Anthropometric, dietary intakes and exercise habits of niddm in guntur city
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    Anthropometric, dietary intakes and exercise habits of niddm in guntur city Anthropometric, dietary intakes and exercise habits of niddm in guntur city Document Transcript

    • Jalaja Kumari D et al., IJSID, 2012, 2 (3), 359-365 ISSN:2249-5347 IJSID International Journal of Science Innovations and Discoveries An International peer Review Journal for Science Research Article Available online through www.ijsidonline.info ANTHROPOMETRIC, DIETARY INTAKES AND EXERCISE HABITS OF NIDDM IN GUNTUR CITY Faculty, Dept.of Foods and Nutritional Sciences, Acharya Nagarjuna University, Guntur, AP, India JALAJA KUMARI.D A study was conducted to know the dietary pattern and exercise behavior of type-Received: 12.02.2012 ABSTRACT 2 diabetics (n=50) using pretested schedule. Twenty five (50%) subjects were in I degreeAccepted: 16.06.2012 obesity classification. Obesity was prevalent among more than 50% of selected diabetics. More than half the diabetics had no family history of disorder. Most of the diabetics were on allopathic medicines (96%). The routine meal pattern was three meals and one snack,*Corresponding Author followed by three meals. The common foods restricted were those rich in sugar, and fruits rich in sugar. Millets, cereal rotis and porridge, bitter gourd and vegetables were the special foods included for diabetes. Indigenous hypoglycemic foods such as fenugreek seeds, Jamun seeds, "ekanavakam roots and bitter gourd juice were consumed. Smoking (14.29 %) and drinking alcohol (47.62 %) were the vices seen in male diabetics. Half the diabetics (53.57Yo) had initiated exercise less than a year back. Walking was the main form of exercise (92.86%) followed by swimming and yogasana (7.69% each).Address: INTRODUCTIONName: Keywords: Type 2 Diabetes, Body Mass Index, Hypoglycemic Foods, Dietary intakes, PhysicalJalaja Kumari D activity/ExercisePlace:Guntur, AP, IndiaE-mail:jalaja9krishna@yahoo.com INTRODUCTION International Journal of Science Innovations and Discoveries, Volume 2, Issue 3, May-June 2012 359
    • Jalaja Kumari D et al., IJSID, 2012, 2 (3), 359-365 Diabetes mellitus has emerged out as a world wide health problem affecting millions of people in both developing and INTRODUCTIONdeveloped countries. It now affects higher proportion of persons in many developing countries than it does in westerncountries. This trend is linked with moves from traditional to modern life style and changes in diet and physical activity. Dietand exercise are considered important components of the treatment strategy for adults with type 2 diabetes. Appropriate useof diet and exercise can improve insulin sensitivity and glycemic control and decrease the need for oral medications orinsulin1,2. Although there is some controversy over the optimal diet for adults with type 2 diabetes (high fiber, Glycemic indexapproaches, low versus moderate fat3.4, there is a consensus to increase consumption of fruits and vegetables and decreasedaily consumption of saturated fats4. Although dietary management is the corner stone of any treatment programme in diabetes, implementation of diettherapy is the biggest problem in diabetes5. The dietary habits of elderly diabetics 6. The dietary habits and exercise pattern ofnon insulin dependent diabetes subjects. Faulty diet regimes can make the best of medicine ineffective 7. So the present studywas conducted to know the dietary habits and exercise behavior of type 2 diabetics. An investigation was undertaken at the out patient department of diabetes clinic at Govt. General Hospital (G.G.H), MATERIAL AND METHODSGuntur. About 50 Type 2 diabetics above 50 years of age, who could spare their time for the interview were selected andinterviewed by using pre-tested schedule. The schedule consisted of general information and questions on dietary habits, thevices present and the exercise behavior of diabetics. Results of the general information of