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      Caregivers’ Nutrition Knowledge and Dietary Intake of Type 1 Diabetic Children Aged 3–14 Years in Uganda

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          Abstract

          Purpose

          This study aimed to assess the association between caregiver’s level of type 1 diabetes (T1D) nutrition knowledge with children’s dietary diversity score (DDS), mean intake of macronutrients, nutrient adequacy ratios (NARs) and mean adequacy ratio (MAR).

          Research Design and Methods

          A cross-sectional analytical study design was used. The study was conducted at 6 diabetes clinics in Uganda among 59 caregivers and 61 children. T1D nutrition knowledge survey (NKS) was used to assess the caregiver’s nutrition knowledge, and the 24-hour dietary recall and dietary diversity score (DDS) questionnaires were used to collect data on the child’s dietary intake.

          Results

          Majority (93.2%) of the caregivers had low T1D nutrition knowledge. Carbohydrate counting was the least performed nutrition knowledge domain. The children’s mean DDS, calorie intake and MAR were 5.7 ± 1.6, 666.7 ± 639.8 kcal and 0.7 ± 0.3, respectively. The mean NARs of carbohydrate, protein, and fat were 0.9 ± 0.3, 0.9 ± 0.4, 0.5 ± 0.5, respectively. There was a significant association between DDS with NARs of carbohydrate, protein, fat, vitamins A, B2, B3, B5, B12, folic acid, zinc and MAR. No formal education was significantly associated with a lower mean NKS score among caregivers ( p = 0.039). Caregivers’ T1D nutrition knowledge, age and family size explained 14% of variation in the child’s dietary diversity ( p = 0.041).

          Conclusion

          Despite poor nutrition knowledge among caregivers especially on carbohydrate counting, dietary diversity among children with T1D remained favorable. Excess carbohydrate intake was observed with inadequate intake of proteins, fats and micronutrients (vitamin A, B vitamins and calcium). Caregivers with low education were more likely to register poor nutrition knowledge; therefore, there is need to develop and tailor nutrition education programmes to enhance comprehensive learning among caregivers for improved outcomes.

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          Most cited references 52

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          Health promotion by social cognitive means.

          This article examines health promotion and disease prevention from the perspective of social cognitive theory. This theory posits a multifaceted causal structure in which self-efficacy beliefs operate together with goals, outcome expectations, and perceived environmental impediments and facilitators in the regulation of human motivation, behavior, and well-being. Belief in one's efficacy to exercise control is a common pathway through which psychosocial influences affect health functioning. This core belief affects each of the basic processes of personal change--whether people even consider changing their health habits, whether they mobilize the motivation and perseverance needed to succeed should they do so, their ability to recover from setbacks and relapses, and how well they maintain the habit changes they have achieved. Human health is a social matter, not just an individual one. A comprehensive approach to health promotion also requires changing the practices of social systems that have widespread effects on human health.
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            Introduction of β-carotene-rich orange sweet potato in rural Uganda resulted in increased vitamin A intakes among children and women and improved vitamin A status among children.

            Vitamin A deficiency (VAD) persists in Uganda and the consumption of β-carotene-rich orange sweet potato (OSP) may help to alleviate it. Two large-scale, 2-y intervention programs were implemented among Ugandan farmer households to promote the production and consumption of OSP. The programs differed in their inputs during year 2, with one being more intensive (IP) and the other being reduced (RP). A randomized, controlled effectiveness study compared the impact of the IP and RP with a control on OSP and vitamin A intakes among children aged 6-35 mo (n = 265) and 3-5 y (n = 578), and women (n = 573), and IP compared with control on vitamin A status of 3- to 5-y-old children (n = 891) and women (n = 939) with serum retinol 30 percentage points) and women (>25 percentage points) (P < 0.01), with no differences between the IP and RP groups of children (P = 0.75) or women (P = 0.17). There was a 9.5 percentage point reduction in prevalence of serum retinol <1.05 μmol/L for children with complete data on confounding factors (n = 396; P < 0.05). At follow-up, vitamin A intake from OSP was positively associated with vitamin A status (P < 0.05). Introduction of OSP to Ugandan farming households increased vitamin A intakes among children and women and was associated with improved vitamin A status among children.
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              B Vitamins and the Brain: Mechanisms, Dose and Efficacy—A Review

              The B-vitamins comprise a group of eight water soluble vitamins that perform essential, closely inter-related roles in cellular functioning, acting as co-enzymes in a vast array of catabolic and anabolic enzymatic reactions. Their collective effects are particularly prevalent to numerous aspects of brain function, including energy production, DNA/RNA synthesis/repair, genomic and non-genomic methylation, and the synthesis of numerous neurochemicals and signaling molecules. However, human epidemiological and controlled trial investigations, and the resultant scientific commentary, have focused almost exclusively on the small sub-set of vitamins (B9/B12/B6) that are the most prominent (but not the exclusive) B-vitamins involved in homocysteine metabolism. Scant regard has been paid to the other B vitamins. This review describes the closely inter-related functions of the eight B-vitamins and marshals evidence suggesting that adequate levels of all members of this group of micronutrients are essential for optimal physiological and neurological functioning. Furthermore, evidence from human research clearly shows both that a significant proportion of the populations of developed countries suffer from deficiencies or insufficiencies in one or more of this group of vitamins, and that, in the absence of an optimal diet, administration of the entire B-vitamin group, rather than a small sub-set, at doses greatly in excess of the current governmental recommendations, would be a rational approach for preserving brain health.
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                Author and article information

                Journal
                Diabetes Metab Syndr Obes
                Diabetes Metab Syndr Obes
                dmso
                dmso
                Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
                Dove
                1178-7007
                14 January 2021
                2021
                : 14
                : 127-137
                Affiliations
                [1 ]Department of Human Nutrition and Home Economics, Kyambogo University , Kampala, Uganda
                [2 ]Department of Food, Nutrition and Dietetics, Kenyatta University , Nairobi, Kenya
                [3 ]Department of Pediatrics and Child Health, Makerere University , Kampala, Uganda
                Author notes
                Correspondence: Nicholas Bari Ndahura Department of Human Nutrition and Home Economics , P.O Box 1 Kyambogo, Kampala, UgandaTel +256772636271 Email barindahura@gmail.com
                Article
                285979
                10.2147/DMSO.S285979
                7813451
                33469330
                © 2021 Ndahura et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 0, Tables: 21, References: 52, Pages: 11
                Funding
                Funded by: Kyambogo University African Development Bank Higher Education Science and Technology Project (Uganda);
                This study was supported by a grant from the Kyambogo University African Development Bank Higher Education Science and Technology Project (Uganda). However, the design, analysis, and reporting of the results are independent of the funder.
                Categories
                Original Research

                Endocrinology & Diabetes

                nutrition education, type 1 diabetes, nutrient intake, diabetes, adolescents

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