NUTRITIONAL PRACTICES AND CHALLENGES AMONG DIABETES PATIENTS IN LAUTECH TEACHING HOSPITAL OGBOMOSO OYO STATE
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- NGN 3000
Background Of The Study
Diabetes mellitus (DM) is a chronic disorder that is not only assuming pandemic proportions worldwide but also poised to affect the developing countries of the world much more than their developed counterparts. The world prevalence is estimated to increase from 425 million people in 2017 to 629 million by 2045[1], and in Africa, the number of people with diabetes will increase from 14.2 million in 2015 to 34.2 million in 2040; predominantly populated in some of the region’s most populous countries: South Africa, the Democratic Republic of Congo, Nigeria and Ethiopia[2]. In 2015, diabetes was one of the leading causes of non-communicable diseases (NCD) death, contributing 1.5 million deaths globally[3,4] and 321,100 deaths in the African region[2].
Along with urbanization and economic growth, many countries have experienced dietary changes favoring increased caloric consumption[5,6], and nutrition is one of the major risk factors of DM. Nutritional management is a key cornerstone modality in the attainment of good glycemic control in DM, and of course, nutrition management of DM is targeted at improving the overall health by achieving and maintaining optimal nutritional status, attaining good glycemic control and preventing acute and long term complications of DM. The current general recommendation is that carbohydrates should provide between 45%-65% of the daily caloric intake, fat should be 25%-35% of total daily calories and protein should be 15%-20% of total daily calories[7,8]. In Nigeria, there is a delusion particularly amongst the diabetic populace that consumption of carbohydrate foods is usually associated with hyperglycemia; hence the popular view that people with DM should either completely avoid carbohydrates or at best take minimal quantities[8].
It is a well-known fact that DM, being a metabolic, endocrine disorder, is directly connected to carbohydrate, lipid and protein metabolism. As a result, nutrition therapy forms an integral part of diabetes management and diabetes self - management education[9]. Medical nutrition therapy has been introduced to guide a systematic and evidence-based approach to the management of diabetes through diet, and its effectiveness has been demonstrated[10]. Also, most diabetes guidelines recommend starting pharmacotherapy only after first making nutritional and physical activity lifestyle changes, but this is not always followed in practice globally[11,12]. Additionally, it is commonly believed that diabetes cannot be completely cured, but it may be more easily regulated and controlled with the right diet and nutritional intake; and with strict adherence to nutritionist’s advice, diabetic patients may be able to significantly improve their quality of life[9].
Furthermore, diabetes mellitus (DM) is a diverse group of metabolic disorders that is often associated with a high disease burden in developing countries such as Nigeria[8]; and most Governments of African countries including Nigeria do not recognize the catastrophic potential of the diabetes epidemic and need to reverse the current trend where DM occupies very low priority in their National Health care agenda, before time runs out[15]. Additionally, cross-sectional studies in Africa indicate low adherence to dietary recommendation for macronutrients intake, and fruits and vegetables consumption among diabetic patients[16,17]. Similarly, most physicians are not trained in nutritional interventions and this is a barrier to the counselling of patients[11,12], and dietary information is often neglected, even though at least modest attention to diet is needed to achieve adequate glycaemic control[12,18].
Despite several recommendations and a number of scientific findings on the beneficial role of appropriate nutritional practices of diabetes, there are still reports on the poor adherence to dietary/nutritional recommendations amongst people with DM[19,20,8], and dietary management as an aspect of DM care is seen as the turf of the nutritionists and as a result, quite a number of physicians have a poor knowledge on nutritional counselling[8]. Thus, the aim of this study is to examine the nutritional practices and challenges of diabetes patients in Oyo State.
1.2 Statement Of The Problem
Nigeria is mainly an agrarian country[13], and in the early nineties, not much was known about DM in Nigeria, and traditionally, people related DM to “curses” or “hexes”[8]. Also, As far back as the beginning of the twentieth century, DM was described by Dr. Cook as being an uncommon disorder in Africa[8]. The low incidence of DM then, perhaps, is traceable to dietary habit which was predominated with local foods. In this light of course, it is not beyond reach for diabetic patients to sustain a good dietary habit which in turn will improves the diabetic condition. However, the transition from our local foods to processed foods and junks tends to be a key player in poor dietary habit. In recent times, there has been an exponential increase in the number of established fast food, consequently contributing to availability of unhealthy diets with high calorie content and unhealthy fats[14,6]. Another key component in the food system transition has been the saturation of large chain supermarkets, which displace fresh local food and farm shops and serve as a source of highly processed foods, high-energy snacks, and sugary beverages[14,6].
In the light of the above, this study seeks to examine the nutritional practices and challenges of diabetes patients in Oyo State.
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