Investigation On Dietary Intake Status In Outpatients With Type 2 Diabetes

Objective:Diabetes is a chronic lifelong disease. The main treatment strategy for this disease is to reduce the patients' physical and psychological burden by preventing complications through appropriate treatment and self-management. The aim of modern diabetes management is to optimize metabolic control and prevent or mitigate chronic complications as well as striving to ensure a healthy life quality. Genetic background and environmental factors are important reasons leading to diabetes. The environmental factors, including excessive food supply and sedentary life style, play a pivotal role in the incidence of diabetes. Recently it has been found that the incidence of diabetes and its complications are closely related to the metabolic disorders of chromium, selenium, zinc,8-iso-PGF2α, vitamin C, vitamin E, vitamin B6, vitamin A and other trace elements. The treatment of diabetes requires the involvement of patients. However, there are a considerable number of patients who seriously lack the knowledge of diabetes, which in turn negatively affects the control of blood sugar, blood pressure and blood-lipid, eventually reduces the treatment effect and quality of life, which is this is directly related to the wrong eating habits. How to cultivate good eating behavior of patients, supply nutrients properly, delay the onset or reduce the complications of diabetes has been a crucial concern of diabetes education. The present paper aims to understand the eating history and quality of life of patients with diabetes, as well as measure nine indicators in serum, including zinc, selenium, magnesium, chromium, vitamin A, vitamin E, vitamin B6, vitamin C and F2-isoprostane levels, assess the relationship of the indexes and diabetes control and incidence of complications. The result will provide the basis for the implementation of nutrition guidance mode and scientific nutritional management.Design and Method1 Subjects:205 out-patients who met the inclusion criteria from August to November in 2009. Inclusion criteria:Voluntary recruited to this study, no language barriers,8 to 65 years of age, diabetes consistent with the 1997 American Diabetes Association (ADA) diagnostic criteria.Exclusion patients with diabetic kidney disease, liver disease, blood diseases and malignant tumor, vegetarians, eating disorders and those with supplement of nutrients. Fifty patients were randomly selected to measure the serum nutrients (The first 50 patients recruited).2. Methods2.1 Nutritional Status2.1.1 Methods All the patients were given to sign an informed consent. Question and answer form were filled in a face to face manner with 205 patients in the survey.2.1.2 Demographic questionnaire:Self-compiled background information sheet was employed, including the patient's general information such as age, education level, job status, duration of diabetes, whether received dietary guidance, the current treatment methods, with or without diabetes, complications, body mass index, fasting blood glucose,2h postprandial blood glucose, blood glucose control satisfaction, whether newly diagnosed patients, treatment methods (diet, exercise, oral hypoglycemic agents, insulin therapy, insulin therapy+oral hypoglycemic agents), HbA1c etc..2.1.3 Questionnaire of dietary intake:Using food frequency questionnaire (FFQ). FFQ based on the "balanced diet Pagoda of Chinese residents" from Chinese Nutrition Society in April,1997, the food is divided into 9 major categories and 13 Classes:Except for edible oil intake was assessed in unit of family, the rest are assessed in an individual unit.2.1.4 The recommended amount of intake:The recommended amount of balanced diet (g/d)comes from China Nutrition Society.2.1.5 Definition of body mass:The criteria comes from the standard of Ministry of Health Disease Control Division, April 2003, the published " Overweight and obesity prevention and control guidelines of Chinese adults (Trial)". The standard body mass index:body mass index 18.5 to 23.9 is regarded normal,24～27.9 as overweight,≥28.0 as obesity.2.1.6 Table of diet-related psychosocial variables:The questionnaire includes three parts, (1) self-efficacy (5 entries), social support (4 entries), (3) cognitive impairment of healthy diet (6 entries)2.1.7 Determination of nutrients Three ml blood were drawn in the early morning and stored in normal tubes, serum separated timely and delivered to AIDIKANG company for determination.2.1.7.1 Vitamin E, vitamin C, vitamin A, vitamin B6 concentration in plasma was determined by ferrous hydrochloride spectrophotometry.2.1.7.2 The concentration of