diabetics are presented in the table 1. The onset of diabetes was maximum RESULTS AND DISCUSSIONbetween the ages of 50-60 years followed by the age group of 40-50. More than half (52%) the subjects had no family historyof diabetes. The environmental factors play an important role in causation of diabetes. Increased calorie intake, sedentary lifestyle, intake of refined carbohydrates and low fibre can result in obesity leading to diabetes. Most of the diabetics were onallopathic medicines (90%), out of this 60 per cent on sulphonylurea and 16 per cent on biguanides and 14 per cent oncombination of the two drugs. The distribution of the selected diabetics according to the Body Mass Index (B.M.I) is presented table 2. This tableshows that out of the 50 subjects 11(22%) had BMI between 20-25, which indicated normal health. Twenty five (50%)subjects were in I degree obesity classification. Their body mass indicates were more than 25. Twelve (24%) subjects wereBMI below normal. Obesity was prevalent among more than 50% of selected diabetics. The higher rate of non-insulindependent diabetes may be etiologically linked to the morbid obesity and associated insulin resistance 8. Obesity is themetabolic gateway to the disorders of the elderly like Type II diabetes, atherosclerosis, hypertension and osteoarthritis 9. Majority of diabetics were non vegetarians (60%) (Table3). The routine meal pattern was three meals and one snack per day (52%) followed by three meals alone (34%) and two meals and a snack (12%). There is a need to counsel the diabetics to consume the meals regularly and not to skip the breakfast. Common foods restricted by diabetics were (Table 4) those rich in carbohydrates and fats and fleshy foods. More than half avoided sweets such as sugar, jaggery (54%) sweet fruits (10 %), cool drinks and tea. The observed modification of diet was due to the advice given by physician and the other diabetics. A similar observation was made in another large cohort study, who International Journal of Science Innovations and Discoveries, Volume 2, Issue 3, May-June 2012 360
    • Jalaja Kumari D et al., IJSID, 2012, 2 (3), 359-365reported awareness among 3000 diabetics of Australia6. Majority of diabetics (72%) included one or more food forthe management of diabetes (Table 5). Subjects Table 1: General information of diabetics regarding diabetes mellitus Total n=50 Characteristics Male n=21 Female n=29 Frequency % Frequency % Frequency % <1 3 14.29 7 24.14 10 20 Duration (year) 1-5 9 42.86 11 37.93 20 40 5 - 10 7 33.33 5 17.24 12 24 > 10 2 9.52 6 20.69 8 16 30 - 40 1 4.76 1 3.45 2 4 Age of Onset (Years) 40 - 50 6 28.57 13 44.83 2 19 4 38 50 - 60 11 52.38 12 41.38 23 46 > 60 3 14.29 3 10.34 6 12 Both parents 1 4.76 0.00 0.00 1 2 Family History of Diabetes One parent 5 23.81 11 37.93 16 32 Blood related members 3 14.29 4 13.79 7 14 No family history 12 57.14 14 48.28 26 52 No medication 2 19.52 - - 2 4 Medication Medication 19 90.48 29 100.00 48 96 Allopathic alone 18 85.71 27 93.10 45 90 Sulphonylurea 13 6190 17 58.62 30 60 Biguanides 2 9.52 6 20.69 8 16 Combination 3 14.29 4 13.79 7 14 Ayurvedic & allopathy 1 4.76 1 3.45 2 4 Homeopathic 0 0 1 3.45 1 2 Classification* Male n=21 Femalen=2 Table 2: Distribution of the selected diabetics according to Body Mass Index (B.M.I) Frequency % 9 Frequency % 16.0 (III Degree CED) 0 0 0 0 16.0-17.0 (II Degree CED) 0 0 0 0 17.0-18.49 (I Degree CED) 0 0 0 0 18.5-20.0 (Low normal) 3 14.3 9 31.0 20.0-25.0 (Normal) 10 47.6 1 3.5 25.0-30.0 ( Over weight / I Degree Obesity) 8 38.1 17 58.6 >30.0 (II Degree Obesity) Nil 2 6.9 *NIN (1999); CED – Chronic Energy Deficiency International Journal of Science Innovations and Discoveries, Volume 2, Issue 3, May-June 2012 361
