of sweet drink, bakery, dessert, high cholesterol food and fatty meat and also vegetable. (Figure 1) 0 20 40 60 80 100 120 Fatty meat High cholesterol food Bakery Dessert Soft drink Sweet drink Fried food Stir food Thai fast food Vegetable Sweet fruit % of the subjects PC GC Figure 1. Percentage of the GC- and PC group by frequency of food intake at least 1 time/week * * * * Significant difference between GC and PC group by χ 2 test at p - value <0.05 301 3.3. Nutritional status In terms of BMI, the nutritional status of both the GC and the PC group were similar. Twenty-one subjects of each group- the GC- and the PC group were overweight (BMI 23– 24.9 kg/m 2 ) and 55 % of participants in each group were obese (BMI  25 kg/m 2 ). (Figure 2) 0 10 20 30 40 50 60 % underweight normal overweight obese GC PC Figure 2. Nutritional status of the GC and PC patients by BMI classification 4. Discussion The diabetic patients with good glycemic control were more aware about their disease than the ones with poor control. The results show that good glycemic control patients reported better dietary habits than the people in the poor glycemic control group, including punctuality of meal time, control of the amount of foods eaten which have a high glycemic index (GI) food such as sweet fruits, sweet drink and desserts. High glycemic index foods generally make blood sugar levels higher. Not surprisingly, therefore, the patients who do not limit the intake of foods with a high glycemic index are more likely to retain high blood glucose level than those that do. Some studies have shown improvements in glucose control following a low GI diet as compared to a high GI diet. For the nutritional status, about half of the patients in both groups were obese. A study in Japanese patients with type 2 diabetes revealed that glycemic control was poorly correlated with BMI. Although the nutritional status of both groups investigated here was not different, eating habits between both groups differed to a great extent, as mentioned before. Since blood glucose levels are also dependent on the total caloric intake, the individuals with a food intake adjusted to their disease and those who obviously did not care about blood glucose levels while eating also display a difference in the total caloric intake. This reflected by a difference in the nutritional status between groups. Why the results of the study did not show this requires further investigations. In this study food intake could only be estimated qualitatively. Another explanation might 302 be that total caloric intake does not make a difference between good and a poor control of bloods glucose levels for the patients, but instead sweet fruits, stir fried food, and Thai fast food which contain a high amount of glucose and fat. 5. Conclusion The importance of an adequate dietary intake is not entirely recognized by the diabetic patients of the Nongbualumphu Hospital. A better understanding about the relationship of certain food items to blood glucose levels seems to be necessary. More investigations would also be helpful in differentiating between various frequently consumed fruits which increase or do not increase blood glucose levels to a great extent. Acknowledgments We thank Prof.(emeritus) Frank P. Schelp for his kindness in English editing for this paper. REFERENCES 1. American Diabetes Association. Nutrition recommendations and interventions for diabetes. A position statement of the American Diabetes Association. Diabetes Care (2008); 31 Suppl 1 2. American Diabetes Association, Standards of medical care in diabetes, Diabetes Care (2005); 28: S4–S36 3. Ben-Avraham S, Harman-Boehm I, Schwarzfuchs D, Shai I. Dietary strategies for patients with type 2 diabetes in the era of multi-approaches; review and results from the Dietary Intervention Randomized Controlled Trial (DIRECT). Diabetes Res Clin Pract. (2009);86 Suppl 1:S41-8. 4. Rawdaree P, Ngarmukos C, Deerochanawong C, Suwanwalaikorn S, chetthakul T, Krittiyawong S. Thailand diabetes registry project: clinical status and long term vascular complications in diabetes patients. J Med Asso. Thai (2006); 89 (Suppl 1): S1- S9. 5. Brand JC, Colagiuri S, Crossman S, Allen A, Roberts DCK, Truswell AS: Low glycemic foods improve long-term glycemic control in NIDDM. Diabetes Care (1991);14: 95–101 6. Heilbronn LK, Noakes M, Clifton PM. The effect of high- and low-glycemic index energy restricted diets on plasma lipid and glucose profiles in type 2 diabetic subjects with varying glycemic control. J Am Coll Nutr. (2002);21(2):120-7 7. Sone H, Yoshimura Y, Tanaka S, Iimuro S, Ohashi Y, Ito H, Seino H, Ishibashi S, Akanuma Y, Yamada N. Cross-sectional association between BMI, glycemic control and energy intake in Japanese patients with type 2 diabetes. Analysis from the Japan Diabetes Complications Study. Diabetes Res Clin Pract. (2007);77 Suppl 1:S23-9 . criteria was applied in defining a BMI of 18.5 to 22 .9 kg/m 2 as normal, a BMI of 23 .0 to 24 .9 kg/m 2 as overweight and a BMI> ;25 kg/m 2 as obese. The chi-square test was used to test. overweight (BMI 23 – 24 .9 kg/m 2 ) and 55 % of participants in each group were obese (BMI  25 kg/m 2 ). (Figure 2) 0 10 20 30 40 50 60 % underweight normal overweight obese GC PC Figure 2. Nutritional. school 4.9 90 .2 3.5 1.4 7.0 81.0 9.9 2. 1 Occupation: No occupation Farmers Merchants Laborers Officers 54 .2 27 .5 6.3 10.6 1.4 48.6 32. 4 7.8 5.6 5.6 3 .2 Eating habits