selenium, chromium, zinc, magnesium in plasma was determined by inductive coupled mass spectrometry detection(Agilent 7500a).2.1.7.3 The amount ofδ-iso-PGF2ain plasma is determined by HPLC-MS.2.1.8 Eating habits questionnaire:A self-compiled background information sheet was employed, including the usual diet, taste, cooking method, whether eating fried foods, whether eating pickles foods, whether eating snacks (sweets/candied fruit) and whether drinking sweet drinks.2.1.9 Quality of Life Survey Chinese version of the 36-item health status assessment sheet(SF-36) was employed, a total of 36 entries, including eight health dimensions:physical function (PF), physical performance (RP), bodily pain (BP), general health (GH), vigor(VT), social function (SF), Role-Emotional (RE), mental health (MH).3. Statistical Methods In this paper, based on Epidata3.1 database, statistical analysis was performed with SPSS 15.0.α=0.05 level for statistical tests, taking 95 percent confidence interval range. Comparison between two groups, two independent samples t-test was performed, enumeration data using chi-square test. Data was described as mean, standard deviation, constituteResults:1. Demographic indicators includes age, ethnicity, education level, occupation, history of other diseases, whether newly diagnosed patients, when selected, divided into two groups by sex, of which 102 cases of male sex,103 female. No significant difference between the two groups(t=0.565, P=0.572), and no significant difference between the different ages of each group(χ2=6.016, P=0.198).205 patients were Chinese Han population. Education level between the two groups showed a significant difference, men were significantly higher than females (χ2=54.526, P<0.001). There is no significant difference in the occupations between the two groups (χ2=4.149, P=0.125). The male group showed a significantly higher in positive disease history than female (χ2=10.731, P=0.001), but the newly diagnosed diabetes was distributed to the two groups with no significant difference (χ2= 1.504, P=0.220) (The height, weight, waist circumference and waist-hip ratio in male group were significantly higher than the female group (P≤0.017). Comparison of diabetes duration between two groups was no significant difference (P=0.479)2. The control of total dietary intake of diabetic outpatients:Inadequate intake were 32 cases (15.6%), the ideal intake were 31 cases ((15.1%)), excessive intake were142 cases (69.3%). The number of total intake among different body mass was significantly different (χ2=13.847, P=0.008). In the group of obesity, there was the largest number of daily total calorie intake, as 34 cases.3. Dietary imbalance in patients of diabetes. Patients with type 2 diabetes have an imbalance diet, as found grain intake was 81.62% of the recommended amoun, 127.71% of the recommended amount of milk intake,105.66% of the recommended amount of vegetable,123.04% of fish and shrimp,87.26% of the fruit,294.74% of poultry meat,118.16% of eggs,28.36% of beans,184.48% of fats and oils. The data suggested that dietary structure is irrational, characterized by the low amount of carbohydrate, mainly cereal and fruit, and high percentage of poultry meat, egg-based proteins and fats(P<0.05). Study in this group, intake of diet dairy, poultry meat, eggs, fish and shrimp, fats and oils is high, whereas grains, legumes intake is low. All the data about intake of various types of food above were statistically significant compared with the recommended amount (P<0.05). The amount of vegetables and fruits compared with the recommended amount showed no statistically significant difference (P> 0.06),4. Factors affecting eating behaviour:4.1 The impact on eating behavior of demographic factors:Employment is an impact factor on the intake of protein, fat, the difference was statistically significant (P <0.05). Whether receive any dietary guidance, obese affected fat intake significantly (P<0.05),4.2 Psychosocial factors on dietary behavior:57.6% of the patients are optimistic even much effort are required to prepare the healthy food. They lacks of confidence when depressed or on leave. Social support shows a weak influence on the eating behavior.56.1%,57.6%,58.0% of patients think it was difficult to change eating habits, busy lifestyles and lack of knowledge about diabetes diet are the causes of cognitive impairment. Protein and fat intake were higher than the recommended amount, which are related to emplyment, eating out, depressed, busy lifestyles, unhealthy eating habits; cereal intake lower than the recommended amount are related to the lack of knowledge about what kind of food can lower blood sugar, unhealthy