    • Jalaja Kumari D et al., IJSID, 2012, 2 (3), 359-365 Millets were included in the form of dumpling and ganji (12%), Jowar roti and porridge (6% each), among thevegetables, bitter gourd found a prominent place in the form of juice and bhaji (18%) followed by increased consumption ofvegetables (8%) and vegetable salads (4%). Similar awareness about the foods among diabetics 6. Forty eight per centdiabetics included foods such as green leafy vegetables, bitter gourd and millets in diabetes management 7. Table 3: Dietary pattern of Diabetics Dietary pattern Male n=21 Female n=29 Total n=50 Frequency % Frequency % Frequency % Type or Meal Vegetarian 7 33.33 13 44.83 20 40 Non- Vegetarian 14 66.67 16 55.17 30 60 Meals per day Three meals 7 33.33 10 34.48 17 34 Three meals and snacks 9 42.86 17 58.62 26 52 Two meals 0 --- 1 3.45 1 2 Two meals and snacks 5 23.81 1 3.45 6 12 Table 4: Foods restricted and avoided by diabetics Foods restricted Frequency % Reasons given Sweets, sugar and jiggery 21 42 Raise the sugar level, contain sugar Foods rich in Carbohydrates Chocolates 2 4 Rice 26 52 Potato 7 14 Sweet potato 1 2 Carrot 1 2 Mutton 8 16 Contain fat & raise the weight Fleshy Foods Eggs 1 2 Ghee 5 10 Cause heart attack Fats Butter 1 2 Fruits in general 5 10 Contain more sugar Fruits Banana 6 12 Sapota 2 4 Grapes 2 4 Sugar, jiggery and sweets 27 54 Raise the blood sugar Foods avoided Tea 2 4 Potato 3 6 Fruits in general 5 10 Banana 2 4 Sapota 1 2 International Journal of Science Innovations and Discoveries, Volume 2, Issue 3, May-June 2012 362
    • Jalaja Kumari D et al., IJSID, 2012, 2 (3), 359-365 Inclusion of foods 72 (36) Foods included % Quantity No inclusion 28 (14) Ragi dumping and ganji 12 (6) 2 tsp. – 100g Millets Navne rice 02 (1) 30 – 40g Jower porridge 6 (3) 40g – 50g Jower roti 6 (3) 2-3 No Increased quantity of vegetables 8 (4) 50 – 100g Vegetables Vegetable salads 4 (2) 50 – 75g Bitter gourd juice and bhaji 18 (9) 1 No Ladies finger 6 (3) 4 No Knol khol 2 (1) 1* No Green leafy vegetables in general 6 (3) 50g Fenugreek leaves 4 (2) 50 – 100g Drumstick leaves 2 (1) 25*g Citrus fruits 2 (1) ½ to 5 Nos. per week Fruits Jamun 6 (3) 5 – 10* Fenugreek seeds 18 (9) 1 tsp. Spices Cumin seeds 2 (1) 1 pinch Milk 2 (1) 1 cup *Wherever available; **Figures in parenthesis indicate numbers. Table 5: Foods specially included for management of diabetes** Indigenous hypoglycemic foods were used by 36 percent of subjects (Table 6) for the control of diabetes. Fenugreekseeds either singly (18%) or in combination with other spices (6%) and bitter gourd juice (6%) were used for control ofdiabetes. Very few included Jamun seed powder and ekanaykam roots. Fenugreek seeds are known for its hypoglycemicactivity10 and hypoglycemic activity of bitter gourd and ekanayakam is proved 11, 12. Table: 6 Intake of indigenous hypoglycemic foods in habitual diet Subject N=50 Hypoglycemic foods 18 36 Foods Direction of use Quantity Frequency % Fenugreek seeds 9 18 1-2 months 1,2 t spoons Fenugreek, cumin and 1 6 6-8 months ½ t spoon kalounji mixture Fenugreek, bitter gourd 1 2 12 months ½ t spoon and patri mixture Bitter gourd juice 3 6 6 months to 5 years 1 bitter gourd Jamun seed powder 2 4 3 weeks ½ t spoon Eknayakam, (salacia 1 2 2 months 1 pinch prenoides roots) No hypoglycemic seeds 32 64 The prevalent vices in diabetics (Table 7) were smoking (14.29%) and drinking alcohol (47.62%) in males. Tobaccochewing and snuff inhaling was seen in negligible subjects. In the present study majority of diabetics had no vices. Similar International Journal of Science Innovations and Discoveries, Volume 2, Issue 3, May-June 2012 363
    • Jalaja Kumari D et al., IJSID, 2012, 2 (3), 359-365observations (68%) have been made in another large study 7. The vices, being absent in majority of diabetics in the presentstudy may be due to the awareness regarding the bad effect of alcohol, cigarettes and tobacco. Table 7: Prevalent vices in diabetes Subjects N=50 Vices Males n = 21 Females n = 29 Total Vice present 15 71.42 1 3.45 16 32 Frequency % Frequency % frequency % Smoking 3 14.29 0 0 3 6 Tobacco chewing 1 4.76 1 3.45 2 4 Snuff inhaling 1 4.76 0 0 1 2 Alcohol 10 47.62 0 0 10 20 consumption occasional) None 6 28.58 28 96.55 34 68 Table 8: Exercise behavior of diabetes Subjects N= 50 Characteristics