EVALUATION OF NUTRITION AND HEALTH STATUS AMONG CHILDREN WITH DIABETES.

Introduction

Nutrition recommendations are developed and implemented to meet treatment goals and desired outcomes for children with type 2 diabetes. It is essential that ongoing nutrition self-management education and care be provided for individuals with diabetes American diabetes affectation (ADA). Nutrition status should be evaluated for children with type 1 Diabetes mellitus (DM) as they are growing and they are usually underweight with malnutrition probably because of diabetes itself as a debilitation disease or because of associated celiac disease (American Diabetes Association, 2000).

One of the first steps in managin g type 1 DM is diet control. The diet treatment is based upon nutritional assessment and treatment goals. Diet recommendations should be made in view of the patient's eating habits and lifestyle. Diet management includes education about the timing, size, frequency, or composition of meals to avoid hypoglycemia or postprandial hyperglycemia. In these patients, the caloric distribution is important; a recommended distribution consists of 20% of daily calories for breakfast, 35% for lunch, 30% for dinner, and 15% for late evening snack. The minimum protein requirement for good nutrition is 0.9 g/kg/d (range = 1-1.5 g/kg/d), at intake should be limited to 30% or less of the total calories, and a low-cholesterol diet is recommended. Patients should consume sucrose in moderation and increase their fiber intake. In some cases, mid morning and mid afternoon snacks are important to avoid hypoglycemia. The role of diet in type1 is to provide adequate nutrition for proper growth, supplement nutrition deficiency secondary to diabetes and to help in metabolic control of diabetes namely hyperglycemia (American Diabetes Association, 2001). The present study aimed to assess dietary nutritional status in relation to body measurements, and metabolic control among children with type1 diabetes

SUJECTS AND METHODS

Subjects:

A total number of 40 patients with type 1 diabetes mellitus for more than 3 years who were receiving their diabetic care at the diabetic unit in the outpatient department of sugar institute were recruited. They were divided into 2 groups: Group 1 for boys(n=20) and group 2 for girls (n= 20). The age of children range was 7-13 years. Exclusion criteria included type 2 diabetes , presence of acute illnesses, acute diabetic complications as diabetic ketoacidosis, chronic diabetic complications. Children diagnosed with celiac disease were excluded as well as children who were under special dietary restriction other than for diabetes or receiving any form of dietary supplementations.

Methods:

Des  caption of subjects:

1-      Demographic data :Age, gender, degree of consanguinity, type of diabetes mellitus, number of the diabetics in the family and  smoking among fathers.

2-      Socioeconomic data: level of education, occupation of parents, school year, and family income.

3-       Biodemographic Status

1. The most frequent symptoms encountered by the children duringthecourse of their illnesses.
2. The cause of disease as believed by the child:  Genetics, food induced, psychological state, viral induced, immunity related or unknown
3. The change of the weight as noticed by the child:
4. The history of regular exercise.

4-      Dietary history:

1. The daily food consumed, using 24 hour recall method.
2. Food that they like, or dislike.
3. Food intake when children feel hungry according to( WHO,1995).

Physical examination:

Anthropometric measurements:

Anthropometric measurements  and percentile body mass index for age were performed for all children according to the method of(Jellyfe, 1966).

Biochemical analysis:

1. Hemoglobin level was determined as the method published by to Waterman et al.,(1975).
2. -Blood sugar level was determined by home blood glucose momiter.

Nutritional assesment:

Daily dietary consumption by each child was calculated using Food composition Tables (Nutrition Institute, 1996). Total fat (g), saturated fatty acid SFA (g) monounsaturated MFA (g) and polyunsaturated PFA (g) were calculated. The adequacy of diets with regard to dietary references Intake (DRI, 2000) and Recommended Dietary allowances (RDA, 1989) was calculated. Food frequency information were Analyzed according to krauss and Mohan (1992).

Statistical analysis

Of all data were performed by using computer program, Statistical Package Social Science ( SPSS, 1998).

