الفهرس 
Diabetes MellitusOnly 14 pages are availabe for public view
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Abstract
Diabetes mellitus is a chronic illness that requires continuing medical care and ongoing patient self-management education and support to prevent acute complications and to reduce the risk of long-term complications.
Type 1 diabetes is a common chronic disease in childhood associated with long-term damage, dysfunction and failure of various organs. Type 1 diabetes is the outcome of environmental, genetic and immunologic interactions.
According to international diabetes federation, Arab region has one of the world highest rates of diabetes, A multidisciplinary team composed of physicians, diabetes educators, dietitians, nurse educators and psychologist is needed. The chief aim of the therapy is to obtain near normal blood glucose level and maintain good control over the years. The primary goal of medical nutrition therapy (MNT) for individuals with diabetes mellitus is to help them optimize their metabolic control through dietary choices that are attainable and sustainable within the culture, preferences, and capacities of the patients themselves. For youth with type 1 diabetes, coordination of food intake, physical activity, and insulin needs is emphasized to achieve blood glucose goals.
The main aim of the present study is to assess anthropometric status, dietary intake and nutritional management of children and adolescents with diabetes in benghazi- libya, The specific objectives are to study the sociodemographic features, to assess the anthropometric status, food habits and dietary intake of the diabetic children, to evaluate the process of dietary management and nutritional counseling practiced by hospital dietitians and to relate the degree of compliance to dietary intake recommendations with glycemic control.
The present study was conducted on recently diagnosed diabetic children and adolescents attending pediatric hospital in Benghazi- libya, A total sample of 97 subjects, aged 8-18 years, both sexes was selected.
Data was collected using four tools, interview questionnaire, anthropometric assessment, record review from patient files, and observational checklist for hospital dietitians involved in the education program of nly diabetic children. A predesigned questionnaire was used to collect data on sociodemographic characteristics, personal and family characteristics, child and maternal history, infant feeding pattern and life style pattern of diabetic children. Anthropometric assessments for weight, height, body mass index and waist circumference were done. 24 hour recall methed was used to asses food consumption presented in the form of mean intake in household measures and food frequency questionnaire was completed to assess the frequency of consumption of all foods and drinks the week before diagnosis of the disease.
A record review from patient files to record fasting blood sugar, sugar and acetone in urine, diastolic and systolic blood pressure and glycated hemoglobin. An observational checklist for the hospital dietitian to record meal planning approach, number and timing of meals and snacks, insulin regimen used, covering sick days and exercise guidelines, and management of hypoglycemia.
Data management: BMI and waist circumference were categorized by using the percentile system. Findings of 24-hour recall method All food and drink consumed during the last 24 hours was asked for in the form of household measures. Then this was analysed into its components which include energy, protein, carbohydrate, fat, minerals (iron, calcium, zinc) and vitamins (A and C), and food frequency questionnaire subjects or their mothers were asked about the frequency of consumption of each food item and the amount of it to indicate how often, on the average, they consumed each item per day, per week , or less than that (rare consumption). Nutrient adequacy and nutrient density of diet was also calculated. Also, relations were done between glycated hemoglobin and some study parameters as (BMI for age, weekly exercise, intake of concentrated sugary foods, constansy of meal times and nutrient density) Statistical management of the collected data was done using descriptive statistics (arithmetic mean, standard deviation and graphical presentation).
Main findings revealed the following:
The studied sample was composed of 97 diabetic children. Their ages ranged from 8-18 years, with mean age for both sex was 10.27±2.51 year for males vs 13.7±2.75 year for females. The greatest percent of diabetic children was during early adolescence, and males gt the disease in higher percentage than females 67% vs 33%. Referring to family characteristics, about the nationality all subjects of the sample were libyan. About education of parents the illiteracy level was low (5.2% in fathers, 13.4% in mothers) and the highest percentage for education level was for university and over. The percentage of working mothers was higher than that of non working (66% vs 34%). Mean Per capita income was 146.8±45.95 L.D, and this was enough for them. The mean family size was 6.6±1.74, and the highest percentage (54.6%) was for the range 6-8 persons.
Concerning birth order, the highest percentage was among the high birth order from the third and more. Concerning child and maternal history characteristics, 63.9% gave positive family history of DM. About (29.9%) of children gave positive history of exposure to infectious disease before occurrence of DM. All subjects of the sample did not take any drugs and 44.3% were exposed to sad stressful situations. Maternal exposure to infectious disease during pregnancy was present among 19.6% of the sample mothers. The mean maternal age at giving birth of the diabetic child under study was 30.0±6.66 year. Regarding infant feeding, only 5.2% were exclusively breast fed, and 89.7% on mixed feeding. The majority (81.4%) were introduced wheat diet from age of one month to eleven months of age and about 47.4% to cow’s milk at age of 1 month. The mean duration of breast feeding was 4.0±4.52 months.
