Eating behavior among persons with type 2 diabetes mellitus in North Ethiopia: a cross-sectional study

Dietary practice and associated factors among patients with type 2 diabetes mellitus in the horn of Africa: a systematic review and meta-analysis

BACKGROUND

Dietary practices have a valuable impact on lowering the risk of complications associated with diabetes mellitus. The countries in the horns of Africa do not follow properly the approaches of dietary recommendation to prevent diet related complications among patients with type-2 diabetes mellitus. Numerous primary observational studies on the relationship between diabetes mellitus and dietary practices have been conducted in the horns of Africa up to this point. Inconsistent and variable findings across different countries in the Horn of Africa hinder the establishment of suitable intervention designs. To address this issue, this systematic review and meta-analysis was conducted.

METHOD

We searched PubMed, Medline, EMBASE, Google Scholar, and Google for studies that had been conducted in the Horn of Africa. Searches were using the English language. A preferred reporting item for systematic reviews and meta-analysis (PRISMA) checklist was used. Two authors independently reviewed the studies. The effect size of the meta-analysis was dietary practices and the adjusted odds ratio (AOR) of the associated factors. Studies were summarized on the use of dietary practices quantitatively and qualitatively. A random-effects model was conducted to obtain the pooled estimates.

RESULT

A total of twenty-one observational studies with 5,117 study participants were included 5,117 in this review. The pooled proportion of good dietary practices among patients with type 2 diabetes mellitus in the Horn of Africa was 44.0% (95% CI: 36.0-51.0). The pooled odds ratio showed that a significant association was found between educational status (AOR = 2.57; 95% CI: 1.79-3.70). Age of the patient (AOR = 2.59; 95% CI: 2.16-3.11), Wealth index status (AOR = 3.64; 95% CI: 2.71-4.89), nutrition education (AOR = 3.35; 95% CI: 2.50-4.49), knowledge about diabetes mellitus (AOR = 2.59; 95% CI: 1.18-3.59) and patients' attitude about diabetes mellitus (AOR = 2.64; 95% CI: 1.64-4.29).

CONCLUSION

The overall pooled proportion of good dietary practices among patients with type-2 diabetes mellitus was below half. Educational status wealth index, nutrition education, dietary knowledge and attitude about diabetes mellitus were significantly associated with good dietary practices. Therefore, establishing strategy to promote nutrition education at the health care facilities and raising awareness about the significance of healthy eating habits through various platforms can improve patients' eating behaviors.

Patient-centered nutrition education improved the eating behavior of persons with uncontrolled type 2 diabetes mellitus in North Ethiopia: a quasi-experimental study

Background

Improving the clinical outcome of people with type 2 diabetes mellitus by modifying their eating behavior through nutrition education is an important element of diabetes self-management. Significant data from the literature supports this idea, however in the Ethiopian setting, there is a practice gap. Therefore, the purpose of this study was to assess how patient-centered nutrition education affected the eating behavior and clinical outcomes of people with uncontrolled type 2 diabetes mellitus.

Method

In this quasi-experimental trial, 178 people with uncontrolled type 2 diabetes were purposely assigned to the intervention (n = 89) or control (n = 89) arm. The intervention arm was given patient-centered nutrition education, whereas the control arm received the routine care. Eating behavior and clinical outcome indicators such as HbAc, lipid profile, anthropometric indices, and blood pressure were assessed in both groups at the start and completion of the intervention. All scale variables were tested for normality and log transformed when appropriate. The baseline characteristics of the intervention and control groups were compared using the t-test for continuous variables and the chi-square test for categorical variables. The effect of nutrition education was determined using a difference in differences (DID) approach. P < 0.05 was established as the criterion of significance.

Result

Food selection (DID = 15.84, P < 0.001), meal planning (DID = 31.11, P < 0.001), and calorie needs (DID = 37.65, P < 0.001) scores were statistically higher in the nutrition education arm. Furthermore, their overall eating behavior score (DID = 27.06, P < 0.001) was statistically greater than the controls. In terms of clinical outcomes, the overall picture reveals that the intervention did not outperform over the routine care. However, in comparison to the controls, the intervention arm showed clinically significant improvement in HbA1c (DID = -0.258, P = 0.485).

Conclusion

Patient-centered nutrition education has resulted in positive adjustments in the eating behavior of people with uncontrolled type 2 diabetes mellitus. Furthermore, it has shown a great potential for improving their glycemic control.

Chinese Residents' Healthy Eating Intentions and Behaviors: Based on an Extended Health Belief Model

Unhealthy eating is one cause of obesity and some chronic non-communicable diseases. This study introduces self-efficacy and health consciousness to construct an extended health belief model (HBM) to examine the factors influencing healthy eating intentions and behaviors of Chinese residents and explore the moderating effect of perceived barriers and the mediating effect of healthy eating intentions. Through the survey platform “Questionnaire Star”, this study collected quantitative data from 1281 adults, and partial least squares structural equation modeling was used for confirmatory factor analysis, path analysis, importance-performance map analysis, and multi-group analysis. Results showed that perceived susceptibility, perceived severity, perceived benefits, self-efficacy, and health consciousness had a significant positive effect on residents’ healthy eating intentions. Perceived barriers had a significant negative effect on residents’ healthy eating intentions. Healthy eating intentions had a significant positive effect on healthy eating behaviors. Perceived barriers played a significant negative moderating effect between healthy eating intentions and behaviors. Healthy eating intentions had a positive and significant mediating effect. The multi-group analysis showed that extended HBM has relative generalization ability. The extended HBM has good explanatory and predictive power for healthy diet and provides a new framework for understanding the influencing factors of individuals’ healthy eating intentions and behaviors.

High atherogenic risk concomitant with elevated HbA1c among persons with type 2 diabetes mellitus in North Ethiopia

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a chronic disease associated with worse clinical presentation. However, the current investigation practices in Ethiopia have limitations to demonstrate the scope of the clinical burden. Hence, this study was aimed at assessing the glycemic status and coronary heart disease (CHD) risk of persons with T2DM using HbA1c and atherogenic index of plasma (AIP).

METHOD

This institution-based cross-sectional study was conducted among 421 adults with T2DM from September to November 2019. Demographic, socioeconomic, and lifestyle data were collected through a face-to-face interview. Clinical information was retrieved from medical records whereas anthropometric and biochemical measurements were performed using the WHO protocols. Glycemic status was determined using HbA1c and CHD risk assessed using an atherogenic index of plasma (AIP). Gaussian variables were expressed using mean and standard deviation (SD), Log-normal variables using geometric mean and 95% CI and non- Gaussian variables using median and interquartile ranges. Categorical variables were summarized using absolute frequencies and percentages. Multivariable logistic regression was used to identify factors associated with glycemic control with a statistical significance set at 5%.

RESULT

A total of 195 male and 226 female subjects were involved in this study. The results demonstrated that 77% (324) had HbA1c value ≥7% and 87.2% (367) had high atherogenic risk for CHD. Besides, 57% and 67.9% of persons with T2DM had metabolic syndrome according to International Diabetes Federation (IDF) and the National Cholesterol Education Program-Adult treatment panel III (NCEP-ATP III) criteria, respectively. About 36.8% had one or more comorbidities. Having healthy eating behavior [AOR 1.95; CI 1.11-3.43] and taking metformin [AOR 4.88; CI 1.91-12.44] were associated with better glycemic outcomes.

CONCLUSION

High AIP level concomitant with poor glycemic control indicates increased risk for coronary heart disease among persons with T2DM in Northern Ethiopia.