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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Health promotion by social cognitive means.

Albert Bandura (2004)

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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Food variety and dietary diversity scores in children: are they good indicators of dietary adequacy?

NP Steyn, JH Nel, G Nantel … (2006)

To assess whether a food variety score (FVS) and/or a dietary diversity score (DDS) are good indicators of nutrient adequacy of the diet of South African children. Secondary data analyses were undertaken with nationally representative data of 1-8-year-old children (n = 2200) studied in the National Food Consumption Study in 1999. An average FVS (mean number of different food items consumed from all possible items eaten) and DDS (mean number of food groups out of nine possible groups) were calculated. A nutrient adequacy ratio (NAR) is the ratio of a subject's nutrient intake to the estimated average requirement calculated using the Food and Agriculture Organization/World Health Organization (2002) recommended nutrient intakes for children. The mean adequacy ratio (MAR) was calculated as the sum of NARs for all evaluated nutrients divided by the number of nutrients evaluated, expressed as a percentage. MAR was used as a composite indicator for micronutrient adequacy. Pearson correlation coefficients between FVS, DDS and MAR were calculated and also evaluated for sensitivity and specificity, with MAR taken as the ideal standard of adequate intake. The relationships between MAR and DDS and between anthropometric Z-scores and DDS were also evaluated. The children had a mean FVS of 5.5 (standard deviation (SD) 2.5) and a mean DDS of 3.6 (SD 1.4). The mean MAR (ideal = 100%) was 50%, and was lowest (45%) in the 7-8-year-old group. The items with the highest frequency of consumption were from the cereal, roots and tuber group (99.6%), followed by the 'other group' (87.6%) comprising items such as tea, sugar, jam and sweets. The dairy group was consumed by 55.8%, meat group by 54.1%, fats by 38.9%, other vegetables by 30.8%, vitamin-A-rich by 23.8%, other fruit by 22%, legumes and nuts by 19.7% and eggs by 13.3%. There was a high correlation between MAR and both FVS (r = 0.726; P < 0.0001) and DDS (r = 0.657; P < 0.0001), indicating that either FVS or DDS can be used as an indicator of the micronutrient adequacy of the diet. Furthermore, MAR, DDS and FVS showed significant correlations with height-for-age and weight-for-age Z-scores, indicating a strong relationship between dietary diversity and indicators of child growth. A DDS of 4 and an FVS of 6 were shown to be the best indicators of MAR less than 50%, since they provided the best sensitivity and specificity. Either FVS or DDS can be used as a simple and quick indicator of the micronutrient adequacy of the diet.

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Is Open Access

B Vitamins and the Brain: Mechanisms, Dose and Efficacy—A Review

David O. Kennedy (2016)

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

Journal ID (nlm-ta): Diabetes Metab Syndr Obes

Journal ID (iso-abbrev): Diabetes Metab Syndr Obes

Journal ID (publisher-id): dmso

Journal ID (pmc): dmso

Title: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy

Publisher: Dove

ISSN (Electronic): 1178-7007

Publication date (Electronic): 14 January 2021

Publication date Collection: 2021

Volume: 14

Pages: 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

Author information

Ezekiel Mupere http://orcid.org/0000-0002-8746-9009

Article

Publisher ID: 285979

DOI: 10.2147/DMSO.S285979

PMC ID: 7813451

PubMed ID: 33469330

SO-VID: 697cb7bf-46bf-4ce1-b773-d18853795bf2

License:

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).

History

Date received : 30 October 2020

Date accepted : 07 January 2021

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.

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

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Most cited references 52

Health promotion by social cognitive means.

Food variety and dietary diversity scores in children: are they good indicators of dietary adequacy?

B Vitamins and the Brain: Mechanisms, Dose and Efficacy—A Review

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