Concerning life style pattern, 80.4% of the subjects have no weekly regular activity. Findings of relation between practice regular weekly physical activity and low glycated hemoglobin in our study demonstrated a significant association between them.
Anthropometric characteristics revealed that Mean body height was 141.3±20.0 cm and 161.7±6.9 cm for younger and older males, and 132.9±15.03 cm and 149.0±8.13 cm for younger and older females, Mean body weight was 42.5±12.34 kg and 57.9±10.03 kg for males, and 40.6±9.85 kg and 47.4±6.63 kg for females, for younger and older age groups. Height for age percentile 69.7% and 75.0% was normal while 30.3% and 25.0% was stunted for younger and older males, and 33.3% and 64.7% was normal while 66.7% and 35.3% was stunted for younger and older females. There was a significant difference between males and females in HAP of younger age group.
BMI for age categories, 30.3% and 53.1% was normal,45.4% and 43.8% was overweight while 24.2% and 3.1% was obese for younger and older males. For females 26.7% and 88.2% was normal, 40.0% and 11.8% was overweight for younger and older females while 33.3% and 0.0% was obese for younger and older females. The present study revealed that there is no significant association between glycemic control and BMI for age (P=0.26) Waist-Hip ratio was in the normal range for 90.9% and 90.6% of younger and older males and 73.3%, 76.4% of younger and older females.
Dietary data showed daily caloric intake was adequate in about three quarters in both sex for younger age group. While all males and 70.6% of females of older age group have inadequate caloric intake. Protein and carbohydrate intake of both sex in younger and older age groups of the sample was adequate, The majority of the sample have inadquate calcium intake. Intake of zinc of the whole sample was adequate, but iron intake was adequate in younger age group for both sex, but the older age group have inadequate iron intake (31.2% in males, 11.8% in females), About vitamins intake, more than half of males and about three quarter of females of younger age group have adequate vitmin A intake and the majority of older age group have inadequate vitamin A intake. About vitamin C the majority of the younger age group have adequate vitamin C intake, while older it was inadequate in 40.6% of males and 25.5% of females. Nutrient density of the consumed diet showed that all macronutrients were within recommendations, except fat intake especially in females exceeded it. Also carbohydrate intake in older group males exceeded the RDA. The present study revealed that there is no significant association between glycated hemoglobin and fat density and protein density, but there is significant association between glycated hemoglobin and carbohydrate density. Concerning food habits fried food takes the highest type of food taken.
Concerning record review of laboratory investigations, fasting blood sugar mean was 169.3±36.0 mg/dl, glycated hemoglobin mean was 8.0±0.90% with sugar in urine in 99.0% of subjects and acetone in urine in 12.4% of the subjects.
Observational checklist for the role of dietitian in nutrition care and counseling activities during the hospital stay of the newly diagnosed diabetic children and adolescents, demonstrated that time of offering daily meals and snacks was fixed in (64.3%) of cases. No meal planning approaches were given to them by practicing dietitian. Counseling activities, covering the sick day guidelines was given in 62.9% of cases. Covering exercise guidelines, and management of hypoglycemia was given in 38.1% and 90.7% of cases respectively.
The main conclusion Positive family history of diabetes was present among 63.9% of the sample. Child characteristics revealed a pattern of increased risk of developing type DM is associated with presence of infectious disease, and exposure of the child to stressful situation. Short duration of breast feeling, early introduction of cow’s milk and wheat diet were predominant practices. Lack of physical activity was prominent among the study sample. Overweight and obesity were more evident among males especially of the younger age group. Unhealthy eating habits were common such as low intake of fibers, nuts, olive oil,fruits and high intake of fried foods, starchy foods and concentrated sugary foods. The practice of Nutrition counseling by hospital dietitians for children either those newly admitted to hospital or those attending outpatient diabetes clinic about meal planning approaches was absent. Counseling activities were good in case of covering sick day guidelines, and management of hypoglycemia, but in covering exercise guidelines the practices were poor.
The main recommendations, Raising education of society which leads to healthy food habits for the family (parents and children) by rich fiber diet, decrease saturated and trans fat intake, control high sugar and beverages, increasing intake of monounsaturated and polyunsaturated fat. Encouraging regular physical activity and decrease sedentary life. The need for developing a guide manual to educate and inform school personnel about diabetes, also weekly/ monthly campaigns for children to practice healthy life by exercise and food habits. Insurance on the role of specialized dietitian for almost every part of medicine. Association or club for diabetic subjects and their families. Research studies should be conducted to develop new procedures for management and nutrition therapy to reach all numbers of diabetes subjects.