Evaluation of Nutritional Status and Dietary Management of In-Patient Diabetic in Enugu State University Teaching Hospital, Parklane
Chapter One
Objective of the study
The objectives of the study are;
- To determine the nutritional status of patients using anthropometry, biochemical and dietary studies.
- To assess energy and nutrient composition of hospital diets served to patients on admission
- To determine carbohydrate distribution in daily meals.
- To determine proportion of carbohydrate, protein and fat in daily diet.
CHAPTER TWO
REVIEW OF RELATED LITERATURE
Definition and Causes
Diabetes is a chronic condition characterized by hyperglycemia. It is caused by deficient insulin production, resistance to insulin action or a combination of both (Alberti KGmm and Zimmet 1998). Knowledge of the relationship between glucose, insulin and counter-regulatory hormones and glucose homeostasis is important in understanding these defects and how they result in abnormal glucose and fat metabolism (Atkinson and Maclareen, 1994). Type 1 and type 2 diabetes are at least partly inherited. Type 1 diabetes appears to be triggered by infection, stress, or environmental factors, example exposure to a causative agent.
There is a genetic element in the susceptibility of individuals to some of these triggers which has been traced to particular 11LA genotypes (that is genetic “self identifiers used by the immune system). Even in those who have inherited the susceptibility, type 1 diabetes Mellitus seems to require an environmental trigger.
There is an even stronger inheritance pattern for type 2 diabetes, those with type 2 ancestors or relatives have very much higher chances of developing type 2 diabetes. It is also often connected to obesity, which is found in approximately 85% of patients diagnosed with type 2 diabetes. Inheriting a tendency towards obesity seems also to contribute. Age is also thought to be a contributory factor, as most type 2 patients develop theirs at old age. Symptoms of diabetes mellitus include – polydipsia, polyuria, polyphagia, weight loss, blurred vision and weakness (Wardlaw, 1996).
Summary of causative and predisposing factor of diabetes
Type 2 diabetes has increased especially in areas that have seen major changes in eating patterns, increase in overweight and obesity (SCN, 2006). The evidence for a relationship between excessive weight gain, a high waist-to hip ratio and development of type 2 diabetes is strong. The waist circumference is a stronger predictor of risk for type 2 diabetes than BM1 (WHO/FAO, 2003). The risk of diabetes was associated with increasing age, BMI and systolic and diastolic blood pressure. The highest diabetes prevalence (13.6 percent) was found in the 64 + age group. A national study of non-communicable disease in Nigeria showed that 2.8 percent of the population had diabetes Federal Ministry of Health and Social Services (MOHSS, 1997). The prevalence was higher in females and those with increasing age. Children born to women who had gestational diabetes are more likely to develop obesity in childhood and are, therefore, at increased risk for developing type 2 diabetes at an early age (WHO/FAO, 2003) There is association between intrauterine growth retardation and low birth weight and development of insulin resistance (SCN, 2006). It is thought that this may have been advantageous for surviving famine but with increased energy intakes and decreased physical activity this is rather enhancing insulin resistance and type 2 diabetes. The rapid post-natal catch up growth is also associated with an increased risk of type 2 diabetes in adulthood.
There is also some evidence of the role of genetic and immunological factors in the pathogenesis of diabetes. African-Americans with West African origins were found to be less sensitive to insulin and, as a result, more susceptible to type 2 diabetes. Studies from five West African Communities in Nigeria and Ghana have identified genes within populations that are susceptible to diabetes (Rotimi et al., 2001).
CHAPTER THREE
RESEARCH METHODOLOGY
Research design
The researcher used descriptive research survey design in building up this project work the choice of this research design was considered appropriate because of its advantages of identifying attributes of a large population from a group of individuals. The design was suitable for the study as the study sought to evaluation of Nutritional status and Dietary management of in-patient Diabetic in Enugu state University Teaching Hospital, Parklane
Sources of data collection
Data were collected from two main sources namely:
(i)Primary source and
(ii)Secondary source
Primary source:
These are materials of statistical investigation which were collected by the research for a particular purpose. They can be obtained through a survey, observation questionnaire or as experiment; the researcher has adopted the questionnaire method for this study.
Secondary source:
These are data from textbook Journal handset etc. they arise as byproducts of the same other purposes. Example administration, various other unpublished works and write ups were also used.
Population of the study
Population of a study is a group of persons or aggregate items, things the researcher is interested in getting information on evaluation of Nutritional status and Dietary management of in-patient Diabetic in Enugu state University Teaching Hospital, Parklane. 200 staff of Enugu state University Teaching Hospital, Parklane was selected randomly by the researcher as the population of the study.