RESULTS  AND  DISCUSSION

Table (1) shows the mean age, weight, height and BMI for the studies groups. Means for age, weight and BMI were nearly equal in boys and girls patients, while the height was higher in girls than in boys significantly''

According to the BMI curves (for boys mean age was 8.5 ± 1.83, BMI was 22.03 ± 15.01, for girls, mean age was 8.7±1.91, and BMI was 21.78±13.75). This significant difference could be explained by the earlier growth spurt in girls. BMI for both boys and girls are higher than their 95 percentile . These results agreed with that of Nafiu et al., (2007).

Data in table (2) shows the socio-economic status of patients. It is noticed that all the studied children were in the primary school, boys were clustered in the 3^rd year (30%) and girls in the fifth year (25%). It can be seen that 40% of fathers of boys children received education to the middle level, while those of girls children were nearly equal in their educational level. For mothers education level of boys children 25% received middle or secondary education, while, 35% of those of  boys  received middle education. History of smoking by fathers were detected in 45% of boys and 40% of girls children. High family income (≥ 6000 SR monthly) is found in 60% among boys and 50% among girls.

            Table (3) shows the most frequent presenting symptoms among boys children with type 1 diabetes which were polyurea, dry mouth, dizziness, hunger pains, sweating, and less frequently blurring of vision. Among the girl children, symptoms were polyurea, hunger pains, and less frequently sweating. dizziness, blurring, mouth & dryness . Polyurea is more in boys than girls (25% of boys and 15% in girls ) .  On the other hand, other non diabetes related common symptoms was  sneeze (25% of boys and 30% in girls). These findings agreed with Jasinskl et al .,(2003) who stated that prevalence of dryness mouth, polydpsia and polyuria and agreed with Rosenbauer et al., (2002) who reported that polyuria was the most common symptom.

Data in table (4) shows the biodemographic status.weight loss was in  60%  and  50% for boys and girls respectively white exercise appear in boys as 55% and 75% of girls were no excerceis. These results agreed with Rosenbauer et al., (2002) and Jasinski et al., (2003).

Data in table (5) shows the hemoglobin level and glucose level for studied samples.

It noticed that 60% & 50% of boys and girls patients respectively have moderate hemoglobin level (13-14 gm/dl). Also 75% & 85% for boys and girls patients respectively had uncontrolled fasting blood sugar level (>130 mg/dl). 70% & 60% of boys and girls, respectively had uncontrolled post prandial blood sugar levels (≥160 mg/dl) and 65% & 55% respectively had > 200mg/dl  random blood sugar.

Table (6) shows the type of the meal snacks, 85% of boys and 90% of girls consume snaks. Children were found to consume snacks when they felt hungry, not according to the dietary prescription by their dieticians. For boys snacks were 40% chips, 20% chocolate, 15% sweets or jams and 10% ice cream; for girls showed 25% sweets, 20% chips or ice cream, or jams, and 15% chocolate.

In table (7) the number of daily meals results show that 50% of boys and 45% of girls have five meals daily, 75% of boys and 65% of girls eat breakfast, 55% of boys and 60% of girls consume dairy products daily of them  and 15% of boys and 25% of girls consume dairy products twice daily. Thirty % of boys and 40% of girls consume legumes, 20% of boys and 35% of girls consume bran bread, 80% of boys and 65% of girls consume white bread, 65% of boys and 55% of girls consume red meat, and 100% of boys and 95% of girls consume chicken meat. Forty % and 65% of boys and 50% and 75% of girls consume fresh vegetables and fruits respectively.

            Table (8): Mean ± SD Of Macronutrients Intake Of Children .

Data of table (8) shows the mean daily nutrients intake by diabetic children, compared to their DRI. Mean macronutrients for boys and girls were higher than 100% of DRI except for carbohydrates for both gender (87% boys and 95% girls) and calories (90%) for girls only. On the other hand, macronutrients intake for boys were higher than girls except for protein-Plant and fat-Plant. These resultsagreed with Kylberg et al., (1985).

