Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-23T13:23:52.528Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  02 January 2007

Gladys Nthangeni ,
Nelia P Steyn ,
Marianne Alberts ,
Krisela Steyn ,
Naomi S Levitt ,
Ria Laubscher ,
Lesley Bourne ,
Judy Dick  and
Norman Temple
Gladys Nthangeni
Affiliation:
Department of Human Nutrition, University of the North, Pietersburg, South Africa
Nelia P Steyn*
Affiliation:
Chronic Diseases of Lifestyle (CDL) Unit, Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa
Marianne Alberts
Affiliation:
Department of Medical Sciences, University of the North, Pietersburg, South Africa
Krisela Steyn
Affiliation:
Chronic Diseases of Lifestyle (CDL) Unit, Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa
Naomi S Levitt
Affiliation:
Department of Medicine, University of Cape Town, South Africa
Ria Laubscher
Affiliation:
Centre for Epidemiological Research in Southern Africa, Medical Research Council, Cape Town, South Africa
Lesley Bourne
Affiliation:
Health and Development Group, Medical Research Council, Cape Town, South Africa
Judy Dick
Affiliation:
Health Systems Research Unit, Medical Research Council, Cape Town, South Africa
Norman Temple
Affiliation:
Centre for Science, Athabasca University, Athabasca, Alberta, Canada
*
*Corresponding author: Email nelia.steyn@mrc.ac.za
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
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.

Keywords

Black South AfricansDiabetes mellitusNon-insulin-dependentdiet therapyDiet therapy
Type
Research Article
Information
Public Health Nutrition , Volume 5 , Issue 2 , April 2002 , pp. 329 - 338
Copyright
Copyright © CABI Publishing 2002