CHAPTER FOUR
PRESENTATION ANALYSIS INTERPRETATION OF DATA
Introduction
Efforts will be made at this stage to present, analyze and interpret the data collected during the field survey. This presentation will be based on the responses from the completed questionnaires. The result of this exercise will be summarized in tabular forms for easy references and analysis. It will also show answers to questions relating to the research questions for this research study. The researcher employed simple percentage in the analysis.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATION
Introduction
It is important to ascertain that the objective of this study was to ascertain Evaluation of Nutritional status and Dietary management of in-patient Diabetic in Enugu state University Teaching Hospital, Parklane. In the preceding chapter, the relevant data collected for this study were presented, critically analyzed and appropriate interpretation given. In this chapter, certain recommendations made which in the opinion of the researcher will be of benefits in addressing the challenges of Nutritional status and Dietary management of in-patient Diabetic in Enugu state University Teaching Hospital, Parklane
Summary
This study was on evaluation of Nutritional status and Dietary management of in-patient Diabetic in Enugu state University Teaching Hospital, Parklane. Four objectives were raised which included : To determine the nutritional status of patients using anthropometry, biochemical and dietary studies, to assess energy and nutrient composition of hospital diets served to patients on admission, to determine carbohydrate distribution in daily meals and to determine proportion of carbohydrate, protein and fat in daily diet. In line with these objectives, two research hypotheses were formulated and two null hypotheses were posited. The total population for the study is 200 staff of Enugu state University Teaching Hospital, Parklane. The researcher used questionnaires as the instrument for the data collection. Descriptive Survey research design was adopted for this study. A total of 133 respondents made up doctors, nurses, lab technicians and junior staffs were used for the study. The data collected were presented in tables and analyzed using simple percentages and frequencies
Conclusion
- Diabetes mellitus is a major public health problem that requires proper medical and dietary management to control high blood glucose and its complications.
- Adequate dietary management is the hub to providing adequate care to diabetics.
- Diabetes occurs much more in males than in females 54.5% vs 45.5% and more at the age of 61 years and above. The females had higher BMI than the males.
- Therapeutic diets were adequate in macronutrients except for slightly excess fat as against the RDI value. The distribution of macronutrient in terms of percentage as found in this study is in line with the recommended levels. The effort to relate dietary management to insulin dosage failed due to irregular meal times.
Recommendation
Combinations of intensive nutrition education, medical nutrition therapy, prescribed medication and counselling are key to successful management of diabetes mellitus.
The obese diabetics must reduce weight and adiposity to be successful in the management of their diabetes, as most of the patients with diabetes are either overweight or obese.
Late arrivals of meals especially breakfast should be avoided to enable food intake to be matched with the anticipated rise and fall of insulin.
Food high in soluble fiber is a relatively cheap and effective way to lower both cholesterol and triglyceride levels that are associated with increased heart diseases in diabetes and are therefore recommended.
Food preparation methods that would help reduce the amount of fat in the diet of hospitalized patients should be encouraged.
Increased intake of fish, meat and poultry should be encouraged to enable patients meet their recommended intakes for B vitamins and iron.
It would be helpful, as a follow up of this study if research were carried out on evaluation of energy and nutrient intakes of diabetics in other tertiary and secondary health institution where diabetics are cared for, for comparison.
Continuous nutrition monitoring is needed to assess the adherence of diabetics to their prescribed dietary regime.
Health care providers and the general public should be sensitized to the relevance of adequate nutritional care for people living with diabetes mellitus through workshops, lectures, seminars and interactive sessions.
References
- ADA (1994). Nutrition recommendations and principles for people with diabetes mellitus. J. AM. Diet Assoc. 94:504 – 506.
- ADA (2002). Evidence base nutrition principles and recommendations for the treatment and prevention of diabetes and related complications: technical review, Diabetes care 25: 148 – 198.
- ADA (2003). Position statement of the American Diabetes Association. Evidence based nutrition principles and recommendation for the treatment and prevention of diabetes and related complications. Diabetes care. 26: supplement 1.
- ADA, (1994). New Recommendations for diabetes Management: Nutrition recommendations and principles for people with diabetes mellitus. 504 – 506.
- Akinlade A, Ogbera A. O., Awobusuyi J. (2008). Dietary and lifestyle pattern of people with diabetes mellitus. NSEM Conference proceedings. 54.
- Alberti KG NM, Zimmet P.Z, (1998). Definition, diagnosis and classification of diabetes mellitus and its complications part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabetes Med. 15: 539 – 553.
- Al-Shoshan A. A. (1992). Study of regular diet of selected hospitals of the ministry of health in Saudi Arabia. Edible plate waste and monetary value. JR Soc. Health 112:7 – 11.
- Alva M. (2000). “Diabetes and lifestyle in the New Millennium. World Diabetes day presentation.