eating habits and busy lifestyles.5. Unhealthy eating habits of outpatients with type 2 diabetes (1) The diet:134 cases regular and quantitative (65.4%), regular non-quantitative 50 cases (24.4%),21 cases irregular quantitative (10.2%).; (2) Diet flavors:salty 73 cases (35.6%), general 64 cases (31.2%), low-salt diet 68 cases (33.2%); (3) Cooking method:greasy 48 cases (23.4%), light 85 cases (41.5%), general 72 cases (35.1%); (4) fried food:never 44 cases (21.5%), sometimes 33 cases (16.1%), occasionally 75 cases (36.6%) normally 14 cases (6.8%), often 33 cases (16.1%), frequent in 6 cases (2.9%); (5) pickled foods:never 22 cases (10.7%), occasionally 43 cases (21.0%), and sometimes 34 cases (16.6%), normally 20 cases (9.8%) often 69 cases (33.7%), frequent in 17 cases (8.3%), (6) Snacks (sweets/candied fruit):never 157 cases (76.6%), occasionally 37 cases (18.0%), and sometimes in 9 cases (4.4%), often 2 cases 1.0%), indicating that patient with type 2 diabetes there prefer salty, greasy, fried and pickled foods.6. The low quality of life in outpatients of type 2 diabetes. Scores of each dimension: PF (89.07±15.92), RP (46.89±3.27), BP (82.36±20.08) GH (60.42±21.54) VT (76.51±15.59), SF (94.94±11.05), RE (64.23±41.87), MH (73.23±18.77), except for BP, MH (P> 0.05), PF, RP, GH, VT, RE, SF showed statistically significant difference ((P<0.05) from general population in China.7. Related factors affecting the quality of life of people with type 2 diabetes includes age, treatment approaches(oral hypoglycemic agents, insulin therapy), diet, occupation, fried food, which are significantly correlated (R=0.495, F=9.893, P= 0.000), the difference was statistically significant (P<0.015).8. Nutrient status in 50 outpatients. Blood selenium (μg/L):115.28±30.19; blood chromium (μg/L):6.45±8.62; vitamin A (nmol/L):1430.69±755.26; vitamin E (nmol/L):1185.24±779.82; Vitamin C (ng/L):1939.47±1111.03; vitamin B6 (ng/ L):503.65±208.52;δiso-prostaglandin F2α(ng/L):137.02±106.04; zinc (μmol/L): 110.08±14.55; Magnesium (mol/L):1.65±0.14. Statistically significant different with the normal value (P<0.005), shows there was low blood selenium, blood chromium, vitamin E, vitamin B6, lowδiso-prostaglandin F2α. In type 2 diabetic patient. 9. Among the possible factor affecting nutrient contents includes the incident of complications and blood glucose control. Age only shows a correlation with the intake of vitamin C, vitamin B and the selenium (P<0.05), negative with other nutrients and age. There was no significant difference between the various nutrients and the course of diabetes(P> 0.256).Conclusion:1.Outpatients with type 2 diabetes shows a poor control of the total calories intake, point out that the educator must formulation of individual patient prescriptions and diet to choose the right food teaches patients.in diet guide.2.Outpatients with type 2 diabetes shows widespread unhealthy eating habits.In the diet should be established to help patients in the guidance of dietary habits,reducing salt and fat intake.3.Because of on-the-job,dine out,busy lifestyle,depressed and social psychological factors,the patient often influence diet behaviors,patient excessive intake or intake imbalance.In dietary guide is the key that affect patients psychological and social problem eating behavior,helping patients formulate methods to solve the problems and the behavior change target the support of your family,make patient develop good eating behavior.4.Insulin treatment,patients usually eat Fried foods, not nurturance quantitative eating habits in type 2 diabetes is caused by a drop in the quality of life.In education should assess the patient should focus on training and practice ability of management of patients with self-efficacy, achieves truly knowledge.5.Outpatients with type 2 diabetes widespread serum chromium,selenium and vitamin E,vitamin C,vitamin B6,lack of the situation,The course,and without blood glucose control satisfaction,complications.Education should be informed in food grains,rich in patients with appropriate intake of trace elements,avoid Fried food,cooking methods to reduce the loss of micronutrients. This study analyzes the diet status and quality of life in patients with type 2 diabetes, filter out the most relevant factors to the eating behavior and thus strengthen the scientific basis for dietary guidance, which provides effective measures to promote the cultivation of healthy eating habits, helps the patients realize their own abilities to control the development of diabetes, and consciously improve eating habits, control blood sugar and eventually, these efforts will help reduce the risk of diabetic chronic complications.