References

1Levitt, NS, Katzenellenbogen, JM, Bradshaw, D, Hoffman, MN, Bonnici, F. The prevalence and identification of risk factors for NIDDM in urban Africans in Cape Town, South Africa. Diabetes Care 1993; 16: 601–7.CrossRefGoogle ScholarPubMed
2Omar, MAK, Seedat, MA, Motala, AA, Dyer, RB, Becker, P. The prevalence of diabetes mellitus and impaired glucose tolerance in a group of urban South African blacks. S. Afr. Med. J. 1993; 83: 641–3.Google Scholar
3Erasmus, RT, Blanco, E, Okesina, AB, Matsha, T, Gqweta, Z, Mes, JA. Prevalence of diabetes mellitus and impaired glucose tolerance in factory workers from Transkei, South Africa. S. Afr. Med. J. 2001; 91: 157–90.Google ScholarPubMed
4Motala, AA, Pirie, FJ, Gouws, E, Omar, MAK, Gray, IP. The prevalence of diabetes mellitus and associated risk factors in a rural South African community of Zulu descent. J. Endocrinol. Metal. Diabetes S. Afr. 2001; 6: 39.Google Scholar
5Levitt, NS, Bradshaw, D, Zwarenstein, MF, Bawa, AA, Maphumolo, S. Audit of public sector primary diabetes care in Cape Town South Africa; high prevalence of complications, uncontrolled hyperglycaemia, and hypertension. Diabetes Med. 1997; 14: 1073–7.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
6Van Rooijen, AJ, Rheeder, P, Eales, CJ. Urban black female patients' perception and knowledge of non-insulin dependent diabetes mellitus (NIDDM): a pilot study. J. Endocrinol. Metal. Diabetes S. Afr. 2001; 6: 38.Google Scholar
7Mohamed, E. The implementation of the national diabetes type 2 guidelines at primary level. J. Endocrinol. Metal. Diabetes S. Afr. 2001; 6: 38.Google Scholar
8Working Group of the National Diabetes Advisory Board (SEMDSA). Guidelines for the management of type II (noninsulin- dependent) diabetes mellitus at primary health care level in South Africa. S. Afr. Med. J. 1997; 87: 497–512.Google Scholar
9Association for Dietetics in Southern Africa. Dietary management of people with diabetes mellitus. Position Statement. S. Afr. J. Clin. Nutr. 1997; 9: 1233–4.Google Scholar
10Erasmus, RT, Blanco, EB, Okesina, AB, Gqweta, Z, Matsha, T. Assessment of glycaemic control in stable type 2 black South African diabetics attending a peri-urban clinic. Postgrad. Med. J. 1999; 75: 603–6.CrossRefGoogle ScholarPubMed
11Gohdes, D. Diet therapy for minority patients with diabetes. Diabetes Care 1988; 11: 189–91.CrossRefGoogle ScholarPubMed
12Alberts, M. The Dikgale Health and Demographic Study. Sovenga: University of the North, 1995.Google Scholar
13Nelson, M, Bingham, SA. Assessment of food consumption and nutrient intake. In: Margetts, BM, Nelson, M, eds. Design Concepts in Nutritional Epidemiology, 2nd ed. Oxford: Oxford University Press, 1997.Google Scholar
14Bourne, LT, Langenhoven, ML, Steyn, K, Jooste, PL, Laubscher, R, Van der Vyfer, E. Nutrient intake in the urban African population of the Cape peninsula South Africa. The Brisk Study. Central Afr. J. Med. 1993; 39: 238–48.Google ScholarPubMed
15Ladzani, R, Steyn, NP, Nel, JH. A socio-economic profile of households in semi-rural areas of Lebowa with specific reference to dietary habits. S. Afr. J. Food Sci. Nutr. 1992; 4: 60–3.Google Scholar
16Gresse, A, Voster, HH. The glycaemic index and second meal effect of the typical African meal in black non-insulin dependent diabetic subjects. S. Afr. J. Food Sci. Nutr. 1992; 4: 64–9.Google Scholar
17Gresse, A, Voster, HH. Eating habits and nutrient intakes of black patients with diabetes mellitus. S. Afr. J. Food Sci. Nutr. 1992; 4: 76.Google Scholar
18SAS Institute, Inc. SAS User's Guide: Statistics, 5th ed. Cary, NC: SAS Institute, Inc, 1985.Google Scholar
19National Research Programme for Nutritional Intervention. Food Composition Tables. Tygerberg: South African Medical Research Council, 1999.Google Scholar
20Food and Nutrition Board, National Research Council Recommended Dietary Allowances, 10th ed. Washington, DC: National Academy Press, 1989.Google Scholar
21Polit, DF, Hungler, BP. Nursing Research, Principle and Methods, 5th ed. Philadelphia, PA: Lippicot Company, 1995.Google Scholar
22Ely, M, Anzul, M, Friedman, T, Garner, D, Steinmetz, AM. Doing Qualitative Research: Circles within Circles. London: The Falmer Press, 1998.Google Scholar
23Friedewald, WT, Levy, RJ, Frederickson, DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge. Clin. Chem. 1972; 18: 499–502.CrossRefGoogle ScholarPubMed
24Society for Endocrinal Metabolism and Diabetes of Southern Africa. Guidelines for Type 2 Diabetes at Primary Care Level. Johannesburg: Servier, 1999.Google Scholar
25Lipid and Atherosclerosis Society of Southern Africa Working Group. Diagnosis, management and prevention of the common dyslipidaemias in South Africa – clinical guidelines, 2000. S. Afr. Med. J. 1999; 90: 164–77.Google Scholar
26Raubenheimer, PJ & Levitt, NS. What is good control in diabetes mellitus?. Cont. Med. Educ. 2000; 18: 915–8.Google Scholar
27Mahan, LK, Escott-Stump, S. Krause's Food, Nutrition, and Diet Therapy, 10th ed. Philadelphia, PA: WB Saunders Company, 2000.Google Scholar
28World Health Organization (WHO). Arterial Hypertension. Report of a WHO expert committee. WHO Technical Reports Series No. 628. Geneva: WHO, 1978.Google Scholar
29American Heart Association (AHA). Dietary guidelines for healthy American adults. Position statement. Circulation 1988; 77: 721A–4A.Google Scholar
30Steyn, NP, Burger, S, Monyeki, KD, Alberts, M, Nthangeni, G. Seasonal Variation in Dietary Intake of the Adult Population of Dikgale. Sovenga: University of the North, 1999.Google Scholar
31Steyn, NP, Senekal, M, Brits, S, Nel, JH. Urban and rural differences in dietary intake, weight status and nutrition knowledge of black female students. Asia Pacific J. Clin. Nutr. 1999; 9: 53–8.CrossRefGoogle Scholar
32Steyn, NP, MacIntyre, UE, Olwagon, R, Albert, M. Validation of multiple 24-hour recalls in a rural adult population using energy intake and estimated basal metabolic ratios. Epidemiol Infec. 2001; 16(1), 23–6.Google Scholar
33Nuttall, FQ. Dietary fiber in the management of diabetes. Diabetes 1993; 42: 503–6.CrossRefGoogle ScholarPubMed
34Bertelsen, JC, Christiansen, C, Thomsen, C, Poulsen, PL, Vestergaard, S, Steinov, A, Rasmussen, LH, Rasmussen, O, Hermansen, K. Effect of meal frequency on blood glucose, insulin, and free fatty acids. Diabetes Care 1993; 16: 4–7.CrossRefGoogle ScholarPubMed
35Jenkins, DJ, Ocana, A, Jenkins, AL, Wolever, TM, Vuksan, V, Katzman, HM, Greenberg, G, Patten, R. Metabolic advantages of spreading nutrient load: effects of increased meal frequency in non-insulin dependent diabetes. Am. J. Clin. Nutr. 1992; 55: 461–7.CrossRefGoogle ScholarPubMed
36Venter, CS, Voster, HH, Van Rooyen, A, Kruger-Locke, MM, Silvis, N. Comparison of the effects of maize porridge consumed at different temperatures on blood glucose and acetate levels in healthy volunteers. S. Afr. J. Food Sci. Nutr. 1990; 2: 2–5.Google Scholar
37Silvis, N. Nutritional recommendations for individuals with diabetes mellitus. S. Afr. J. Food Sci. Nutr. 1992; 81: 162–6.Google ScholarPubMed
38Turner, RC, Millns, H, Neil, HAW, Stratton, IM, Manley, SE, Matthews, DR, Holman, RR. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS: 23). BMJ 1998; 316: 823–8.CrossRefGoogle ScholarPubMed
39Grundy, SM. Hypertriglyceridemia, atherogenic dyslipidemia, and the metabolic syndrome. Am. J. Cardiol. 1998; 81(4A), 18B–25B.CrossRefGoogle ScholarPubMed
40Mbenyane, XG. The glycemic index of indigenous South African foods. PhD thesis, Potchefstroom Universiteit vir Christelike Hoer Onderwys, Potchefstroom, 1997.Google Scholar