Males n = 21 Females n = 29 Total Frequency % Frequency % frequency % Yes 13 61.90 15 51.72 28 56 Regular exercise No 8 38.10 14 48.58 22 44. <1 8 61.55 7 46.67 15 53.57 Period of initiation ( years) 1-5 2 15.35 6 40.00 8 28.37 5-10 2 15.38 2 13.33 4 14.29 >10 1 7.67 - - 1 3.57 Daily 11 84.62 13 84.69 24 85.71 Frequency of exercise Thrice a week 2 15.38 1 6.66 3 10.71 Once a week - - 1 6.66 1 3.58 Walking 11 54.62 15 100 26 92.86 Type of exercise Swimming 1 7.69 - - 1 3.58 Yoga and walking 1 7.69 - - 1 3.57 <1hr 5 38.56 11 73.33 16 57.14 Time spent on exercise 1-2 hrs 8 61.54 4 26.67 12 42.86 About 56 per cent of diabetics were regular exercisers (Table 8), higher percentage of men exercised compared towomen (61.9 % men and 51.72 % women). Nearly half (53.57 %) had initiated exercise less than a year back. Walking everyday was the main form of exercise (92.86 %) followed by swimming and yogasana (7.69% each). Anon (1996) has suggestedwalking as the most appropriate exercise for the diabetics. Benefits of yoga have been reported on the diabetics 14. In thepresent study the awareness about exercise led to the positive exercise behaviour in the diabetics. Thus, it can be concluded that more than half the diabetics had no family history of diabetes and most of them were on CONCLUSIONallopathic drugs. They were aware of the foods to be restricted hypoglycemic foods and the special foods beneficial for International Journal of Science Innovations and Discoveries, Volume 2, Issue 3, May-June 2012 364
    • Jalaja Kumari D et al., IJSID, 2012, 2 (3), 359-365diabetes management. Most of them had no vices and half the subjects followed regular exercise mostly in the form of walking.Diabetes is not curable; one has to live with it. Living with diabetes is like living with diabetic lifestyle. There is urgent need tocreate awareness amongst the population for prevention of diabetes.1. Chandalia M, Garg A, Lutjohann D, von Bergmann K, and Grundy SM, Brinkley LJ: Beneficial effects of high dietary fiber REFERENCES intake in patients with type 2 diabetes mellitus. N Engl J Med, 2000, 342:1392–1398.2. Horton ES: Exercise and diabetes mellitus. Med Clin North Am, 1998, 72:1301–1321.3. Garg A: High-monounsaturated fat diet for diabetic patients: Is it time to change the current dietary recommendations? Diabetes Care, 1994, 17:242–246.4. American Diabetes Association: Evidence- based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications (Position Statement). J Am Diet Assoc, 2002, 102:109–118.5. Nutrition and Your Health: Dietary Guidelines for Americans. Washington, DC, US Department of Agriculture, US Department of Health and Human Services, 1995 (Home and Garden Bulletin no. 232)6. Howarth, C.C and Worsley, A. Dietary habits of elderly persons with diabetics. Journal of American Dietetic Association, 1991, 91: 553-557.7. Torangatti, G and Naik, R.K.: Dietary behaviour and exercise habits of non insulin dependent diabetic patterns, Karnataka Journal of Agricultural Sciences, 2002. 13(3): 697-702.8. Chan, N.N. and Bridges, N.A. Metabolism forming therapy for diabetes in Prader-Willi syndrome. JRSM, 1998, 91, 78.9. Sadhukhan, B. Progress in obesity research: 7, Proceedings of the VII international congress on obesity, 1997, 20-25.10. Raghuram, TC; Pasricha, S. and Sharma R. D.: Diet and Diabetes. NIN, Hyderabad (1998).11. Upadhyaya, G I.. Kumar, Ajay and Pant M. e.: Effect of Karela as hypoglycemic agent. Journal of Diabetic Association of India 1985, , 25(1): 12-15.12. Kowsalya, S., Usha. C. and Geetha, N.: Development and evaluation of a hypoglycemic tablet with herb Salacia prinoides, The Indian Journal of Nutrition and Dietetics, 1996, 32(1): 33-39.13. Anonvmous: A Hand Book for the Management of SIDDM Based on lndian Consensus. A Diabetic Care Service. Bocbringer Mannhe im India Ltd. Mumbai (1996).14. Das, S.: Newer oral hypoglycemic drugs. Proceedings of Nidus Diabetelogy, 1998, 3: 59. International Journal of Science Innovations and Discoveries, Volume 2, Issue 3, May-June 2012 365