Mineral intake of boys was higher than 100% of DRI except for zinc  (95%) that consumed at lower than 100% of DRI. While minerals intake of girls were lower than 100% of DRI except for sodium, potassium and magnesium which consumed at higher than 100% of DRI. Mean vitamins intake of boys were higher than 100% of DRI except vitamin D and B₆. While mean vitamins intake of girls were lower than 100% of DRI except vitamin C, niacin and folates. These results agreed with that of  Patton et al., (2007) who reported that mean vitamin B12 and calcium intake were less than the dietary reference intake for girl children.

Table (10) shows the value of mean daily consumption of saturated, monoenoic, polyenoic and total unsaturated fatty acids, as percent, for the different sex groups. For boys C18:0, C14:0, C16:0 and C10:0 fatty acids with the highest percentage intake among other saturated fatty acids (21.77%, 20.49%,21.77 & 17.63%) respectively, which were for girls C10:0, C18:0 and C16:0 fatty acids had the highest percentage intake among other saturated fatty acids (19.42%, 19.42% and 16.39%) respectively. In the present study C16:1 fatty acid had the highest percentage intake among other monounsaturated fatty Acids (50.84% and 35.58%) for boys and girls respectively. Also C18:2 fatty acids showed the highest percentage intake among other polyunsaturated fatty acids (69.66% and 83.28%) for boys and girls respectively, while C20:4 fatty acid had the lowest intake among other polyunsaturated fatty acids being Nil for gender.

Table (11) shows the mean daily intake of fatty acids fractions and their percentage of essential fat daily intake according to different sex groups. It is noticed that mean percentage of omega-6 FA (% of RNI) was 50.26% in girls which was higher than boys (26.58%), but percentages for boys and girls were less than 100% of RNI. While the percent of omega-3 FA% of RNI in boys was higher than in girls. T.unsat. FA/T.sat. FA and P/S in girls were higher than boys previously. Orton et al., (2007) cullied out a comparison between omega-3 and omega-6 polyunsaturated fatty acid intake as assessed by a food frequency in young children at risk for developing type 1 diabetes. (Habib, 2005) recorded that prevention of diabetic ketoacidosis and reduction of its frequency should be a goal in managing children with diabetes and medical information and general awareness can contribute to this.

Recommendations

This study advise, recommended increasing the intakes of  fiber, legumes, fruits and vegetables And increasing milk and milk products in diet as and decreasing snack meals. It is recommended to increase intake of fiber, legumes, fruit and vegetables and also increase intake of milk and milk production in diet . In controly,It is recommended to decrease snack meals. Increasing nutritional knowledge as well  awareness and medical in for motions for parents and children in particularly care be provided for individuals with diabetes.

Table (1): Mean ± SD of age, anthropometric  measurements

for boys and girls patients with type 1 diabetes.

      *P< 0.05

Table (2): Frequency distribution of boys and girls patients according to socioeconomic status.

Table (3): The most frequent presenting symptomsamong children with type 1 diabetes .

Table (4): Biodemographic status of children with type 1 diabetes.

Table (5): Hemoglobinlevel (g/d I) and blood glucose level   (mg/100 ml) for study samples. 

Table (6): The type of the meal snacks.

Table (7): Food behaviour for studies samples.

Table (8): Mean ± SD of macronutrients intake of children.

#RDA: Recommended Dietary Allowances(1989).

DRI: Dietary Reference Intake (2002).                         *p<0.05               ***p<0.001

Table (9): Mean ± SD of micronutrients intake of children.

DRI: Dietary Reference Intake (2002).

Table (10): Mean ± SD of daily consumption (in g) of individual saturated and unsaturated fatty acids and their percentage of total FA for group according to different sex groups.

Table (11): Mean ± SD of fatty acids (g) and percentage of essential FA intake of (RNI) according todifferent sex groups.

P/S: T. Ployunsat. FA/T. sat . FA.

DI: Dietary Intake RNI: Recommended Nutrient Intake