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Dietary intake and barriers to dietary compliance in black type 2 diabetic patients attending primary health-care services

  • Gladys Nthangeni (a1), Nelia P Steyn (a2), Marianne Alberts (a3), Krisela Steyn (a2), Naomi S Levitt (a4), Ria Laubscher (a5), Lesley Bourne (a6), Judy Dick (a7) and Norman Temple (a8)...

Abstract

Objective:

To determine the dietary intake, practices, knowledge and barriers to dietary compliance of black South African type 2 diabetic patients attending primary health-care services in urban and rural areas.

Design:

A cross-sectional survey. Dietary intake was assessed by three 24-hour recalls, and knowledge and practices by means of a structured questionnaire (n=133 men, 155 women). In-depth interviews were then conducted with 25 of the patients to explore their underlying beliefs and feelings with respect to their disease. Trained interviewers measured weight, height and blood pressure. A fasting venous blood sample was collected from each participant in order to evaluate glycaemic control.

Setting:

An urban area (Sheshego) and rural areas near Pietersburg in the Northern Province of South Africa.

Subjects:

The sample comprised 59 men and 75 women from urban areas and 74 men and 80 women from rural areas. All were over 40 years of age, diagnosed with type 2 diabetes for at least one year, and attended primary health-care services in the study area over a 3-month period in 1998.

Results:

Reported dietary results indicate that mean energy intakes were low (<70% of Recommended Dietary Allowance), 8086–8450 kJ day−1 and 6967–7382 kJ day−1 in men and women, respectively. Urban subjects had higher (P<0.05) intakes of animal protein and lower ratios of polyunsaturated fat to saturated fat than rural subjects. The energy distribution of macronutrients was in line with the recommendations for a prudent diet, with fat intake less than 30%, saturated fat less than 10% and carbohydrate intake greater than 55% of total energy intake. In most respects, nutrient intakes resembled a traditional African diet, although fibre intake was low in terms of the recommended 3–6 g/1000 kJ. More than 90% of patients ate three meals a day, yet only 32–47% had a morning snack and 19–27% had a late evening snack. The majority of patients indicated that they followed a special diet, which had been given to them by a doctor or a nurse. Only 3.4–6.1% were treated by diet alone. Poor glycaemic control was found in both urban and rural participants, with more than half of subjects having fasting plasma glucose above 8 mmol l−1 and more than 35% having plasma glycosylated haemoglobin level above 8.6%. High triglyceride levels were found in 24 to 25% of men and in 17 to 18% of women. Obesity (body mass index ≥30 kgm−2) was prevalent in 15 to 16% of men compared with 35 to 47% of women; elevated blood pressure (≥160/95 mmHg) was least prevalent in rural women (25.9%) and most prevalent in urban men (42.4%).

Conclusions:

The majority of black, type 2 diabetic patients studied showed poor glycaemic control. Additionally, many had dyslipidaemia, were obese and/or had an elevated blood pressure. Quantitative and qualitative findings indicated that these patients frequently received incorrect and inappropriate dietary advice from health educators.

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Copyright

Corresponding author

*Corresponding author: Email nelia.steyn@mrc.ac.za

References

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Keywords

Dietary intake and barriers to dietary compliance in black type 2 diabetic patients attending primary health-care services

  • Gladys Nthangeni (a1), Nelia P Steyn (a2), Marianne Alberts (a3), Krisela Steyn (a2), Naomi S Levitt (a4), Ria Laubscher (a5), Lesley Bourne (a6), Judy Dick (a7) and Norman Temple (a8)...

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